Pershing Michelle, Hirekhan Omkar, Syed Azfar, Elliott John O, Toot Jonathan
Research Institute, OhioHealth, Columbus, USA.
Hospital Medicine, OhioHealth, Columbus, USA.
Cureus. 2024 Jan 13;16(1):e52209. doi: 10.7759/cureus.52209. eCollection 2024 Jan.
To determine headache diagnosis and treatment patterns in the outpatient setting, focusing on documentation of the International Classification of Headache Disorders (ICHD) criteria.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort data were collected from electronic medical records of adults aged 18-35 who presented to resident-staffed family medicine outpatient clinics in the Midwest, USA, for a new or worsening headache between 2015 and 2016. Diagnosis codes were used to summarize the overall nature and prevalence of headaches. A random subset of 30 patients each for migraine headache (MGH) with and without aura and tension-type headache (TTH) were reviewed to determine how many of the five possible ICHD criteria were documented. Demographics/clinical characteristics, ICHD criteria, number and type of medications, and healthcare utilization (imaging, primary and emergency department care) through one year following the initial visit were summarized and compared across headache types.
There were 716 unique patients during the study period (414 MGH, 227 unspecified headaches, 75 TTH, or others). Complete ICHD criteria were documented for two patients in total. There was partial documentation (e.g., one to four of the possible five) for 30% of TTH, 63% of MGH without aura, and 77% of MGH with aura (p<0.05). Across headache types, patients were prescribed an average of 2.3 to 3.3 medications over one year, with MGH patients generally trying more medications (up to eight for those with aura and up to 12 for those without). Abortive or rescue medications were prescribed to nearly all patients; prophylactics were prescribed for 50% of MGH with aura, 66.7% of MGH without aura, and 53.3%. Non-pharmacologic interventions were less prescribed: 33.3% of TTH patients and 3.3% of MGH types combined (p<0.05). Healthcare utilization was highest for MGH with aura (ED visits) and without aura (clinic visits) patients compared to TTH (p<0.001).
Headache-related documentation is often incomplete, which may limit interpretation and associations between diagnoses, prescribing patterns, and healthcare utilization. Future studies should evaluate the use of electronic medical records (EMR)-based templates to improve documentation, and additional detailed studies are needed in the local setting to determine whether treatment, including the use of non-pharmacologic and prophylactic methods of treatment, is optimal.
确定门诊环境中的头痛诊断和治疗模式，重点关注头痛疾病国际分类（ICHD）标准的记录情况。
设计、设置和参与者：回顾性队列数据收集自2015年至2016年间在美国中西部由住院医师坐诊的家庭医学门诊就诊的18 - 35岁成年人的电子病历，这些患者因新发或加重的头痛前来就诊。使用诊断编码总结头痛的总体性质和患病率。对30例伴有先兆和不伴有先兆的偏头痛（MGH）以及紧张型头痛（TTH）患者的随机子集进行回顾，以确定五项可能的ICHD标准中有多少得到记录。总结并比较了不同头痛类型患者的人口统计学/临床特征、ICHD标准、药物数量和类型以及初次就诊后一年内的医疗服务利用情况（影像学检查、初级和急诊科护理）。
研究期间共有716例独特患者（414例MGH、227例未明确的头痛、75例TTH或其他类型）。总共仅有2例患者记录了完整的ICHD标准。30%的TTH、63%的无先兆MGH和77%的有先兆MGH有部分记录（例如，五项可能标准中的一至四项）（p<0.05）。在不同头痛类型中，患者在一年中平均被开具2.3至3.3种药物，MGH患者通常尝试更多药物（有先兆的患者最多达8种，无先兆的患者最多达12种）。几乎所有患者都被开具了终止发作或急救药物；50%的有先兆MGH、66.7%的无先兆MGH和53.3%的TTH患者被开具了预防性药物。非药物干预措施的开具较少：33.3%的TTH患者和3.3%的各类MGH患者（p<0.05）。与TTH相比，有先兆MGH（急诊科就诊）和无先兆MGH（门诊就诊）患者的医疗服务利用最高（p<0.001）。
与头痛相关的记录往往不完整，这可能会限制对诊断、处方模式和医疗服务利用之间的解读及关联。未来的研究应评估基于电子病历（EMR）的模板的使用情况以改善记录，并且需要在当地环境中进行更多详细研究，以确定包括使用非药物和预防性治疗方法在内的治疗是否最佳。
