Genc Hamit, Uluduz Derya, Bolay Hayrunnisa, Baykan Betul, Unal-Cevik Isin, Kissani Najib, Luvsannorov Otgonbayar, Togha Mansoureh, Ozdemir Asena Ayca, Ozge Aynur
Neurology Clinic, Health Application and Research Center, Gaziantep City Hospital, 27470 Gaziantep, Türkiye.
Department of Neurology, Medical Faculty, Istanbul University-Cerrahpaşa, 34098 Istanbul, Türkiye.
J Oral Facial Pain Headache. 2025 Mar;39(1):187-195. doi: 10.22514/jofph.2025.019. Epub 2025 Mar 12.
Misdiagnoses often lead to suboptimal therapeutic approaches, making early and accurate diagnoses by experts crucial for effective headache management. This study primarily aims to investigate the referred patient profiles with headaches to optimize diagnostic and referral approaches.
In this cross-sectional multicenter international study, sixty-nine neurologists from 13 countries evaluated headache patients referred to neurology clinics (NCs). Researchers recruited patients on different weekdays selected by the research randomizer program for five consecutive weeks in April and May 2022. The clinicians collected data on various factors such as age, sex, headache characteristics and accompanying symptoms using the Head-MENAA study questionnaire and the International Classification of Headache Disorders-3 (ICHD-3) criteria. Patients were grouped according to the settings as emergency services (ESs), other specialty clinics (OSCs) and private offices (POs) in which they were evaluated.
A total of 3722 individuals out of 12043 evaluated in NCs had headache complaints. Among them, 15.07% consisted of patients referred to neurology by these three different settings. 14.8% of them were referred from ESs, 16.58% from OSCs, and 68.64% were applied to POs. While there was not a significant difference between groups regarding the mean age, the proportion of male patients in the ESs (49.4%) was higher than those in OSCs (26.9%) and POs (23.1%) ( < 0.001). Headache severity was higher in the ESs and POs than in the OSCs and Neurology Outpatient Clinics (NOCs) ( < 0.001). Primary headaches were the reason for consultation in 89.2% of patients in the ESs, 90.3% of patients in OSCs and 93.5% of patients in POs, migraine without aura being the most common headache type in all groups.
This study suggests that preferences for admission and referral may vary based on demographic characteristics, types and severity of the headache, as well as accessibility and availability of different settings.
误诊常常导致治疗方法欠佳，因此专家进行早期准确诊断对于有效管理头痛至关重要。本研究主要旨在调查因头痛前来就诊的患者情况，以优化诊断和转诊方法。
在这项横断面多中心国际研究中，来自13个国家的69名神经科医生对转诊至神经科诊所（NCs）的头痛患者进行了评估。研究人员在2022年4月和5月连续五周，通过研究随机程序选择不同工作日招募患者。临床医生使用Head-MENAA研究问卷和《国际头痛疾病分类第3版》（ICHD-3）标准收集了有关年龄、性别、头痛特征和伴随症状等各种因素的数据。患者根据其接受评估的场所分为急诊服务（ESs）、其他专科诊所（OSCs）和私人诊所（POs）。
在NCs评估的12043人中，共有3722人有头痛主诉。其中，15.07%的患者是由这三种不同场所转诊至神经科的。其中14.8%来自急诊服务，16.58%来自其他专科诊所，68.64%前往私人诊所。虽然各组之间平均年龄无显著差异，但急诊服务组男性患者比例（49.4%）高于其他专科诊所组（26.9%）和私人诊所组（23.1%）（P<0.001）。急诊服务组和私人诊所组的头痛严重程度高于其他专科诊所组和神经科门诊（NOCs）（P<0.001）。原发性头痛是急诊服务组89.2%的患者、其他专科诊所组90.3%的患者和私人诊所组93.5%的患者前来就诊的原因，无先兆偏头痛是所有组中最常见的头痛类型。
本研究表明，基于人口统计学特征、头痛类型和严重程度以及不同场所的可及性和可用性，入院和转诊偏好可能会有所不同。
