Göbel Carl H, Müller Ursula, Witte Hanno, Heinze-Kuhn Katja, Heinze Axel, Cirkel Anna, Göbel Hartmut
Kiel Migraine and Headache Center, 24149 Kiel, Germany.
Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, 24149 Kiel, Germany.
J Clin Med. 2025 Jun 25;14(13):4497. doi: 10.3390/jcm14134497.
: Headache disorders, particularly migraine, are a leading cause of disability among active-duty military personnel, significantly affecting operational readiness and fitness for duty. Despite their high prevalence, limited data exist on how headache disorders are managed within military primary care systems. This study aimed to evaluate diagnostic confidence, treatment strategies, and structural challenges in the management of headache disorders from the perspective of military primary care physicians. : A prospective, nationwide cross-sectional survey was conducted between May and July 2023 among all active-duty military physicians in primary care roles. An anonymous 15-item questionnaire assessed diagnostic practices, therapeutic approaches, referral pathways, perceived knowledge gaps, and suggestions for system improvements. The survey was distributed across military medical centers and outpatient clinics in Germany. : Ninety military physicians participated. Migraine and tension-type headache were commonly encountered, with 70% having treated at least one headache patient in the week prior to the survey. Diagnostic confidence was high for migraine (83.4%) and tension-type headache (77.8%) but lower for medication-overuse headache (65.5%) and cluster headache (47.8%). Acute treatment was widely implemented, but only 27.8% of respondents regularly initiated preventive therapies. Awareness of clinical guidelines was limited: only 23.3% were familiar with the ICHD-3, and just 58.9% with national headache treatment guidelines. Respondents expressed strong demand for targeted education, practical diagnostic tools, and improved interdisciplinary coordination. : Headache disorders are a prevalent and clinically significant issue in military primary care. While military physicians show high engagement, important gaps exist in preventive treatment, guideline familiarity, and access to specialist care. Structured training, standardized treatment protocols, and system-level improvements are essential to optimize headache care and maintain operational readiness.
头痛疾病，尤其是偏头痛，是现役军人致残的主要原因，严重影响作战准备状态和履职能力。尽管其患病率很高，但关于军事初级保健系统中如何管理头痛疾病的数据有限。本研究旨在从军事初级保健医生的角度评估头痛疾病管理中的诊断信心、治疗策略和结构挑战。
2023年5月至7月，对所有担任初级保健角色的现役军事医生进行了一项全国性的前瞻性横断面调查。一份包含15项内容的匿名问卷评估了诊断实践、治疗方法、转诊途径、感知到的知识差距以及对系统改进的建议。该调查在德国的军事医疗中心和门诊诊所进行。
90名军事医生参与了调查。偏头痛和紧张型头痛较为常见，70%的医生在调查前一周至少治疗过一名头痛患者。对偏头痛（83.4%）和紧张型头痛（77.8%）的诊断信心较高，但对药物过量使用性头痛（65.5%）和丛集性头痛（47.8%）的诊断信心较低。急性治疗广泛应用，但只有27.8%的受访者定期启动预防性治疗。对临床指南的知晓度有限：只有23.3%的人熟悉《国际头痛疾病分类第三版》（ICHD - 3），只有58.9%的人熟悉国家头痛治疗指南。受访者对有针对性的教育、实用的诊断工具和改善跨学科协调表达了强烈需求。
头痛疾病在军事初级保健中是一个普遍且具有临床重要性的问题。虽然军事医生参与度很高，但在预防性治疗、对指南的熟悉程度以及获得专科护理方面存在重要差距。结构化培训、标准化治疗方案和系统层面的改进对于优化头痛护理和维持作战准备状态至关重要。
