Analysis of the quality of diagnosis and treatment of primary headache in different social groups of the Ural Region

Objective: to analyze the quality of diagnosis and treatment of primary headache (HA) in different social groups of the Ural Region.
Patients and methods. The study enrolled 3124 persons who were divided into three groups: 1) 1042 students; of them there were 719 women; mean age 20.6 years; range 17–40 years; 2) 1075 workers; of them there were 146 women; mean age 40.4 years; range 21–67 years; 3) 1007 blood donors; of them there were 484 women; mean age, 34.1 years; range 18–64 years. Semi-structured interviews involving the characteristics of HA and its prior diagnosis and treatment were conducted face-to-face in all those included in the study. HA was diagnosed using the International Classification of Headache Disorders, 3rd edition, beta version.
Results and discussion. The following factors decreasing the quality of diagnosis and treatment of HA were identified in all the study groups: 1) low physician visit rates. Despite the high prevalence of all types of primary HA in 3 groups (67%), only 496 (23%) out of 2110 participants with HA visited their physician with this problem. Among the patients with HA, physicians were visited most often by 342 (35%) out of 968 students, least often by 60 (13%) out of 457 workers and by 94 (14%) out of 685 donors; 2) inadequate diagnosis of HA. Only 12 and 11.7% of the patients were correctly diagnosed with migraine and tension HA (THA), respectively; 3) the practically complete absence of preventive treatment for HA. The majority of patients used drugs to arrest HA attacks; preventive treatment for migraine was performed in 2 (0.4%) and not performed in any of the patients with THA. 

It is necessary to improve the diagnosis and treatment of primary HA and to elaborate new Russian clinical guidelines for patient management on the basis of international standards. 

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