Headache diagnosis, management and morbidity in the Singapore primary care setting: findings from a general practice survey.

INTRODUCTION: We sought to determine the epidemiological features and the headache burden of headache patients in the Singapore primary care setting. Particular attention was given to the adequacy of migraine diagnosis and management as well as the utilisation of prophylactic medication by primary care doctors.
METHODS: Consenting patients who consulted participating general practice clinics with the chief complaint of headache, were administered a questionnaire incorporating demographical data, headache characteristics and burden as well as treatment patterns. For each patient, the attending doctor independently completed a second questionnaire covering diagnosis and treatment of the patient.
RESULTS: A disproportionate number of non-Chinese and females presented for headache management in the primary care setting as compared to the Singapore population at large. Migraineurs had more headache-related disability (67.3 percent) than non-migraineurs (45.7 percent). In our study setting, the IHS diagnostic criteria (38.2 percent of respondents), ID migraine (61.1 percent) and physician's diagnosis (62.0 percent) correlated poorly with each other when employed for case definition of migraine. In the study population, 22.6 percent used acute pain medication excessively (more than four days a week), 39.3 percent were dissatisfied with their current treatment and 58.3 percent had frequent headaches (more than four attacks a month). Only a minority of those in whom prophylaxis was indicated were treated appropriately.
CONCLUSION: Diagnosis of migraine is inconsistent in the primary care setting despite the condition being responsible for considerable disability. Prophylactic treatment is underutilised as a management strategy, and the risk of medication-overuse headaches is underestimated. Our results emphasise the continuing need for education of primary care physicians and the public about strategies for effective headache diagnosis and treatment.