Clinical Characteristics and Management of Headache: A Real-Life Prospective, Observational Study From a Tertiary Care Center in Eastern India

Abstract

OBJECTIVE To describe clinical profile and management pattern of headache in patients presenting to a tertiary care center.  Methods: In this observational study, demographics, radiological investigations, triggers, and treatment pattern in patients aged ≥ 14 years presenting with headache were recorded. Disability and severity of headache were assessed with Migraine Disability Assessment (MIDAS) score, Visual Analogue Scale (VAS), and Headache Impact Test (HIT-6) in case of migraineurs and VAS and HIT-6 for all other headache disorders. Patients were evaluated at baseline and after three and six months post-treatment. RESULTS Out of 400 patients (60.25% females and 39.75% males), 277 (69.25%) had primary headache among whom 119 (42.96%) had migraine without aura. Stress, menstruation, fasting, and inadequate sleep were common triggers for migraine. Nausea, vomiting, photo-phonophobia and neck pain were the most common accompanying symptoms in patients with headache. Out of 106 (38.3%) patients with tension-type headache, 68.9% were episodic. In the migraine subset, 81% presented with moderate to severe disability at baseline, which changed to minimal to mild disability at three and six months post-treatment (p < 0.001). For abortive treatment, 130 (79.7%) patients were prescribed naproxen, domperidone, and sumatriptan. In 69 (42.3%) patients, valproic acid/divalproex was used for prophylaxis. Most common causes of secondary headaches (30.75%) were intracranial bleeds and cerebral venous sinus thrombosis. Most common abnormalities on computerized tomography were intracerebral hemorrhage, subarachnoid hemorrhage, sinusitis, and space-occupying lesions (SOLs). CONCLUSION In our study, migraine was the most common etiology of headache. Headache was more common in females than males, and primary headache was more common than secondary headache. Sodium valproate was the commonly used prophylaxis in migraine.