EHMTI-0332. Health care utilisation for primary headache disorders: insights from Karnataka, India

Abstract

Background: Globally, primary headache disorders are neglected and inadequately treated. There is little information on management or healthcare utilisation for headache disorders from the Indian sub-continent. Aim: To fill this knowledge gap in Karnataka State, south India. Methods: In a population-based survey, 2,329 randomly selected, biologically unrelated adults (18-65 years) (1,141 male, 1,188 female; 1,226 urban, 1,103 rural) were interviewed using a validated structured questionnaire. Ethics approval and informed consent from participants were obtained. Results: Headache was reported by 1,488 persons (crude annual 1-year prevalence 63.9%) with a mean age of 37+/-12 years, 58% females and 53% rural-dwelling. Only 24.7% (32.4% rural, 16.2% urban) had sought medical help. Of these, 80.6% had seen a primary-care doctor and 15.8% a specialist. Greater proportions of urban dwellers (38.6%) and females (17.7%) had consulted specialists. Consultation rates were higher for migraine (41.9% overall) but, even among those with high disability assessed as lost productive time by HALT questionnaire, did not exceed 50% (HALT grade 1: 27.3%; grade 2: 39.0%; grade 3: 45.7%; grade 4: 45.5%). Consultation rates were much higher for any headache occurring on >15 days/month (72.5%) and medication-overuse headache (78.6%). Conclusion: Despite the high prevalence of primary headache disorders, health-care utilisation is poor. The primary care physician is consulted most often, which is where headache services should be built. Structured headache services require primary-care physicians trained in managing headache disorders, facilitated links to secondary care when needed, but also improved awareness among people with headache so that they use them.