Headache Awareness in a Neurological Outpatient Clinic Setting

Objectives: The aim of the study was to investigate headache awareness in patients with neurological disorders. Methods: This study recruited 1044 consecutive neurological patients who were visited as outpatients for complaints other than headache. Patients with reduced cognitive abilities and/or unreliable data were excluded. Patients submitted to a questionnaire on headache awareness. The questionnaire included 3 questions that probed the level of patient sensitivity to headaches (high, intermediate, poor level of awareness). For patients with poor headache awareness, data about the headache were collected in a Case Report Form .The headache was diagnosed according to the criteria proposed by the International Classification of Headache Disorders, second edition (ICHD-2). Results: Of 1044 patients, 689 (66%) were female and 355 (34%) were male; the mean age was 56.3+14.8 years (range 11-93). A total of 240 (23%) subjects reported recurrent headaches. According to the headache awareness questionnaire, 46 patients (19.2%) showed high awareness, 27 patients (11.2%) showed intermediate awareness, and 167 subjects (69.6%) showed poor awareness (they recognized the headache as a complaint only when specifically asked). The prevalence of headache was 23%, and only 4,4% identified headache as a disorder. We examined the headache characteristics of subjects with poor headache awareness. Primary headache was present in 98,2% of the patients and migraine without aura was the most commonly diagnosed (61.1%). The most frequently used drugs were over-the-counter pain medications and non-steroidal anti-inflammatory drugs (72.9%). No subject used prophylactic therapy. Conclusions: Unexpectedly, this study showed that a high percentage of patients with neurological disorders had poor headache awareness. The lack of awareness might have contributed to inappropriate or ineffective use of treatments and failure to find appropriate care. We suggest that physicians should always ask patients whether they suffer from headaches to raise headache awareness.