Objective:

To identify and summarize evidence from empirical studies relating to the cost of care and the economic impact of chronic headache.

Search strategy:

We used a strategy combining the MeSH term "headache" (exploded) with terms and text words pertaining to cost and resource utilization to search the MEDLINE, HealthStar, and CINAHL databases for relevant studies published between January 1966 and December 1996. Other computerized bibliographic databases, textbooks, and experts were also utilized.

Selection criteria:

We considered full reports of original empirical research, published in English, which concerned an adult (non-pediatric) subject population suffering from primary headache (i.e., not traumatic, post-lumbar puncture, or other secondary headaches), reported data relevant to the economic impact of chronic headache on medical resource utilization or work loss, and met minimal methodological criteria related to the validity of cost or utilization measures.

Data collection and analysis:

From studies of patients with primary headache, data were collected on: rates and predictors of headache-related and total health care provider consultation, emergency department utilization, hospitalization, prescription and non-prescription drug use, and work loss and disability. Data were annualized when necessary to make results of different studies more comparable.

Main results:

Of over 400 citations identified, 126 appeared to meet screening criteria, and 35 met all criteria and were included in this review. While between 56% and 91% of chronic headache sufferers seek the care of a health care provider, only one-third report having received a diagnosis of their condition. While most patients with migraine consult a health care provider at some point, most do not continue to seek medical care. Relatively fewer patients with tension-type headache seek medical care. A small sub-population of chronic headache sufferers accounts for a high proportion of provider consultations, emergency department visits, and prescription drug claims. The vast majority of headache sufferers have used drugs to treat their headaches at some time. Non-prescription drugs are used more often than prescription drugs. Patients with more severe headache symptoms are both more likely to consult a health care provider about their headaches and more likely to use prescription medications. Use of prescription drugs for headache increases with age and is higher among women than men. About two-thirds of patients who try prescription medications do not continue to use them, citing the availability of effective non-prescription drugs, unwanted side-effects, and inadequate relief among the reasons for discontinuing prescription drug use. Rates of absenteeism due to headache of 2 to 4.3 days per year were reported in employee and community studies, while higher rates, ranging from 14.3 to 61 days per year, were observed in two studies conducted in clinical settings. These average figures obscure the fact that while many to most patients miss no days of work or school, a relatively small proportion of subjects accounts for many missed days. While headache does cause a large number of absences from work, it appears that many headache sufferers stay on the job, functioning with significantly reduced effectiveness, when they have a headache.

Conclusions:

Chronic headache sufferers represent a diverse population which is difficult to study. Population-based studies suggest that many headache sufferers do not seek medical care for their headaches and do not use prescription drugs to treat them. Studies conducted among headache patients in clinical settings suggest that these patients have more severe headache symptoms, use more prescriptions drugs, and are heavier users of medical resources. Data from both types of studies must be considered if the comprehensive cost of chronic headache is to be estimated.

Contents

• Summary
  • Overview
  • Methodology
  • Findings
  • Future Research
• Technical Review
  • Introduction
  • Methodology
  • Results
  • Conclusions
  • Future Research
• References
• Evidence Tables
• Appendix A Original Electronic Search Strategy
• Appendix B Revised Electronic Search Strategy
• Appendix C List of Excluded Articles
• Appendix D Data Collection Form for Headache Cost Studies: Original Research

Project Directors: Douglas C McCrory, MD, MHSc, David B Matchar, MD. Project Manager: Rebecca N Gray, DPhil. Editorial Assistance: Rebecca N Gray, DPhil. AHCPR Project Officer: Ernestine Murray, RN, MAS.

Prepared for: Agency for Health Care Policy and Research, Department of Health and Human Services, U.S. Public Health Service, Rockville, Maryland. Contract No. 290-94-2025. Prepared by: Center for Clinical Health Policy Research, Duke University.

Suggested citation:

Duke University, Center for Clinical Health Policy Research. Resource Utilization and Costs of Care for Treatment of Chronic Headache. Technical Review 2.1. February 1999. (Prepared for the Agency for Health Care Policy and Research under Contract No. 290-94-2025. Available from the National Technical Information Service; NTIS Accession No. PB99-127938.)

This document does not necessarily represent the views of the Department of Health and Human Services. It is available from the National Technical Information Service at 1-800-553-6847.