title: [Effects of recommendations and patient seminars on effectivity of outpatient treatment for headache].
abstract: BACKGROUND
  Treatment of patients suffering from migraine and/or tension-type headache in primary care needs to be improved. To this purpose we tested two strategies for implementation of evidence-based recommendations for treatment of headaches: first, communication of recommendations to the primary care physicians and, second, standardized communication and discussion of these recommendations with patients in combination with exercising of progressive muscle relaxation during patient seminars.
  
  
  METHODS
  Patients with at least 2 migraine attacks/month or 8 days of tension-type headache/month were included in the study. Evidence-based pharmacological and non-pharmacological recommendations of the Medicines Committee of the German Medical Profession for treatment of migraine and tension-type headache have been offered to primary care physicians by printed material and during conferences. Patient seminars at 10 days for 2 hours were organized by the outpatient pain facility of the neurological department of the university of Erlangen. During seminars the patients were informed about these recommendations and learned progressive muscle relaxation. Agreed therapy between physician and patient was documented by physicians and patients during a 6 months treatment interval and compared with the recommended therapy. Effectivity of treatment was assessed by pre-post changes of days of headache/month, attack frequency/month, headache intensity (visual analogue scale), pain related impairment (German version of the Brief Pain Inventory), and health related quality of life (German Version of the SF-36). 51 patients were documented by 24 primary care physicians after communication of recommendations and 46 patients completed the patient seminar. Data of both groups were compared with those of 80 patients from primary care physicians before interventions.
  
  
  RESULTS
  Communication of recommendations for headache therapy to primary care physicians did not improve conformity of the agreed therapy with the recommended. Contrary conformity of the agreed therapy for pharmacological treatment of migraine attacks and interval therapy of migraine by progressive muscle relaxation with the recommended therapy improved significantly. However, interventions did not significantly improve the outcome quality of outpatient treatment as compared to the therapy of primary care physicians before interventions.
  
  
  CONCLUSIONS
  Effectivity of headache treatment in primary health care could not be improved by communication of evidence-based recommended therapy to primary care physicians nor by direct information of patients about these recommendations in combination with provided availability to learn progressive muscle relaxation.
authors.affiliation: Neurologische Klinik mit Poliklinik, Universität Erlangen-Nürnberg, Erlangen. eberhard.lang@rzmail.uni-erlangen.de
authors.forename: E
authors.initials: E
authors.lastname: Lang
authors.forename: S
authors.initials: S
authors.lastname: Kastner
authors.forename: B
authors.initials: B
authors.lastname: Neundörfer
authors.forename: A
authors.initials: A
authors.lastname: Bickel
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004502:Education, Medical, Continuing; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000628:therapy*; D009126:Muscle Relaxation; D010147:Pain Measurement; D010353:Patient Education as Topic; D011320:Primary Health Care; D018781:Tension-Type Headache / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics