title: Adherence to headache treatment and profile of previous health professional seeking among patients with chronic headache: a retrospective analysis.
abstract: OBJECTIVE
  Chronic headache is common among patients in neurology clinics. Patients may suffer important economic and social losses because of headaches, which may result in high expectations for treatment outcomes. When their treatment goals are not reached quickly, treatment may be difficult to maintain and patients may consult with numerous health professionals. This retrospective study evaluated the relationship between treatment and the profiles of previous health professionals consulted by patients in a tertiary headache center.
  
  
  METHODS
  The records were reviewed of all patients from a headache center who were seen in initial consultation between January 2000 and June 2003. Data related to patient demographic characteristics (sex and age), headache diagnosis, and the profile (quality and quantity) of previous healthcare consultations exclusively related to headache, were collected. The headache diagnoses were confirmed according to the IHS criteria (1988) and to the Silberstein criteria (1994,1996). Although adherence includes taking the prescribed medicines, discontinuing overused symptomatic medications, and changing behavior, among other things, for this study, adherence was defined as when the patient returned at least 2 times within a 3- to 3.5-month period. Patients were separated into groups depending on the number of different healthcare professionals they had consulted, from none to more than 7.
  
  
  RESULTS
  Data from 495 patients were analyzed; 357 were women and 138 were men (ages 6 to 90 years; mean, 41.1 +/- 15.05 years). The headache diagnoses included migraine without aura (43.2%), chronic (transformed) migraine (40%), cluster headache (6.5%), episodic tension-type headache (0.8%), and hemicrania continua (0.4%). The 24.2% of patients who sought care from no more than 1 health professional showed a 59.8% adherence rate; 29% of the total had consulted 7 or more health professionals and showed an adherence rate of 74.3% (P = .0004).
  
  
  CONCLUSIONS
  In Brazil, the belief is widespread that patients attending tertiary headache centers tend to be those who have consulted with numerous health professionals and are, therefore, refractory and/or have adherence problems. Despite the limitations imposed by the retrospective design and the fact that we excluded other important markers of real adherence, this study suggested the opposite. The patients who had seen the lowest number of health professionals presented the worse adherence profile. One of the possible reasons is that patients receive more comprehensive care in a specialized center. Further prospective studies to confirm these observations are warranted.
authors.affiliation: Outpatient Headache Unit, Instituto de Neurologia Deolindo Couto, Department of Neurology, Hospital Pasteur, Universidade Federal do Rio de Janeiro Rio de Janeiro, Brazil. abouchkrym@globo.com
authors.forename: Abouch Valenty
authors.initials: AV
authors.lastname: Krymchantowski
authors.forename: Marcus Vinicius
authors.initials: MV
authors.lastname: Adriano
authors.forename: Renemilda
authors.initials: R
authors.lastname: de Góes
authors.forename: Pedro Ferreira
authors.initials: PF
authors.lastname: Moreira
authors.forename: Carla
authors.initials: C
authors.lastname: da Cunha Jevoux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002908:Chronic Disease; D005260:Female; D006261:Headache / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*