title: Validation of criterion-based patient assignment and treatment effectiveness of a multidisciplinary modularized managed care program for headache.
abstract: This prospective observational study evaluates the validity of an algorithm for assigning patients to a multidisciplinary modularized managed care headache treatment program. N = 545 chronic headache sufferers [migraine (53.8 %), migraine + tension type (30.1 %), tension type (8.3 %) or medication overuse headache (6.2 %), other primary headaches (1.5 %)] were assigned to one of four treatment modules differing with regard to the number and types of interventions entailed (e.g., medication, psychological intervention, physical therapy, etc.). A rather simple assignment algorithm based on headache frequency, medication use and psychiatric comorbidity was used. Patients in the different modules were compared with regard to the experienced burden of disease. 1-year follow-up outcome data are reported (N = 160). Headache frequency and analgesic consumption differed significantly among patients in the modules. Headache-related disability was highest in patients with high headache frequency with/without medication overuse or psychiatric comorbidity (modules 2/3) compared to patients with low headache frequency and medication (module 0). Physical functioning was lowest in patients with chronic headache regardless of additional problems (modules 1/2/3). Psychological functioning was lowest in patients with severe chronicity with/without additional problems (module 2/3) compared to headache suffers with no/moderate chronicity (module 0/1). Anxiety or depression was highest in patients with severe chronicity. In 1-year follow-up, headache frequency (minus 45.3 %), consumption of attack-aborting drugs (minus 71.4 %) and headache-related disability decreased (minus 35.9 %). Our results demonstrate the clinical effectiveness and the criterion validity of the treatment assignment algorithm based on headache frequency, medication use and psychiatric comorbidity.
authors.affiliation: Headache Center Berlin at the Sankt Gertrauden Krankenhaus Berlin, Berlin, Germany. TomWallasch@aol.com
authors.forename: Thomas-Martin
authors.initials: TM
authors.lastname: Wallasch
authors.forename: Christiane
authors.initials: C
authors.lastname: Hermann
mesh_terms: D000328:Adult; D000465:Algorithms; D000704:Analysis of Variance; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000150:complications / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D019370:Observation; D010147:Pain Measurement; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016896:Treatment Outcome