title: Health-care utilization for primary headache disorders in China: a population-based door-to-door survey.
abstract: BACKGROUND
  In order to know the status quo of health care for primary headache disorders in China, questions about headache consultation and diagnosis were included in a nationwide population-based survey initiated by Lifting The Burden: the Global Campaign against Headache.
  
  
  METHODS
  Throughout China, 5,041 unrelated respondents aged 18-65 years were randomly sampled from the general population and visited unannounced at their homes. After basic sociodemographic and headache diagnostic questions, respondents with headache answered further questions about health-care utilization in the previous year.
  
  
  RESULTS
  Significantly higher proportions of respondents with migraine (239/452; 52.9%) or headache on ≥15 days per month (23/48; 47.9%) had consulted a physician for headache than of those with tension-type headache (TTH) (218/531; 41.1%; P < 0.05). Multivariate analysis showed associations between disability and probability of consultation in those with migraine (mild vs. minimal: AOR 3.4, 95% CI: 1.6-7.4; moderate vs. minimal: 2.5, 1.2-5.4; severe vs. minimal: 3.9, 1.9-8.1) and between rural habitation and probability of consulting in those with TTH (AOR: 3.5; 95% CI: 1.9-6.3, P < 0.001). Married respondents with TTH were less likely than unmarried to have consulted (AOR: 0.26; 95% CI: 0.07-0.93; P = 0.038). About half of consultations (47.8-56.5%) for each of the headache disorders were at clinic level in the health system. Consultations in level-3 hospitals were relatively few for migraine (5.9%) but more likely for headache on ≥15 days/month (8.7%) and, surprisingly, for TTH (13.3%). Under-diagnosis and misdiagnosis were common in consulters. More than half with migraine (52.7%) or headache on ≥15 days/month (51.2%), and almost two thirds (63.7%) with TTH, reported no previous diagnosis. Consulters with migraine were as likely (13.8%) to have been diagnosed with "nervous headache" as with migraine. "Nervous headache" (9.8%) and "vascular headache" (7.6%) were the most likely diagnoses in those with TTH, of whom only 5.6% had previously been correctly diagnosed. These were also the most likely diagnoses (14.0% each) in consulters with headache on ≥15 days/month.
  
  
  CONCLUSIONS
  This picture of the status quo shows limited reach of headache services in China, and high rates of under-diagnosis and misdiagnosis in those who achieve access to them. This is not a picture of an efficient or cost-effective response to major causes of public ill-health and disability.
authors.forename: Ruozhuo
authors.initials: R
authors.lastname: Liu
authors.forename: Shengyuan
authors.initials: S
authors.lastname: Yu
authors.forename: Mianwang
authors.initials: M
authors.lastname: He
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
authors.forename: Xiaosu
authors.initials: X
authors.lastname: Yang
authors.forename: Xiangyang
authors.initials: X
authors.lastname: Qiao
authors.forename: Jiachun
authors.initials: J
authors.lastname: Feng
authors.forename: Yannan
authors.initials: Y
authors.lastname: Fang
authors.forename: Xiutang
authors.initials: X
authors.lastname: Cao
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Steiner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002681:China / Q000453:epidemiology; D005260:Female; D051270:Headache Disorders, Primary / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D055815:Young Adult