title: Understanding of headache patterns modification in an emergency department during the economic crisis of Greece.
abstract: Very few neurological research is published regarding health effects of global economic crisis. Our aim was to assess the impact of economic recession on frequency and severity of headaches. We also tested if depression, anxiety and experiences associated with crisis, such as unemployment, were reflected in headaches. This is a retrospective observational study in the Emergency setting of tertiary Clinic from 1 January 2008 until 31 December 2009 and from 1 January 2010 until 31 December 2011. Demographic data were collected of 1094 consecutive adult patients with headache. Multinomial logistic regression performed to examine if hospital anxiety depression (HAD), HAD anxiety, experience of serious life events, year of survey had influence on type of headache. The total number of headache cases increased significantly from 2008 to 2011 (p < 0.001). Tension type and medication overuse headaches remained unchanged over time (p > 0.05), while migraines decreased. Secondary and not otherwise specified (NOS) increased significantly (p < 0.05). The most common, overtime, was Tension type headache, followed by migraines (in 2008, 2011) and NOS (2010). Chi square test showed significant correlation between type of headache and year, as well medication type and year (p < 0.05). Common analgesics, the most common medication, increased five times during survey period (77 % 2008 to 87.6 % 2011). Multivariate analysis revealed stronger association for experience serious events with NOS vs. tension type headache [odds ratio (OR) 0.13; 95 % confidence interval (CI) 0.03, 0.7]. This is the first study showing that the prolonged economic crisis affected headache frequency accompanied by a higher use of analgesics.
authors.affiliation: Neurologic Clinic, First Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 72-74 Vasilissis Sofias Avenue, 11528, Athens, Greece. annita139@yahoo.gr.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Bougea
authors.affiliation: SLT, Speech and Language Institute, University of Ioannina, Ioannina, Greece.
authors.forename: Nicolaos
authors.initials: N
authors.lastname: Spantideas
authors.affiliation: Neurologic Clinic, First Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 72-74 Vasilissis Sofias Avenue, 11528, Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Anagnostou
authors.affiliation: Department of Psychology, Panteion University of Social and Political Sciences, Athens, Greece.
authors.forename: Efthalia
authors.initials: E
authors.lastname: Massou
authors.affiliation: Neurologic Clinic, First Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 72-74 Vasilissis Sofias Avenue, 11528, Athens, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Xirou
authors.affiliation: Head of Neurology Department, Athens Benakion and Korgialenion Red Cross Hospital, Athens, Greece.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thomaidis
authors.affiliation: Neurologic Clinic, First Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 72-74 Vasilissis Sofias Avenue, 11528, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Evdokimidis
authors.affiliation: Neurologic Clinic, First Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, 72-74 Vasilissis Sofias Avenue, 11528, Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Kararizou
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D001007:Anxiety / Q000453:epidemiology; D016009:Chi-Square Distribution; D003863:Depression / Q000453:epidemiology; D057172:Economic Recession; D004636:Emergency Service, Hospital; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006115:Greece / Q000453:epidemiology; D006261:Headache / Q000145:classification* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D000700:Analgesics
keywords: Economic crisis; Emergency department; Hospital Anxiety and Depression Scale (ΗADS); International Headache Classification of Headache Disorder (ICHD); Not otherwise specified (NOS)