Clinical and epidemiological aspects of headache in a neurology clinic in Babol, Northern Iran.

T lifetime prevalence of headache is 93% for men and up to 99% for women.1 The public health significance of headaches is often overlooked, probably due to their episodic nature and lack of mortality, but headache disorders are often incapacitating, with considerable impact on social activities and work, and may lead to significant drug consumption.2 The socio-economic burden of headache includes both direct costs associated with health care utilization and costs associated with missed working activity due to absence from job or reduced efficiency. Due to its high prevalence and wide spectrum of disability, tension-type headache has greater socioeconomic impact than any other type.3 Headache disorders constitute enormous proportions of public-health problems. Epidemiological data are required to determine the significance of these disorders. This cross-sectional study has been conducted to obtain the clinical and epidemiological characteristics of headache disorders in a clinic-based sample of headache patients in our region. This descriptive and clinic-based cross-sectional study with census sampling was conducted on 48,750 patients admitted to a neurology clinic in Babol, north of Iran, from 1995-2004. Babol comprises a University City, smaller satellite towns and agricultural areas with a population of 550,000 (census data). From these patients, we selected only headache cases without any definite and proved systemic or brain disease. According to the Headache Classification Committee of the International Headache Society (IHS) 1988, a definite cause of the headache was recorded. For each patient, a file was recorded including: age, gender, main occupation, initial etiology of headache diagnosed by a primary non neurologist physician, diagnosis of the headache causes according to IHS by neurologist, precipitating factors of headache for primary headaches, sources of drugs supply such as: a drugstore seller recommendation, unprofessional advice (from relatives, friends, and colleagues). The analgesic consumption was defined as using at least one tablet a week. Data were analyzed by descriptive statistical methods to compare the clinical and epidemiological characteristics of headache. Among 48,750 patients referred to a neurology clinic, headache was the chief complaint in 25,810 (52.9%) cases. From these patients, we selected only headache cases without any definite and proven systemic or brain disease. In the final stage, a group of 19,845 patients, whose diagnosis was confirmed in the second evaluation remained and were included in the study. Most patients 5,268 (26.5%) were in the age range of 30-39 years. The females complained of headache more often than the males, 12,145 (61.2%) versus 7,700 (38.8%). The most frequent causes of headaches were tension type headache, migraine headache, cervical disease, systemic and metabolic disorders, sinusitis, ophthalmic disorders and space-occupying lesions of the brain, and other miscellaneous causes (Table 1). Most cases had another diagnosis in their primary consult (Table 1) including sinusitis and ophthalmic disease as the most attributed causes. The most frequent occupation types for females were: housekeepers 6,180 (31.1%), employees 4,254 (21.4%), free jobs 353 (1.8%), unemployed 241(1.2%), retirees 174 (0.9%), and students 943 (4.75%), for the males they were employees 2865 (37.2%), free jobs 1,853 (9.3%), unemployed 1,453 (7.3%), retirees 371 (1.9%), and students 1,158 (5.8%). Out of 14,898 primary headache sufferers, stress, especially due to family, and economical reasons, was the most frequent precipitating factor in 4,844 tension type headaches (49.5%) and 2,010 migraine (39.3%), food items in 1,682 tension type headaches (17.25%) and 1,079 migraine (21.1%), and sleep disturbances in 1,664 tension type headaches (17%) and 925 migraine (18.8%), were the next ones, in the remaining 2,687, no definite factor was found. Most primary headache sufferers 10,721 (72%) declared regular consumption of analgesics for pain relief, before any medical referral was undertaken. An adult cold tablet was the most common drug 5,628 (37.7%), acetaminophen codeine 2,681 (18%), NSAID, especially Ibuprofen 1,370 (9.2%), ergotamine compound drugs 595 (4%), and other different types of drugs 447 (3%) had been used by the other patients. Triptan, sedative, or neuroleptic Headache type Headache etiology diagnosed by neurologist Headache etiology diagnosed by non neurologist physician