Chronic daily headaches may go underreported

Many patients don't express this complaint to physicians, putting patients at risk for adverse events from pain relievers and a worsening of their head pain.

By Victoria Stagg Elliott, AMNews staff. Feb. 12, 2007.

A significant percentage of patients in the primary care setting experience headaches more than 15 times a month -- a fact not always shared with physicians, says a study in the January Headache: The Journal of Head and Face Pain.

"Chronic daily headache may be more prevalent than primary care doctors realize," said Remy Coeytaux, MD, PhD, lead author and assistant professor of family medicine at the University of North Carolina School of Medicine, Chapel Hill. "And for a number of reasons, patients seem hesitant to report headache as a problem that warrants their physicians' attention."

Researchers sent surveys to 1,500 randomly selected patients who had come to an academic family medicine clinic in 2004. About 9% of the 853 who returned the questionnaire reported symptoms consistent with a diagnosis of chronic daily headache. This incidence rate is significantly higher than the 3% to 5% of the general population figures prior studies have documented. Of patients with chronic daily headache, 32% did not believe or were not sure that their physicians knew about their pain.

The authors are calling for educational efforts to make it more likely physicians will ask patients about headache pain. There also is hope that additional attention to this syndrome will lead to the identification of those at risk for developing it and increase the targeted use of preventive strategies, particularly since chronic daily headache frequently has its roots in less-frequent head pain, accompanied by overuse of medications to remedy it.