Headache Management Program Improves Outcome for Chronic Headache

Authors

  • Linda H. Harpole MD, MPH,

    1. Department of Medicine (Drs. Harpole, Samsa, and Matchar), the Center for Clinical Health Policy Research (Drs. Harpole, Samsa, and Matchar and Ms. Jurgelski), and the Department of Biostatistics and Bioinformatics (Dr. Samsa), Duke University Medical Center, Durham, NC; the Departments of Family Medicine (Nurse Shipley) and Neurology (Nurse Shipley and Dr. Bernstein), Kaiser Permanente, Santa Rosa, Calif.; and the Veterans Administration Medical Center, Durham, NC (Dr. Matchar).
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  • Gregory P. Samsa PhD,

    1. Department of Medicine (Drs. Harpole, Samsa, and Matchar), the Center for Clinical Health Policy Research (Drs. Harpole, Samsa, and Matchar and Ms. Jurgelski), and the Department of Biostatistics and Bioinformatics (Dr. Samsa), Duke University Medical Center, Durham, NC; the Departments of Family Medicine (Nurse Shipley) and Neurology (Nurse Shipley and Dr. Bernstein), Kaiser Permanente, Santa Rosa, Calif.; and the Veterans Administration Medical Center, Durham, NC (Dr. Matchar).
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  • Annette E. Jurgelski MAT,

    1. Department of Medicine (Drs. Harpole, Samsa, and Matchar), the Center for Clinical Health Policy Research (Drs. Harpole, Samsa, and Matchar and Ms. Jurgelski), and the Department of Biostatistics and Bioinformatics (Dr. Samsa), Duke University Medical Center, Durham, NC; the Departments of Family Medicine (Nurse Shipley) and Neurology (Nurse Shipley and Dr. Bernstein), Kaiser Permanente, Santa Rosa, Calif.; and the Veterans Administration Medical Center, Durham, NC (Dr. Matchar).
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  • Janice L. Shipley FNP, MSN, MEd,

    1. Department of Medicine (Drs. Harpole, Samsa, and Matchar), the Center for Clinical Health Policy Research (Drs. Harpole, Samsa, and Matchar and Ms. Jurgelski), and the Department of Biostatistics and Bioinformatics (Dr. Samsa), Duke University Medical Center, Durham, NC; the Departments of Family Medicine (Nurse Shipley) and Neurology (Nurse Shipley and Dr. Bernstein), Kaiser Permanente, Santa Rosa, Calif.; and the Veterans Administration Medical Center, Durham, NC (Dr. Matchar).
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  • Allan Bernstein MD,

    1. Department of Medicine (Drs. Harpole, Samsa, and Matchar), the Center for Clinical Health Policy Research (Drs. Harpole, Samsa, and Matchar and Ms. Jurgelski), and the Department of Biostatistics and Bioinformatics (Dr. Samsa), Duke University Medical Center, Durham, NC; the Departments of Family Medicine (Nurse Shipley) and Neurology (Nurse Shipley and Dr. Bernstein), Kaiser Permanente, Santa Rosa, Calif.; and the Veterans Administration Medical Center, Durham, NC (Dr. Matchar).
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  • David B. Matchar MD

    1. Department of Medicine (Drs. Harpole, Samsa, and Matchar), the Center for Clinical Health Policy Research (Drs. Harpole, Samsa, and Matchar and Ms. Jurgelski), and the Department of Biostatistics and Bioinformatics (Dr. Samsa), Duke University Medical Center, Durham, NC; the Departments of Family Medicine (Nurse Shipley) and Neurology (Nurse Shipley and Dr. Bernstein), Kaiser Permanente, Santa Rosa, Calif.; and the Veterans Administration Medical Center, Durham, NC (Dr. Matchar).
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Address all correspondence to Dr. Linda H. Harpole, Duke Center for Clinical Health Policy Research, First Union Tower, Suite 220, 2200 West Main Street, Durham, NC 27705.

Abstract

Objective.—To determine the feasibility of developing a headache management program and to assess the outcomes of patients referred to the program for treatment of chronic headache.

Background.—Effective headache treatment requires that the patient receives the correct headache diagnosis; that appropriate acute and, if indicated, preventive medications be prescribed; and that the patient receives adequate education, including headache self-management skills.

Design/Methods.—A headache management program was established at a northern California staff-model health maintenance organization. Fifty-four patients were enrolled in the program and followed for 6 months. Patients participated in a structured program of group and individual sessions with the program manager. Data collection at baseline and 6 months included the Migraine Disability Assessment (MIDAS), the Short Form-36 Health Survey (SF-36), a patient satisfaction survey, and 2 additional short surveys—one that assessed patient worries about their headaches and another that queried patients on their problems with headache management.

Results.—All enrolled patients participated in the initial group visit; 74% had at least one additional visit. All but one patient suffered from more than one headache type. Sixty-one percent of patients suffered from migraine headache and 98% from tension-type headache. At baseline, patients were severely disabled, with a mean MIDAS score of 41. At 6 months, MIDAS scores decreased an average of 21.2 points (P < .005). Patients reported 14.5 fewer days with headache over the preceding 3 months (P < .0001) and experienced clinically significant improvements in 6 of the SF-36 subscales. Patients were significantly more satisfied with their headache care (P < .0001), reported less problems with their headache management (P < .0001), and were less worried about their headaches (P < .01). During the intervention, emergency department visits for headache decreased (P < .02).

Conclusions.—A headache management program was successfully established. Patients referred to the program experienced significant improvement in headache-related disability and functional health status and reported greater satisfaction with care. Even so, these results were obtained at one site and in a small sample that was not randomized. We currently are conducting a randomized controlled trial to better evaluate the clinical and financial impact of a headache management program for patients with chronic headache.

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