Burden of Illness and Satisfaction With Care Among Patients With Headache Seen in a Primary Care Setting


  • Linda H. Harpole MD, MPH,

  • Gregory P. Samsa PhD,

  • David B. Matchar MD,

  • Stephen D. Silberstein MD,

  • Andrew Blumenfeld MD,

  • Annette E. Jurgelski MAT

  • From the Duke University Medical Center, Department of Medicine, Durham, NC (Drs. Harpole, Samsa, and Matchar); Duke University Medical Center, Center for Clinical Health Policy Research, Durham, NC (Drs. Harpole, Samsa, Matchar, and Ms. Jurgelski); Duke University Medical Center, Department of Biostatistics and Bioinformatics, Durham, NC (Dr. Samsa); Veterans Administration Medical Center, Durham, NC (Dr. Matchar); Thomas Jefferson University, Department of Neurology, Philadelphia, PA (Dr. Silberstein); and Kaiser Permanente, Department of Neurology, San Diego, CA (Dr. Blumenfeld).

Address all correspondence to Dr. Gregory Samsa, Duke University Medical Center, Center for Clinical Health Policy Research, Suite 220, First Union Building, 2200 W. Main Street, Durham, NC 27705.


Objective.—To assess the current level of headache burden and the headache management needs at three diverse clinical sites.

Background.—Headache is a common disabling disorder that is costly for the patient and a management challenge for physicians. The determination of whether and how to intervene to improve headache management depends on both the burden of disease and the characteristics of patients that would likely be targeted.

Methods.—Patients from three healthcare organizations were identified by administrative records as having either migraine or tension-type headache and then mailed a survey that addressed demographics, headache type, headache-related disability, depression and anxiety, satisfaction with care, general health, worry about headache, problems with headache management, and healthcare utilization. Comparisons were made across sites and between patients with more and less severe headache-related impairments.

Results.—Of the 789 patients contacted, 385 (50%) returned a survey. While the socio-demographic characteristics of the patients were diverse, headache-related characteristics were similar. These patients have significant problems with headache management, disability, pain, worry, and dissatisfaction with care. Patients who described higher headache-related impairment experienced significantly greater problems in these areas, perceived themselves to be in worse general health, and had significantly greater use of medical services than those with lower headache severity.

Conclusions.—Despite various elements of heterogeneity, we observed across the sites a consistent need for improvement in headache management. Future efforts should be directed at developing and evaluating methods for effectively improving headache management.