Standard of Care For Headache Diagnosis and Treatment
Established
by the National Headache Foundation and Updated for 2005
With 45 million headache sufferers in the United States and many
individual circumstances to consider relative to the diagnosis and
treatment of headache, the National Headache Foundation (NHF) believes
that it is critical for healthcare providers to have specific guidelines
for working with headache and migraine sufferers. It is for this
reason that the NHF originally published its Standards of Care in
1996, and then updated it in 1999, 2001 and 2005, with the current
version incorporating guidelines from the US Headache Consortium.
According to Dr. Roger
Cady, who co-authored the current Standards of Care, “Since
the last update in 2001, many advancements have been made in the
diagnosis and treatment of headache, and by providing the current
Standards of Care, we allow headache sufferers to benefit from
the most up-to-date guidelines.”
Why are standards of care guidelines necessary in the treatment
of headache?
Headache is one of the most frequent disorders encountered by healthcare
providers in the outpatient setting. More than 45 million Americans
from all walks of life experience recurrent headache, with reports
indicating that this figure may be rising. This includes 28 million
migraine sufferers.
The results of quality of life studies have shown that chronic headache
disorders cause significantly more morbidity and functional impairment
than has been previously appreciated. In fact, the level of impairment,
as measured using standardized quality of life instruments, is comparable
to that of patients with congestive heart failure or recent myocardial
infarction. Other impact measures of migraine such as the Migraine
Disability Assessment Scale (MIDAS) and the Headache Impact Tool
have assessed disability in the form of absenteeism and decreased
productivity in work, school, home, and leisure activities.
What is the cost of failing to successfully treat this large and
diverse sector of the population?
The estimates of decreased productivity are staggering, as are the
number of days, weeks, or even months lost from work each year. For
migraine sufferers, disability is believed to cost employers more
than $17 billion annually and they lose 157 million workdays each
year. American business loses an estimated $50 billion per year to
absenteeism and the payment of medical benefits attributable to headache.
Billions more are spent on physician appointments, emergency room
visits, laboratory and radiographic studies, and prescription drugs,
over-the-counter medications, herbs, and nutritional supplements.
What can healthcare providers
do to improve the quality of life for headache sufferers?
Today, with
a greater understanding of the causes and consequences of headache,
as well as more treatment options than ever before, it is possible
to control headache symptoms in the majority of patients. The guidelines
that are included in the NHF’s Standards of
Care will assist practitioners in making decisions that restore patients’ functional
status.
These guidelines will
help physicians and other healthcare professionals to:
• Rule
out secondary headache and establish a primary headache diagnosis
• Set
reasonable goals with each patient, identifying expectations
and individual needs by tailoring the educational component
to the patient’s level of active participation and desire
• Design
a treatment plan, combining non-pharmacologic with pharmacologic
approaches as necessary to:
1. Minimize symptomatology
2. Reduce disability
3.Improve
quality of life
• Provide follow-up care for long-term headache management to:
1. Reassess
how well the treatment plan is achieving established goals
2. Reevaluate patient
needs and specific headache patterns
• Recognize indications
for appropriate and timely referrals to specialists.
