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The Journal of Headache and Pain

, 15:56

First Online: 01 September 2014Received: 20 May 2014Accepted: 13 August 2014

Abstract

BackgroundCluster headache CH is a severe, disabling form of headache. Even though CH has a typical clinical picture it seems that its diagnosis is often missed or delayed in clinical practice. CH patients may thus face: misdiagnosis, unnecessary investigations and delays in accessing adequate treatment. This study was conducted to investigate the occurrence of diagnostic and therapeutic errors with a view to improving the clinical and instrumental work-up in affected patients.

MethodsOur study comprised 144 episodic CH patients: 116 from Italy and 28 from Eastern European countries Moldova, Ukraine, Bulgaria. One hundred six patients 73.6% were examined personally and 38 26.4% were evaluated through telephone interviews conducted by headache specialists using an ad hoc questionnaire developed by the authors.

ResultsThe sample was predominantly male M:F ratio 2.79:1 and had a mean age of 42.4 ± 9.8 years; approximately 76% of the patients had already consulted a physician about their CH at the onset of the disease. The mean interval between onset of the disease and first consultation at a headache center was 4.1 ± 5.6 years. The patients had consulted different specialists prior to receiving their CH diagnosis: neurologists 49%, primary care physicians 35%, ENT specialists 10%, dentists 3%, etc. Misdiagnoses at first consultation were recorded in 77% of the cases: trigeminal neuralgia 22%, migraine without aura 19%, sinusitis 15%, etc. The average -diagnostic delay- was 5.3 ± 6.4 years and the condition was diagnosed approximately -doctor delay-: one year. Instrumental and laboratory investigations were carried out in 93% of the patients prior to diagnosis of CH. Some of the patients had never received abortive or preventive medications, either before or after diagnosis. Medical prescription compliance: 88% of the cases.

ConclusionsOur results emphasize the need to improve specialist education in this field in order to improve recognition of the clinical picture of CH and increase knowledge of the proper medical treatments for de novo CH. Continuous medical education on CH should target general neurologists, primary care physicians, ENT specialists and dentists. A study on a larger population of CH patients may further improve error-avoidance strategies.

KeywordsCluster headache Diagnostic mistakes Therapeutic mistakes Headache guidelines Electronic supplementary materialThe online version of this article doi:10.1186-1129-2377-15-56 contains supplementary material, which is available to authorized users.

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Autor: Cristina Voiticovschi-Iosob - Marta Allena - Ilaria De Cillis - Giuseppe Nappi - Ottar Sjaastad - Fabio Antonaci

Fuente: https://link.springer.com/







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