Predictors of Outcome in Headache Patients Presenting to Family Physicians ‐ a One Year Prospective Study

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Abstract
SYNOPSISTwo hundred and seventy‐two patients presenting to family physicians with a new complaint of headache were enrolled in a one year prospective study. Data was collected from patients and doctors at the first visit. Patients were interviewed at home six weeks after the first visit, and follow‐up data was obtained by mailed questionnaire or telephone interview at six months and one year. Patients were diagnosed by three of the investigators, using conventional diagnostic categories. Fifty‐six patients (21.1%) had headache of organic origin. Of the 209 with non‐organic headache, the majority were diagnosed as muscle contraction headache (MCH) possible (38.8%), common migraine possible (28.6%) and MCH definite (21.8%). The distinction between common migraine possible and MCH had no value in predicting outcome. There was a gradient of increasing severity across the spectrum of nonorganic headache, from MCH to classical migraine, a finding which we believe supports the “severity model”. The factors independently associated with a good outcome at one year (p<0.05) were the patient's assessment at six weeks that he had had the opportunity to discuss his problem fully at the first visit, an organic diagnosis, and no report of visual symptoms accompanying the headaches. More severe pain and warning vomiting were strongly associated with a poor outcome. Since the distinction has no predictive value, we suggest that headaches without definite features of migraine or cluster headache be categorized as recurrent non‐specific headache (R.N.S.H.).

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