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Abstract：
OBJECTIVE: To determine headache diagnosis and treatment patterns in the outpatient setting, focusing on documentation of the International Classification of Headache Disorders (ICHD) criteria.
METHODS: Retrospective cohort data were collected from electronic medical records of adults aged 18-35 who presented to resident-staffed family medicine outpatient clinics in the Midwest, USA, for a new or worsening headache between 2015 and 2016. Diagnosis codes were used to summarize the overall nature and prevalence of headaches. A random subset of 30 patients each for migraine headache (MGH) with and without aura and tension-type headache (TTH) were reviewed to determine how many of the five possible ICHD criteria were documented. Demographics/clinical characteristics, ICHD criteria, number and type of medications, and healthcare utilization (imaging, primary and emergency department care) through one year following the initial visit were summarized and compared across headache types.
RESULTS: There were 716 unique patients during the study period (414 MGH, 227 unspecified headaches, 75 TTH, or others). Complete ICHD criteria were documented for two patients in total. There was partial documentation (e.g., one to four of the possible five) for 30% of TTH, 63% of MGH without aura, and 77% of MGH with aura (p<0.05). Across headache types, patients were prescribed an average of 2.3 to 3.3 medications over one year, with MGH patients generally trying more medications (up to eight for those with aura and up to 12 for those without). Abortive or rescue medications were prescribed to nearly all patients; prophylactics were prescribed for 50% of MGH with aura, 66.7% of MGH without aura, and 53.3%. Non-pharmacologic interventions were less prescribed: 33.3% of TTH patients and 3.3% of MGH types combined (p<0.05). Healthcare utilization was highest for MGH with aura (ED visits) and without aura (clinic visits) patients compared to TTH (p<0.001).
CONCLUSIONS: Headache-related documentation is often incomplete, which may limit interpretation and associations between diagnoses, prescribing patterns, and healthcare utilization. Future studies should evaluate the use of electronic medical records (EMR)-based templates to improve documentation, and additional detailed studies are needed in the local setting to determine whether treatment, including the use of non-pharmacologic and prophylactic methods of treatment, is optimal.
METHODS: Retrospective cohort data were collected from electronic medical records of adults aged 18-35 who presented to resident-staffed family medicine outpatient clinics in the Midwest, USA, for a new or worsening headache between 2015 and 2016. Diagnosis codes were used to summarize the overall nature and prevalence of headaches. A random subset of 30 patients each for migraine headache (MGH) with and without aura and tension-type headache (TTH) were reviewed to determine how many of the five possible ICHD criteria were documented. Demographics/clinical characteristics, ICHD criteria, number and type of medications, and healthcare utilization (imaging, primary and emergency department care) through one year following the initial visit were summarized and compared across headache types.
RESULTS: There were 716 unique patients during the study period (414 MGH, 227 unspecified headaches, 75 TTH, or others). Complete ICHD criteria were documented for two patients in total. There was partial documentation (e.g., one to four of the possible five) for 30% of TTH, 63% of MGH without aura, and 77% of MGH with aura (p<0.05). Across headache types, patients were prescribed an average of 2.3 to 3.3 medications over one year, with MGH patients generally trying more medications (up to eight for those with aura and up to 12 for those without). Abortive or rescue medications were prescribed to nearly all patients; prophylactics were prescribed for 50% of MGH with aura, 66.7% of MGH without aura, and 53.3%. Non-pharmacologic interventions were less prescribed: 33.3% of TTH patients and 3.3% of MGH types combined (p<0.05). Healthcare utilization was highest for MGH with aura (ED visits) and without aura (clinic visits) patients compared to TTH (p<0.001).
CONCLUSIONS: Headache-related documentation is often incomplete, which may limit interpretation and associations between diagnoses, prescribing patterns, and healthcare utilization. Future studies should evaluate the use of electronic medical records (EMR)-based templates to improve documentation, and additional detailed studies are needed in the local setting to determine whether treatment, including the use of non-pharmacologic and prophylactic methods of treatment, is optimal.
摘要：
目的：确定门诊头痛的诊断和治疗模式，重点是国际头痛疾病分类（ICHD）标准的文档。
方法：回顾性队列数据是从18-35岁的成年人的电子病历中收集的，这些人被送到中西部的住院医师家庭医疗门诊诊所，美国,2015年至2016年期间出现新的或恶化的头痛。诊断代码用于总结头痛的总体性质和患病率。对30例伴有和不伴有先兆和紧张型头痛（TTH）的偏头痛（MGH）患者的随机子集进行了审查，以确定记录了五个可能的ICHD标准中的多少。人口统计学/临床特征，ICHD标准，药物的数量和类型，和医疗保健利用(成像，初级和急诊科护理）在初次就诊后的一年内进行了总结，并比较了头痛类型。
结果：研究期间有716名独特患者（414MGH，227个未指明的头痛，75TTH,或其他)。记录了总共两名患者的完整ICHD标准。有部分文件(例如，可能的五个中的一个到四个)占TTH的30%，63%的MGH无先兆，77％的MGH具有先兆（p<0.05）。在头痛类型中，患者在一年内平均服用2.3至3.3种药物，MGH患者通常会尝试更多的药物（有先兆的患者最多服用8种，没有先兆的患者最多服用12种）。几乎所有患者都服用了堕胎或抢救药物；50%的MGH有先兆，66.7%的MGH无先兆，53.3%。非药物干预的处方较少：33.3％的TTH患者和3.3％的MGH类型的组合（p<0.05）。与TTH相比，有先兆（ED就诊）和无先兆（临床就诊）的MGH患者的医疗保健利用率最高（p<0.001）。
结论：与头痛相关的文档通常不完整，这可能会限制诊断之间的解释和关联，处方模式，和医疗保健利用。未来的研究应该评估使用基于电子病历（EMR）的模板来改进文档，需要在当地进行更详细的研究，以确定治疗是否，包括使用非药物和预防性治疗方法，是最优的。
方法：回顾性队列数据是从18-35岁的成年人的电子病历中收集的，这些人被送到中西部的住院医师家庭医疗门诊诊所，美国,2015年至2016年期间出现新的或恶化的头痛。诊断代码用于总结头痛的总体性质和患病率。对30例伴有和不伴有先兆和紧张型头痛（TTH）的偏头痛（MGH）患者的随机子集进行了审查，以确定记录了五个可能的ICHD标准中的多少。人口统计学/临床特征，ICHD标准，药物的数量和类型，和医疗保健利用(成像，初级和急诊科护理）在初次就诊后的一年内进行了总结，并比较了头痛类型。
结果：研究期间有716名独特患者（414MGH，227个未指明的头痛，75TTH,或其他)。记录了总共两名患者的完整ICHD标准。有部分文件(例如，可能的五个中的一个到四个)占TTH的30%，63%的MGH无先兆，77％的MGH具有先兆（p<0.05）。在头痛类型中，患者在一年内平均服用2.3至3.3种药物，MGH患者通常会尝试更多的药物（有先兆的患者最多服用8种，没有先兆的患者最多服用12种）。几乎所有患者都服用了堕胎或抢救药物；50%的MGH有先兆，66.7%的MGH无先兆，53.3%。非药物干预的处方较少：33.3％的TTH患者和3.3％的MGH类型的组合（p<0.05）。与TTH相比，有先兆（ED就诊）和无先兆（临床就诊）的MGH患者的医疗保健利用率最高（p<0.001）。
结论：与头痛相关的文档通常不完整，这可能会限制诊断之间的解释和关联，处方模式，和医疗保健利用。未来的研究应该评估使用基于电子病历（EMR）的模板来改进文档，需要在当地进行更详细的研究，以确定治疗是否，包括使用非药物和预防性治疗方法，是最优的。
