Headache Medicine, v.10, n.3, p.66-69, 2019
66
ABSTRACT
RESUMO
Descritores: Cefaleias Primárias, prevalência, enxaqueca, cefaleia do tipo
tensional
ORIGINAL ARTICLE
Frequency of diagnoses in a specialized headache clinic in
Buenos Aires
Frequência de Diagnósticos em um Centro de Cefaleia
Especializado de Buenos Aires
Vanessa Nagel
Sol Cavanagh
Marina Olivier
Natalia Larripa
Maria T Gutierrez
Mariela Grandinetti
Daniela Calvo
Fernando Salvat
Lucas Bonamico
Maria Teresa Goicochea
Departamento de Neurología, Hospital Fleni,
Buenos Aires, Argentina
*Correspondence
Maria Teresa Goicochea
E-mail: mtgoycochea@eni.org.ar
Received: September 20, 2019.
Accepted: September 24, 2019.
Objective: Headache is one of the most frequent reason for consultations in
neurology. The global prevalence among adults with migraine is approximately
10% with migraine, 40% for tension-type headache (TTH) and 3% for chronic daily
headache. The purpose of this study is to analyze the prevalence of the diagnoses
of headache and craniofacial pain among patients evaluated in a specialized
headache clinic of Buenos Aires during 2017. Methods: Retrospective, descriptive
study. We reviewed the electronic medical records of patients who consulted
for headaches or craniofacial pain from January 1st to December 31st, 2017.
Diagnoses were made according to the criteria of the International Classication
of Headache Disorders (ICHD-3). Results: We reviewed 3254 electronic medical
records and documented 3941 diagnoses: headache (93.03%), craniofacial pain
(3.62%) and unclassiable (3.35%). The average age was 43.14 years. 80.7% were
women. Primary headaches were the most frequent diagnoses (78.54%). Migraine
represented the main diagnosis (87.42%). Episodic migraine without aura was the
most prevalent diagnosis (48%). Tension- type headache (TTH) was found in 8.74%
of cases of primary headaches and Trigeminal autonomic cephalalgias (TACs) in
2.89%. Medication-overuse headache (MOH) represented 77.93% of the secondary
headaches, and most of them also met chronic migraine criteria fullled criteria of
chronic migraine. Primary trigeminal neuralgia represented 50% of craniofacial pain
and 27% were secondary trigeminal neuralgia, mostly postherpetic or posterior to
dental procedures. Regardin to the frecuency, 33.58% of the patients had chronic
headache. Conclusion: In our section, migraine is the most frequent diagnosis
followed by medication-overuse headache. The percentage of chronic headache
is higher than the prevalence in the general population, probably because it is a
tertiary center.
Keywords: Primary headaches, prevalence, migraine, tension-type headache
Objetivo: Dor de cabeça é uma das razões mais frequentes para consultas em
neurologia. A prevalência global entre adultos com enxaqueca é de aproximadamente
10%, 40% para cefaleia tipo tensional (TTH) e 3% para cefaleia crônica diária. O
objetivo deste estudo é analisar a prevalência dos diagnósticos de cefaleia e dor
craniofacial em pacientes avaliados em uma clínica especializada em cefaleia de
Buenos Aires durante o ano de 2017. Métodos: Estudo retrospectivo, descritivo.
Foram revisados os prontuários médicos eletrônicos dos pacientes consultados
para dores de cabeça ou dor craniofacial de 1 de janeiro a 31 de dezembro de 2017. Os
diagnósticos foram feitos de acordo com os critérios da Classicação Internacional
de Distúrbios da Cefaleia (ICHD-3). Resultados: Foram revisados 3254 prontuários
eletrônicos e documentados 3941 diagnósticos: Cefaleias (93,03%), dor craniofacial
(3,62%) e não classicáveis (3,35%). A idade média foi de 43,14 anos. 80,7% eram
mulheres. Cefaleias primárias foram o grupo diagnóstico mais frequente (78,54%).
Deste, a enxaqueca representou o principal diagnóstico (87,42%). O episódio de
enxaqueca sem aura foi o diagnóstico mais prevalente (48%). Cefaleia tipo tensional
(TTH) foi encontrada em 8,74% dos casos de cefaleia primária e cefaleias trigêmino-
autonômicas (TACs) em 2,89%. A cefaleia por uso excessivo de medicamentos (MS)
representou 77,93% das cefaleias secundárias, e a maioria delas também atendeu
aos critérios de enxaqueca crônica. A neuralgia trigeminal primária representou 50%
da dor craniofacial, 27% eram neuralgia trigeminal secundária, principalmente pós-
herpética ou posterior a procedimentos odontológicos. Em relação à frequência,
33,58% dos pacientes apresentaram cefaleia crônica. Conclusão: Em nosso centro,
a enxaqueca é o diagnóstico mais frequente seguido de cefaleia por uso excessivo
de medicamentos. A porcentagem de cefaleia crônica é maior que a prevalência
na população em geral, provavelmente por ser um centro terciário.
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Headache Medicine, v.10, n.3, p.66-69, 2019
INTRODUCTION
Headache is one of the most frequent consultations
in neurology. It is estimated that 95% of men and 99%
of women will have at least one episode of headache
throughout their life, provided that about 40% have it
quite regularly.
1
The global prevalence among adults is apporxiamtely
10% of migraine, 40% for tension-type headache (TTH)
and 3% for chronic daily headache
.
2
In general population
the most frequent headache is TTH, but among patients
visiting specialized clinics migraine is the rst diagnosis.
Headache can have a signicant impact on
the patients quality of life. On the World Health
Organization’s ranking of causes of disability, headache
disorders are between the 10 most disabling conditions
for the two genders, and between the ve most disabling
for women.
2
There are few data about frequency of headache
and craniofacial pain in South America. The purpose of
this study is to analyse the prevalence of the diagnoses
of headache and craniofacial pain among patients
evaluated in Fleni, a specialized headaches clinic of
Buenos Aires, during 2017.
Patients and methods
We performed a retrospective, descriptive study
based on the electronic medical records of patients
evaluated for headaches or craniofacial pain who
presented to the headache clinic of the Fleni Institute
from January 1
sth
to December 31
sth
, 2017. Diagnoses were
recorded according to the International Classication of
Headache Disorders (ICHD-3) criteria. When a patient
met criteria for more than one type of headache, all of
them were coded.
This work was approved by the ethics committee of
the Fleni Institute.
RESULTS
Between January 1
sth
to December 31
sth
, 2017, 3254
patients (2626 women and 628 men with a ratio of 4.18:
1) were evaluated at headache clinic of the Fleni Institute.
The average age was 43.14 years (range 18 to 95 years).
We reviewed these 3254 electronic medical records and
documented 3941 diagnosis: 3095 primary headaches
(78.54%), 571 secondary headaches (14.49%), 90 primary
craniofacial pain (2.28%), 53 secondary craniofacial pain
(34%) and 132 were considered unclassiable (3.35%)
(Figure 1).
Regarding primary headaches 2706 patients were
migraineurs (87.42%), 270 patients had TTH (8,74%),
89 patients had TAC (2.89%) and 30 patients had
others primary headaches (0.95%). Figure 2 Among
migraine, 1309 patients were diagnosed with episodic
migraine without aura (48%), 993 patients had chronic
migraine without aura (37%) and 404 patients had
diagnosis of migraine with aura (15%). Episodic tension-
type headache was found in 170 patients of primary
headaches (5.50%), whereas 100 patients had chronic
Figure 1. Frequency of headache diagnoses.
forms (3.24%). Trigeminal autonomic cephalalgias
corresponded to 2.89% of the cases. 82 patients were
cluster headache (2.66%) and 7 hemicraneas (0.23%). In
our series there were no cases of Short-lasting Unilateral
Neuralgiform headache attacks with Conjunctival
injection and Tearing (SUNCT) or short-lasting unilateral
neuralgiform headache attacks with cranial autonomic
symptoms (SUNA). Among others primary headaches,
the most frequent was headache associated with sexual
activity, with 9 cases (0.29%). The rest were distributed
as follows: 6 primary cough headache (0.19%), 5 primary
stabbing headache (0.16%), 5 new daily persistent
headache (NDPH) (0.16%), 3 primary thunderclap
headache (0.09%), 1 nummular headache (0.03%) and 1
hypnic headache (0.03%).
Secondary headaches were diagnosed in 571
patients (14.49%). Headache attributed to substances
was the main diagnosis, with 445 patients (77.93%). Of
Figure 2. TTH: tension-type headache, TACs:
Trigeminal autonomic cephalalgias.
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Headache Medicine, v.10, n.3, p.66-69, 2019
68
these, only one was secondary to the use of illicit drugs
(cocaine), while the rest was attributed to medication-
overuse headache (MOH). Among these patients with
overuse of analgesics, 402 had diagnosis of chronic
migraine without aura (97.33%), 5 episodic migraine
without aura (1.22%) and 6 migraine with aura (1.45%).
The remain secondary headaches were distributed as
follows (Figure 3):
• 34 headaches attributed to craniofacial or
cervical structures (5.95%): 17 cervicogenic
(50%), 11 temporomandibular disorder (TMD)
(32.36%), 4 rhinosinusitis (11.76%), 1 trocleodynia
(2.94%) and 1 lesion in subcutaneous tissue
(2.94%).
• 22 traumatic headaches (3.85%): 14
postcraniectomy (63.6%) and 8 head injuries
(36.4%).
• 21 headaches secondary to intracranial
pathologies (3.68%): 8 space-occupying lesions
(38.09%), 7 CSF hypotension (33.33%), 4
idiopathic intracranial hypertension (19.04%)
and 2 secondary hydrocephalus (9.52%).
• 20 headaches attributed to vascular disorders
(3.5%): 8 vascular dissections (40%), 5
reversible cerebral vasoconstriction syndrome
(25%), 2 venous thromboses (10%), 2 strokes
(10%), 1 pituitary apoplexy (5%), 1 subarachnoid
hemorrhage (5%) and 1 giant cell arteritis (5%).
• 7 infections (1.22%): 5 systemic febrile syndrome
(71.42%) and 2 viral meningitis (28.57%).
• 6 headaches attributed to disorders of the
homoeostasis (1.06%): 5 sleep apnea-hypopnea
syndrome (83.26)%) and 1 headache associated
with airplane travel (16.6%).
• 10 cases were due to psychiatric symptoms
(1.77%).
Primary trigeminal neuralgia represented 50%
of craniofacial pain and 27% were secondary
trigeminal neuralgia: 16 postherpetic (42%), 12
posterior to dental procedures (32%), 3 multiple
sclerosis (7,8%), 2 dental infections (5,2%), 2 tumors
(5,2%), 1 mandibular surgery (2,6%), 1 trauma (2,6%)
and 1 venous anomaly (2,6%). 10% of the cases were
diagnosed as primary occipital neuralgia and 3%
secondary: 1 chordoma, 1 multiples sclerosis, 1 tumor
and 1 C2 zoster. 2% were primary glossopharyngeal
neuralgias. 11 patients has diagnoses of other facial
pain: 8 atypical facial pain (72,73%), 1 burning
mouth syndrome (9,09%), 1 pain secondary to
retropharyngeal abscess (9,09%) and 1 facial pain
secondary to a venous tumor (9,09%) (Figure 4).
34% of the patients had diagnosis of chronic
headache (90.8% migraine, 9.2% TTH). Figure 5 2593
patients had 1 diagnosis, 635 patients 2 diagnoses and
26 patients 3 diagnoses. The most common association
was migraine (mostly chronic without aura) and overuse
of medication.
Figure 4. Distribution of craniofacial pain syndromes.
Figure 3. Distribution of Secondary Headaches.
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Headache Medicine, v.10, n.3, p.66-69, 2019
Figure 5. Percentages of Episodic and Chronic
headaches.
DISCUSSION
The demographic characteristics of the study
showed a female-to-male ratio of 4:18, higher than in
other published series
3
. Average age of the patients was
43.14 years, comparable with those reported previously
3
.
As in other specialized headache, the most frequent
diagnosis in our population was migraine. Among them,
episodic migraine without aura was the most prevalent,
followed by chronic migraine and nally migraine with
aura.
The second diagnosis was Medication-overuse
headache. All these patients also have another type of
headache, which was the cause that leaded to the abuse
of analgesics. These patients were mostly diagnosed
with chronic migraine without aura.
Tension headache was the next diagnosis in
frequency. Although this type of headache is the most
frequent in the general population, the percentage is
lower in specialized centers, because it usually generates
less impact on the patients live, and therefore, they need
less medical assistance. In our series the prevalence of this
type of headache is lower than in other published studies.
Cluster headache was the most frequent trigeminal
autonomic cephalalgia. Other primary headaches
accounted a small percentage of the diagnoses.
Medication-overuse headache was the most
frequent secondary headache. The majority were patients
with chronic migraine. The next diagnosis within this
group was headache associated with craniofacial and/or
cervical pathologies, mainly cervicogenic pathology and
temporomandibular joint.
Within craniofacial neuropathic pain, primary
trigeminal neuralgia was the most prevalent, while
postherpetic neuralgia was the next frequency diagnosis.
The percentage of chronic headaches was 34%,
higher than in the general population, probably because
Fleni is a tertiary center. Most of them were migraines.
CONCLUSIONS
There are few published data about frequency of
different types of headaches and craniofacial pain in
South America, being the main data those coming from
Brazil.
4-6
According to our knowledge there are no data
from Argentine headache center
In our section, migraine is the most frequent
headache. Unlike the published data, where tension-type
headache is the next cause of consultation in specialized
centers, medication-overuse headache is the second
diagnosis. The percentage of chronic headache is higher
than the prevalence in the community, probably because
it is a tertiary center.
The high frequency of chronic headache , especially
Medication-overuse headache highlight the need for
more education for doctors and the importance of
raising awareness among patients about its prevention,
detection and treatment.
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