50 Headache Medicine, v.7, n.2, p.50-53, Apr./May/Jun. 2016

Admissive evaluation and the headache diagnosis

Márcia Cristina Matos Macêdo

, Paulo Sergio Faro Santos

, Alan Chester Feitosa de Jesus

Physiatrist, Member of the Brazilian Society of Physical Medicine and Rehabilitation

Resident medical, Department of Neurology, Neurological Institute of Curitiba; Member of the

Brazilian Headache Society

Neurologist, Member of the Brazilian Headache Society; Member of the Brazilian Neurology Academy

Macêdo MCM, Faro Santos PS, Jesus ACF. Admissive evaluation and the headache diagnosis.

Headache Medicine. 2016;7(2):50-3

ORIGINAL ARTICLE

ABSTRACT

Objectives: To question and to describe the headache

prevalence in a population undergone admissive evaluation.

Methods: 607 individuals were undergone admissive

evaluation, whose data were catalogued by the examiner

neurologist. The questions "Do you have headache? Does

headache interfere in your life quality?" were made to all

patients, and the prevalence was compared with the literature.

Results: The sample was composed of individuals from 17

to 66 years old (27.72 on average), in which 98.35% were

male. About 5% of the individuals answered YES to both

questions, 0.65% answered YES to only the first question,

and no female answered YES to both questions. Conclusions:

The observed headache prevalence is smaller than in other

studies of healthy populations. It is possible that the hopeful

applicant omit this information during the admissive evaluation

by fearing that this information would interfere negatively in

their hiring.

Keywords: Headache; Prevalence; Disability; Employment

RESUMO

Objetivos: Questionar e descrever a prevalência de cefaléias

em uma população submetida à avaliação admissional.

Métodos: Foram submetidos a uma avaliação admissional

607 indivíduos. Os dados eram catalogados pelo neurolo-

gista examinador. A todos os pacientes foi feito o

questionamento: "Você tem dor de cabeça? A dor de cabe-

ça interfere na sua qualidade de vida?". A prevalência en-

contrada foi comparada com a literatura. Resultados: A

amostra foi composta de indivíduos com idades entre 17 e

66 anos (média: 27,72) sendo 98,35% do sexo masculino.

Responderam SIM a ambas as perguntas cerca de 5% dos

avaliados. Responderam SIM somente à primeira pergunta

0,65% indivíduos. Nenhuma mulher respondeu "sim" às per-

guntas. Conclusões: A prevalência de cefaléia observada

é menor que em outros estudos de populações sadias. É

possível que o aspirante a um emprego omita esse dado na

entrevista de avaliação admissional pelo receio de que a

informação tenha interferência negativa em sua contratação.

Palavras-chave: Cefaleia; Prevalência; Incapacidade;

Emprego

INTRODUCTION

The employee's health and welfare are essential to a

satisfactory productivity in the company where he or she

works. Costs generated by unhealthy workers go beyond

the direct costs with their health care. In addition, the

effective workforce reduction from an enterprise for

absenteeism, as well as the decreasing productivity from

those who remain at the workplace with any inability, are

also included.

(1-4)

Clinical admissive evaluations, periodic and dismissal,

mandatory for all workers from the formal sector of the

economy, consist the health monitoring at work. Admissive

evaluation, particularly, infers if the applicant is able, in

terms of physical and mental health, to take the applying

position. The structure of this evaluation varies according

to the applying position, to meet the particularities of each

situation.

(5)

Admission assessment has proved solidly effective

in preventing physical injuries to the worker when properly

performed.

(6,7)

The headache, however, does not seem to

Avaliação admissional e o diagnóstico de cefaleias

Headache Medicine, v.7, n.2, p.50-53, Apr./May/Jun. 2016 51

have its owing heed in the most of admissive evaluations,

and its prevention starting from this evaluation is not well

established.

Despite the large volume of admissive evaluations that

are made daily, information like acquired data validity and

data concerned to epidemiological profile of these

evaluations has not been described in the current literature.

Analysing whether this goal is being achieved satisfactorily

is opportune if the objective of the admissive evaluation is,

beyond promoting health and security to the worker,

perfecting the productivity of the company, because

according to Houghton and his contributors, most of the

causes of absenteeism related to illness are not foreseen by

the tracking of the admissive evaluation.

(8)

Headache is an

important cause of absenteeism and decrease on the

productivity,

(9)

and deserves a special heed during the

interrogation in this type of evaluation.

The admissive evaluation permits workers, in theory,

to be allocated in the positions befittingly to their health,

which guarantees its preservation and individual

productivity. Environmental situations, including work ones,

have a decisive influence on manifestations of multi-

symptomatic chronic illnesses, like headache, which

influences on their life quality and productivity.

(10)

Regarding

headache, several crisis-triggering factors may be present

at the workplace as threatens to those individuals

predisposed to this pathology. Among these factors are worth

mentioning: sleep deprivation, fatty and irregular feeding

habits, exposure to excessive stress, noise and smell, and

even postural factors.

(11,12)

Raak e Raak

(13)

estimated a 25%

drop in effectiveness at work in patients with headache.

The greatest loss is not in the absenteeism days, but in the

reduction of the performance at worktime.

(14)

Migraine, the

headache type that generates more inability at work,

(15,16)

has been considered more disabling than chronic diseases

such as systemic hypertension, diabetes, back pain,

osteoarthritis, and just as disabling as depression.

(17)

About 12% of world population suffers from

migraine.

(16)

In Brazil, this number must be even higher.

(18)

Other types of headache, mostly tensional, do not display

a well-defined prevalence, since its presentation form, in

general, is more variable.

(16)

The high headache prevalence

in population, and its chronic character makes this disease

generator of very high costs in Brazil

(19)

and in the world,

(20)

and one of the main causes of declining productivity in the

workplace.

(9,21)

No study has been performed so far approaching

headache during admissive evaluation. The objective of

this study is to observe the headache prevalence in this

evaluation and to compare the data with prevalence in

current literature in other healthy populations.

METHODS

It was conducted an observational and cross-sectional

study in which patients undergone admissive evaluation

between September 2006 and September 2007 were

included. These evaluations were conducted in an

occupational medicine private practice in Aracaju, Sergipe,

Brazil. All included patients were applicants in a job that

required a neurological admissive evaluation and it was

done by the same neurologist, fact that homogenized the

questioning and headache registration obtained in these

evaluations.

The neurological evaluation as part of the admissive

evaluation follows an established pattern. It consists of an

initial interrogation, followed by the execution of an

electroencephalogram. The questions "Do you have

headache?" and "Does headache interfere on your life

quality" were done to all patients. The obtained data in the

evaluation were immediately catalogued in a database by

the examiner neurologist as well the headache record these

evaluations. Besides, the patient was questioned about case

histories of seizures, dizziness, severe head trauma and using

of psychotropic drugs, such as tranquilizers, stimulants,

energy drinks, benzodiazepines and anticonvulsants. It was

analyzed the prevalence of patients who answered YES to

the questions. Furthermore, the obtained results were

compared to the prevalence of migraine obtained in other

studies in healthy populations.

The work was sent to Ethis Committee from Federal

University of Sergipe, Brazil (Comitê de Ética da Universi-

dade Federal de Sergipe) and it was approved in August

7th, 2009, through CAAE - 0119.0.107.000-09.

RESULTS

Six hundred seven patients undergone admissive

evaluation whose job required a neurological evaluation

were analyzed. From these, 98.35% were male – the

remaining percentage was formed by only 10 women in

this evaluated group. The sample was composed of

individuals with ages ranging between 17 and 66 years,

with an average of 27.72 years. Upon hearing the questions

"Do you have headache?" and "Does headache interfere

on your life quality?", 5.1% of all interviewees answered

YES to both questions. Only 0.65% answered YES to the

first question. No woman answered YES to both questions.

ADMISSIVE EVALUATION AND THE HEADACHE DIAGNOSIS

52 Headache Medicine, v.7, n.2, p.50-53, Apr./May/Jun. 2016

MACÊDO MCM, FARO SANTOS PS, JESUS ACF

DISCUSSION

The information that only 5.1% from the 607

candidates evaluated reporting that the headache interfe-

res in their life quality makes room for questions. When

taken into consideration that these 5.1% covers all existing

types of headache, migrainous and non-migrainous,

primary and secondary, it can be affirmed that it is a

prevalence considerably lower than that found in any other

study about headaches, including those that has an object

of study the healthy populations.

When looking at the population profile of the study, it

was verified that this is a population of similar ages studied

in other papers, unemployed, but almost exclusively male.

It is not allowed, of course, to compare with the found

prevalence in studies which observed a population in that

the proportion of men and women is relatively equivalent.

The fact that the studied population is predominantly male

generates a lower prevalence, since women are more

affected by headaches, particularly migraine. Analysing

the available literature, however, the found prevalence

would still be below description.

Only migraine, excluding all other types of primary

headaches in males has a prevalence of about 8%, as the

study of Hagen et al in 2000 displays. The prevalence of

migraine in men and women was of 12%. In the same study,

non-migrainous headaches displayed 26% of prevalence,

30% in women and 22% in men.

(22)

In Denmark, 37% of

the interviewed population reported the presence of tension-

typed headache several times a month.

(23)

In Hong Kong,

another study found similar prevalence of recurrent

headache, of 37.1%.

(24)

Added to this data, Brazil has already

proved to have a prevalence of migraine above other Latin

American countries such as Argentina, Venezuela, Colombia,

Ecuador and Mexico, and above those found in some studies

conducted elsewhere in the world: 17.4% in women and

7.8% in men.

(17)

The attached chart displays the prevalence

of migraine found in several studies around the world,

summarized in a review article.

(16)

Another possible bias would be the questioning

method. However, the questions used would make room

for an even higher prevalence, since it does not specifies

diagnostic criteria and headache classification; it just

questions their existence and their impact on life quality of

the applicant. Moreover, the questioning was conducted

by the same neurologist, which homogenizes the

interrogation. In a study in the state of Espírito Santo, Brazil,

52.8% answered YES to the question "Do you consider

yourself a person who suffers from headache?". In addition,

the study divides the population from unemployed ones

and, in those, the headache prevalence was of 47.9%.

(25)

It is possible that the applicant omits this datum during

the admissive evaluation interview fearing that the

information has a negative interference in its recruitment.

Although admissive evaluation theorically may be

conducted only after a concrete employment offer, in which

the employer is subjected to legal proceedings in the case

of further withdrawal without any explicit reason, in practice

it may not always happen. It is conceivable that such

information may be omitted by the applicant. Headache

subdiagnosis in admissive evaluation hinders designing even

a preventive treatment for these employees, and including

an adequate allocation for a position that befits their status

and their individual characteristics.

The majority of patients with primary headaches never

sought medical care for this complaint.

(26)

Perhaps the

admissive evaluation was the ideal moment to meet their

pathology and control symptoms adequately. A prospective

study with workers from New York proved that the

combination of an educational program for employees to

know headache, with adequate access to a trained

professional is effective in reducing symptoms.

(27)

CONCLUSION

To achieve this, the first step is to adequately collect

subjective information such as headache in admissive

evaluation, given the importance of this pathology in the

worker's productivity decrease and spendings on health care.

However, the instability that the employee lives in among

the private sector of the economy and historical heritage of

authority by the employer probably still exists as threatens

to the sincerity at the moment of the admissive evaluation.

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Correspondence

Paulo Sérgio Faro Santos

Instituto de Neurologia de Curitiba

Rua Jeremias Maciel Perretto, 300

81210-310 - Curitiba, PR, Brazil

Fone/fax: + 41 3248.8580

dr.paulo.faro@gmail.com

ADMISSIVE EVALUATION AND THE HEADACHE DIAGNOSIS

Received: June 10, 2016

Accepted: June 17, 2016