Headache Medicine 2021, 12(3):235-239 p-ISSN 2178-7468, e-ISSN 2763-6178

235

ASAA

DOI: 10.48208/HeadacheMed.2021.34

Headache Medicine

Original

Analysis of the Prevalence of Headaches Subtypes in a Specialized

Outpatient Clinic in a Medium-sized Municipality, Minas Gerais,

Brazil

Estephanie Veronese Ribeiro , Gustavo Alvarenga Rodrigues , José Rafael Araújo e Costa ,

Julia Rodrigues Pereira , Marcelo Rodrigues de Assis Júnior , Mauro Eduardo Jurno

Faculdade de Medicina de Barbacena – FAME/FUNJOB

Abstract

Objective

To evaluate the prevalence of different subtypes of headaches in a tertiary referral clinic for

headache care in the city of Barbacena, Brazil.

Methods

A retrospective and descriptive cross-sectional study that evaluated the medical records of

130 patients previously seen by a neurologist in the headache clinic from January 2020 to

March 2021.

Results

The mean age of patients was 42.5 years, most of them female (83%). Primary headaches

were the most common, with migraine found in 73% of cases and tension-type headache (TTH)

in 17%. Among secondary headaches, the most common subtype was headache attributed

to a substance or its suppression (11%), followed by cases such as headache due to cranial

neuralgia and central causes of facial pain (3%) and headache attributed to trauma or head

and/or cervical injury (3%). All cases in which there was an association of diagnoses of

headache subtypes were found in patients with migraine (100%).

Conclusion

This study denes the prevalence of headaches in a specialized outpatient clinic, conrming

literature data that show migraine as the most common headache.

Mauro Eduardo Jurno

mejurno@gmail.com

Praça Pres. Antônio Carlos, 8 -

São Sebastiao, Barbacena - MG,

36202-336, mejurno@gmail.

com, (032) 3331-7681 (032)

99983-1266

Edited by:

Marcelo Moraes Valença

Keywords:

Headache

Prevalence

Tertiary care center

Epidemiology

Migraine Disorders

Tension-Type Headache

Received: November 15, 2021

Accepted: November 24, 2021

236

ASAA

Ribeiro EV, Rodrigues GA, Costa JFA, Pereira JR, Assis Júnior MR, Jurno ME

Analysis of the Prevalence of Headaches Subtypes in a Specialized Outpatient Clinic in a Medium-sized Municipality, Minas Gerais, Brazil

Introduction

eadache is an important health problem in Brazil and

worldwide because of its high incidence and prevalence,

its socioeconomic impact, including its signicant costs for

medical services, its social and individual impact with pos-

sible reduction in quality of life and loss of productivity, and

its high potential for chronication.

1-5

It is estimated that 95%

of men and 99% of women will have at least one episode

of headache in their lifetime, of which approximately 40%

will manifest with some regularity.

The causes of headache are diverse, but the so-called

primary headaches are more prevalent, which result from

alterations in the central nervous system, such as tension-

type headache (TTH) and migraine.

Headaches vary

in frequency and intensity and can be as disabling as

depression.

8,9

The high morbidity among sufferers of headaches such as

migraine with or without aura, chronic migraine, and TTH,

who seek routine and emergency medical care, shows the

need for and the importance of epidemiological studies.

According to Rouquayrol e Almeida Filho

epidemiology

plays an important role in improving the health of the

population, since it provides the quantitative basis for the

evaluation of prophylaxis measures and for the consistency

of diagnostic hypothesis and the etiology of the disease.

The International Association of Epidemiology establishes

three main objectives for epidemiology: to describe the

distribution and magnitude of health problems in human

populations; to provide essential data for planning,

implementing, and evaluating disease prevention, control,

and treatment actions, as well as to establish priorities;

and also, to identify etiological factors in the genesis of

diseases.

According to a study that aimed to review previous literature

on headache, the average prevalence of headache in

Brazil is 70.6% (male 61.6% and female 77.8%), of

migraine 15.8% (male 9.0% and female 22.0 %), of TTH

29.5% (male 28.1% and female 30.3%).

Therefore, the

incidence of the diagnostic types of headache in the present

study is discordant compared to the frequency observed

in the community, since the TTH characterizes the most

prevalent headache in the general population, moreover,

in large tertiary centers, a predominance of migraine is

observed.

9,13

This discrepancy is explained in part because

TTH, although common, is less disabling, which decreases

the demand for outpatient medical care,

while in migraine,

a type of headache that can be characterized by strong

intensity and symptoms such as photo and phonophobia,

scotomas, nausea and vomiting; greater demand for care

is required.

Thus, it is important to know the epidemiological prole of

headaches seen in tertiary centers for a better diagnosis and

for an effective treatment in primary and secondary care

levels, aiming at health promotion and better management

of pain. Therefore, this work is a descriptive study aimed at

presenting the prevalence of the main headache disorders

in a tertiary referral center for headache care in a medium-

sized city in Minas Gerais (Barbacena), Brazil.

Methods

A cross-sectional, retrospective, and descriptive study

was conducted to analyze the prevalence of the main

headache disorders in a tertiary referral outpatient clinic

for headache care in the city of Barbacena, a medium-

sized city in the state of Minas Gerais- Brazil, by collecting

data from patients' medical records. The study was

carried out during the period from January 1, 2020, to

February 28, 2021. Patients were previously evaluated by

a neurologist and subsequently referred to the outpatient

clinic. The patients' medical records were included in the

study only after their rst visit to the headache outpatient

clinic.

For the classication of headaches, the criteria established

by the 3rd Edition of the International Classication of

Headache Disorders

(ICHD-III) was used. The medical

records contained the patients’ anamnesis, collected by a

specialist with experience in the treatment of headaches,

ending with a diagnostic hypothesis, which was nally

identied according to the International Headache

Classication (ICHD-III).

Parameters such as gender, age, adherence to treatment,

imaging exams before or after the consultation, and use of

abortive and/or prophylactic medication for the treatment

of headaches were recorded.

Analysis of the results

A descriptive analysis of the variables used in the

study was performed. The data collected through pre-

established criteria for diagnosis of the various subtypes

of headache with the neurologist's examination quantied

the cases, and their data were transcribed to an electronic

spreadsheet and processed in Excel software. For nominal

or categorical variables, frequency distribution tables

237

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Ribeiro EV, Rodrigues GA, Costa JFA, Pereira JR, Assis Júnior MR, Jurno ME

Analysis of the Prevalence of Headaches Subtypes in a Specialized Outpatient Clinic in a Medium-sized Municipality, Minas Gerais, Brazil

were made. For continuous variables, measures of central

tendency and variability were used.

Results

Among the 130 records analyzed, it was observed a

mean patient age of 42.55 years, with a predominance

of females (83%). Among these patients, the request

for imaging exams was made to 29 patients (22%), of

which 20 had already presented previous exams, either

requested in previous visits to the headache clinic or by

other professionals.

Regarding the subtypes of headache, primary headaches

were prevalent, with migraine without aura being the

most common diagnosis (42%), followed by TTH (17%);

migraine with aura (14%); chronic migraine (5%); cluster

headache (1%) and primary shooting headache (1%).

Regarding the other headache subtypes, which totaled

9% of the sample, the results were: 11% of the patients

had the diagnosis of headache attributed to a substance

or its suppression, 3% headache due to cranial neuralgias

and central causes of facial pain, 3% headache attributed

to trauma or head and/or neck injury, 1% headache

attributed to cranial and/or neck vascular disorder and

1% headache attributed to homeostasis disorder.

In addition, there was coexistence of headaches in the same

patient, especially the association of primary headaches,

mainly migraine, with headaches due to analgesic

abuse, totaling 7.6% of patients. Table 1 illustrates the

prevalence of headaches reported in this study. It can be

observed that the prevalence of headaches exceeds the

number of individuals studied, since a patient may present

concomitantly more than one type of headache.

Table 1. Distribution of the number of headache cases, according to

diagnosis (n=130).

Diagnósticos n %

Migraine 85 73

Migraine without aura 49 42

Migraine with aura 17 14

Chronic migraine 6 5

Tension-type headache 21 17

Salva headache 1 1

Cranial neuralgias and central causes of facial pain 4 3

Headache attributed to head and/or neck trauma or injury 3 3

Headache attributed to cranial and/or cervical vascular disorder 1 1

Headache attributed to homeostasis disorder 1 1

Headache attributed to a substance or its suppression 13 11

Primary cluster headache 1 1

It should be noted that adherence to treatment totaled 101

people (86.3%) predominantly females (84.2%). Of the

total number of patients who adhered to the treatment,

75% had migraine headache, and 17% the TTH type.

All cases in which there was an association of headache

subtype diagnoses in patients with migraine (100%), most

of them related to analgesic overuse headache (71.4%)

although it was also associated with: TTH (7.15%),

headache attributed to trauma (7.15%), cluster headache

(7.15%) and primary shooting headache (7.15%). The

associations of these types of diagnoses with migraine can

be seen in Table 2.

Table 2. Distribution of the number of cases with an association between

migraine and other headache diagnoses (n=14).

Diagnoses n %

Headache attributed to a substance or its suppression 10 71,4

Tension-type headache 1 7,15

Salva headache 1 7,15

Headache attributed to trauma or injury to the head and/or neck 1 7,15

Primary shooting headache 1 7,15

Discussion

In 2016, TTH and migraine have reached third and sixth

place, respectively, in the world's most prevalent diseases,

affecting approximately 1.89 billion people and 1.04

billion people, according to the Global Burden of Disease

Study 2016.

In addition, the number of years lived

with disability due to migraine reached second place,

generating approximately 15 years of disability due to

the disease. According to a study published in the Journal

of Headache and Pain, migraine is the leading cause of

disability under age 50.

Epidemiological data highlight the relevance of headache

as a symptom that directly impacts the quality of life

of patients through physical suffering and emotional,

economic, social, and labor losses. Notwithstanding, it is

estimated that only 16% of patients with TTH and 56% of

patients with migraine seek care from general practitioners,

and among these, only 4% and 16%, respectively, seek

consultation with headache specialists.

Estimating that only a small percentage of individuals

with headache seek care from specialized doctors

, it

is expected that the prevalence of headache in primary

care and in the general population is divergent from the

prevalence found in tertiary outpatient clinics. Although

CTT is more prevalent in the general population, migraine

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Ribeiro EV, Rodrigues GA, Costa JFA, Pereira JR, Assis Júnior MR, Jurno ME

Analysis of the Prevalence of Headaches Subtypes in a Specialized Outpatient Clinic in a Medium-sized Municipality, Minas Gerais, Brazil

is the most prevalent type of headache in tertiary outpatient

clinics due to its characteristic of greater severity and

greater impact on the quality of life of patients.

According to a study in a tertiary outpatient clinic in Minas

Gerais, primary headaches were the most prevalent,

with migraine being found in 79.8% of cases and TTH in

20.4%. Among the secondary ones, the most common

type was headache due to excessive use of analgesics

(16.6%), followed by less common cases such as idiopathic

intracranial hypertension. Chronic daily headache (CDH)

was present in 31.8% of the cases.

Our study, conducted in a tertiary headache outpatient

clinic in a medium-sized city in Minas Gerais with 130

patients (108 females and 22 males), showed that within

the headache complaints (90%; 117 individuals), 91%

(106 individuals) were diagnosed with primary headache.

Among the primary headaches, the prevalence of migraine

was 73% (85 individuals), and the prevalence of TTH

among the primary headaches was 17% (21 individuals).

Our results show a very similar prevalence when compared

to the one described in the literature in another tertiary

outpatient clinic in Minas Gerais, with prevalence of

migraine in 79.8% of cases and tension-type headache in

20.4%.

In a Swiss study, migraine prevalence was 47.3%,

although 32.7% of patients had migraine in association

with TTH

, situation found in only 1% (1 individual) of the

patients in our study.

Tension-type headache was the second most frequent cause

of headache in our study, with 17% (21 individuals) of the

primary headache cases in the tertiary outpatient clinic.

A Chinese study showed a 23.7% prevalence of TTH in a

tertiary clinic.

A 2005 study conducted in Switzerland

showed a 20% prevalence of TTH cases in a specialized

headache clinic at a university hospital.

There was coexistence of different headache disorders in

the same patient, especially the association of primary

headache disorders, mainly migraine, with analgesic

abuse headache, totaling 7.6% of patients, a relatively

lower rate when compared to another tertiary outpatient

clinic of Minas Gerais.

The prevalence of primary

shooting headache was 1% (1 patient), differing from

the prevalence found in another tertiary center in Minas

Gerais.

The mean age of the patients in our study was 42.55

years; regarding sex, there was a predominance of

females (83.08%), in agreement with results found in

another tertiary outpatient clinic in Minas Gerais.

A study

conducted in Switzerland showed a mean age of 38.5

years, with a predominance of females (71,8%)

, while

the Chinese study showed a mean age in a tertiary clinic

of 42.8 years and a predominance of females (66,9%).

Our study had very similar results when evaluating the

prevalence of migraine and TTH compared to another

tertiary outpatient clinic in Brazil. Our study was also

very similar to the studies conducted in tertiary outpatient

clinics in Switzerland and China. Considering the impact

of the disease on the lives of patients with headache, it is

necessary that studies such as this one be conducted to

highlight the relevant prevalence of headache subtypes,

demonstrating the importance of diagnosis and the need

for treatment to increase the quality of life and productivity

of patients.

Conclusion

This study denes the prevalence of headaches in a

specialized outpatient clinic, conrming literature data

showing migraine as the most common headache subtype.

Moreover, these data can help in the differential diagnosis

of headache subtypes for the correct and early diagnosis

and, consequently, ensure a good quality of life for those

affected.

Conflict of interest statement: The authors declare that

there are no conicts of interest.

Funding: This work has no funding.

Estephanie Veronese Ribeiro

https://orcid.org/0000-0001-5432-9846

Gustavo Alvarenga Rodrigues

https://orcid.org/0000-0003-4700-2073

José Rafael Araújo e Costa

https://orcid.org/0000-0002-6167-7694

Julia Rodrigues Pereira

https://orcid.org/0000-0002-3863-5023

Marcelo Rodrigues de Assis Júnior

https://orcid.org/0000-0001-7105-0142

Mauro Eduardo Jurno

https://orcid.org/0000-0002-8743-9395

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