Headache was the main cause of referrals for neurological care. With regard to age, headache and epilepsy were the most frequent among young adults and Alzheimer's disease and Parkinson's disease affected more the elderly.
These results come at little surprise, since findings are supported by the literature which suggests that headache responds for around one third of referrals to neurological care.(3) The relative frequency of referrals due to headaches is particularly expressive when contrasted to other reasons. For instance, epilepsy responded to less than half of the headache referrals. Parkinson's disease responded by only 3.7%.
The expressive frequency of referrals due to headaches has several potential explanations. First, the prevalence of headaches in the population is far higher than the prevalence of other neurological disorders. However, since headaches are diagnosed based on clinical grounds and are benign in most cases, this fact alone unlikely explains the high proportion of referrals. According to Galdino et al.,(14) the lack of dissemination of diagnostic criteria for headaches among primary care doctors is associated with reduced comfort in assigning headache diagnoses and may explain the referrals.(15) Indeed, according to Vincent and Carvalho,(16) only 44.9% of the migraine cases seen by primary care doctor in Brazil received a proper diagnosis.
Our study has clear limitations. The most important is the lack of specific headache diagnoses, since we relied on information obtained from the referral letters. Second, our data may not be generalizable to other regions. We aim to repeat this study after these educational initiatives are conducted, in order to test the hypothesis that referral rates will be reduced.
Accordingly, we demonstrated that high proportion referrals to neurological cares are due to headaches in the PHS. This may reflects the high prevalence of headaches in the population, but also the ineffectiveness of the primary care system in dealing with headaches. Educational initiatives are to be created and tested in order to change this paradigm.
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8.Carvalho BG, Souza RKT, Soares DA, Yagi MCN. Diseases of the circulatory system before and after the Family Health Program, Londrina, Paraná. Arq Bras Cardiol. 2009;93(6):597-601, 64550. [Article in English, Portuguese].
Headache Medicine, v.2, n.4, p.200-3, Oct/ Nov/Dec. 2011