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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR36

Headaches, self-care and health care seeking behaviour: a pilot study

By H. F. Boardman, P. R. Croft* and D. S. Millson

Introduction Headaches are common in the general population. A population survey in Denmark has shown that over 90 per cent of both men and women have had a headache at some time in their lives1 and there is evidence that headaches can have a considerable effect on the lives of sufferers.2 A street survey in Northern Ireland showed that over 90 per cent of the public would self-treat a headache3 and a study of patient records in a general practice found that 17 per cent of patients had consulted for headache in the previous five years.4 However, headache sufferers' use of medication and advice seeking from other primary health care professionals are largely unknown.
The aim of the study is to measure the prevalence of headache in primary care and its effect on the lives of sufferers as well as to investigate health care utilisation for headache. This paper describes results from the pilot study.

Method A questionnaire was developed based on literature sources, advice from physicians and researchers and recognised standard questionnaires. This instrument covered headache experiences, impact of headache, and self-care and healthcare-seeking behaviour for headache in primary care. The questionnaire was mailed to a random sample of 200 patients aged 18 and over registered with one GP practice. A repeat mailing was sent to non-responders after two weeks. Data from returned questionnaires was entered into an Access database and exported to SPSS for analysis. Validation studies were completed in two separate samples of headache patients, and repeatability after one month was tested in a sub-sample of the survey respondents.

Focal points

  • A pilot questionnaire was used to investigate headache experiences, impact and management in primary care
  • Lifetime prevalence of headache was 97.5 per cent and three month prevalence was 81.1 per cent
  • More than two-thirds had taken medication for headache in the past three months
  • Over 40 per cent had asked a health care professional for advice about headache
  • Consultations with a general practitioner were consistent with other UK findings; however, only a small minority had consulted a pharmacist about headache

Results Completed questionnaires were returned by 122 patients, of whom 78 (63.9 per cent) were women and 44 (36.0 per cent) men - a response of 61 per cent. One-hundred-and-nineteen (97.5 per cent) respondents reported having had a headache ever and 99 (81.1 per cent) reported having a headache in the previous three months (74 per cent for men and 88 per cent for women). Just over half (52.4 per cent) of the respondents reported having more than one headache a month and 28 (23.0 per cent) had experienced headaches at least weekly in the previous three months.
Headaches were reported to affect at least some of the work, home and social lives of 42 (34.4 per cent) respondents. Twenty-two (18.0 per cent) respondents reported work effects with missed or reduced ability days, 34 (27.9 per cent) reported home effects with household work missed or reduced ability days, and 14 (11.5 per cent) had missed social activities due to headache.
Eighty-five (69.7 per cent) of respondents had taken medication for headache in the previous three months. Of those who took medication, 56 (66 per cent) bought the medication in a pharmacy, 17 (20 per cent) used prescribed medication and 29 (34 per cent) took medication bought elsewhere (mostly from supermarkets). Paracetamol was the most widely used medicine followed by ibuprofen and aspirin.
A total of 52 (42.6 per cent) respondents reported ever asking a health care professional for advice about their headaches. Twenty-eight (23.0 per cent) had asked their family doctor, eight (6.6 per cent) in the past three months. Eight (6.6 per cent) had asked a pharmacist, one in the previous three months.

Discussion The headache prevalences both for lifetime and three months were slightly higher than expected from the literature.5 Response bias may have overestimated the prevalence, if headache sufferers were more likely to complete the questionnaire. Given the lower response in males the estimates for men might be less representative than for women - this will be addressed in the main study. Consultations with a general practitioner for headache were consistent with a recent UK study.4
The main study will confirm whether the prevalences reported here are typical of the wider population as well as measuring the impact of headache. The pilot study has given some insight into advice seeking behaviour for headache from health care professionals for a condition that for most is a minor self-limiting one. Only a small minority had consulted a pharmacist about this problem, even though it represents an ideal condition for such advice. The next stage to 5,000 adults will further enlighten us.

Department of medicines management, Keele University; *Primary care sciences research centre, Keele University

References

1. Rasmussen BK. Epidemiology of headache. Cephalalgia 1995;15:45-68.
2. Edmeads J, Findlay H, Tugwell P, Pryse-Phillips W, Nelson RF, Murray TJ. Impact of migraine and tension-type headache on life-style, consulting behaviour, and medication use: a Canadian population survey. Can J Neuro Sci 1993;20:131-137.
3. McElnay JC, Nicholl AJ, Grainger-Rousseau T-J. The role of the community pharmacist: a survey of public opinion in Northern Ireland. Int J Pharm Pract 1993;2:95-100.
4. Laughey WF, Holmes WF, MacGregor AE, Sawyer JPC. Headache consultation and referral patterns in one UK general practice. Cephalalgia 1999;19:328-9.
5. Waters WE. The Pontypridd headache survey. Headache 1974;14:81-9.