Società Italiana per lo Studio delle Cefalee


Società Italiana per lo Studio delle Cefalee

When it comes to headaches

Maria Adele Giamberardino - SISC General Secretary

  • 8th National Headache Day 2016

"Headache" is one of the most frequent and disabling medical conditions. It is estimated that almost half of the population has had at least one episode of headache within the previous year and, taken together, the various forms of headache – that is, migraine, tension-type headache, cluster headache, or other primitive forms - are among the top ten causes of disability in the world and the top five in women. Migraine in particular represents the third morbid condition in terms of prevalence and the seventh leading cause of disability. Nearly 5% of the population also suffers from chronic forms, that is, headache for 15 or more days per month. Not to mention headache from drug abuse, linked to an excessive, frequent consumption of symptomatic drugs for the attack, present in approximately 50% of patients with chronic forms, but which can potentially develop in any patient with headache. Personal and social burdens of headache are very high, with reduced quality of life and high financial costs. Migraine, for example, determines the loss of approximately 400,000 work or school days per year per million population in developed countries, to which must be added the costs related to the use of drugs and healthcare in general.

In spite of the great epidemiological and social impact of headache, the percentage of patients receiving diagnosis and appropriate care remains a minority today. In fact, many surveys reveal that about 50% of headache sufferers do not seek medical care for their condition, and even those that do so, a third of these patients do not return at follow-up.

The reasons for this attitude are probably many, but there is no doubt that the lack of adequate information plays a crucial role. Many stereotypes still persist when talking about headaches. One of the most common among patients and the general population is that of a "normal headache", or the belief that some headaches, for example, concomitantly with the menstrual cycle, or under stress, are physiological, and do not require special attention or care, apart from use of any analgesic when needed. After all, our mother, grandmother or aunt …., also suffered from it. A dangerous cliché, at the origin of a "do-it-yourself" attitude that often leads to the exponential increase in the use of symptomatic medication, leading up to chronification and abuse. One requests a medical examination - specialist or not - only when the headache has become an almost daily companion, very unpleasant, and very difficult to eliminate. Having a headache, even occasionally, is not however "normal", and if there is pain, it should be investigated and treated. Another common limiting belief is that "protracted" treatments are to be avoided. Preventive treatment medication prescribed by the physician, if not properly explained, is often experienced negatively by the headache patient: why take medication continuously for months, even when the headache is not present? The most frequent request made by patients to doctors is generally for "the most effective analgesic" when there is pain, but rarely for a basic treatment that has the purpose of reducing the frequency and intensity of the crisis. This should be adequately explained at the first visit, that taking medication constantly for some time may be the best way to reduce drug intake for pain, and preventing abuse.

At the other end of the spectrum, among some patients, is the cliché that headache is always an indication of "something bad". A belief that can push to endless, expensive, often unnecessary or even harmful sequence of investigations, consultations and examinations of all kinds, sometimes without any specific and targeted indication. Above all, it is a belief that can make one live in a constant state of anxiety and tension, perpetuating in a vicious circle the conditions which are triggering the attacks. Instrumental examinations, which are correct and imperative to carry out when there are specific warning signs that only the physician can evaluate, are not in fact indicated as routine exams in all headache sufferers, most of which have "primitive" forms where there are no underlying diseases to discover, and pain represents the totality of the clinical picture.

Once again, the root shared by these and other stereotypes, and inappropriate attitudes regarding headache, is the lack of adequate knowledge about the characteristics of the health condition, the real risks involved, the resources available for a correct diagnosis and the right therapeutic programme. The "headache day" was developed to address the need to fill this gap; to talk about and with patients and professionals, compare experiences, inform and be informed. Diversified initiatives carried out contemporary across the country have the same goal: "awakening" awareness on the importance of this condition and its treatment, so that, the approach to the headache problem is attentive and timely, but also balanced and prudent, avoiding the "do-it-yourself" attitude, but at the same time encouraging an informed self-management after a correct diagnostic and therapeutic assessment by physicians. Because headache is neither a normal situation, nor a condemnation, but only a treatable condition to cure.

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Registro Persone Giuridiche - Prefettura di Firenze - n. 534/2011
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