Standard of Care For Headache Diagnosis and Treatment

Established by the National Headache Foundation and Updated for 2005

With 45 million headache sufferers in the United States and many individual circumstances to consider relative to the diagnosis and treatment of headache, the National Headache Foundation (NHF) believes that it is critical for healthcare providers to have specific guidelines for working with headache and migraine sufferers. It is for this reason that the NHF originally published its Standards of Care in 1996, and then updated it in 1999, 2001 and 2005, with the current version incorporating guidelines from the US Headache Consortium.

According to Dr. Roger Cady, who co-authored the current Standards of Care, “Since the last update in 2001, many advancements have been made in the diagnosis and treatment of headache, and by providing the current Standards of Care, we allow headache sufferers to benefit from the most up-to-date guidelines.”

 

Why are standards of care guidelines necessary in the treatment of headache?

Headache is one of the most frequent disorders encountered by healthcare providers in the outpatient setting. More than 45 million Americans from all walks of life experience recurrent headache, with reports indicating that this figure may be rising. This includes 28 million migraine sufferers.

The results of quality of life studies have shown that chronic headache disorders cause significantly more morbidity and functional impairment than has been previously appreciated. In fact, the level of impairment, as measured using standardized quality of life instruments, is comparable to that of patients with congestive heart failure or recent myocardial infarction. Other impact measures of migraine such as the Migraine Disability Assessment Scale (MIDAS) and the Headache Impact Tool have assessed disability in the form of absenteeism and decreased productivity in work, school, home, and leisure activities.

What is the cost of failing to successfully treat this large and diverse sector of the population?

The estimates of decreased productivity are staggering, as are the number of days, weeks, or even months lost from work each year. For migraine sufferers, disability is believed to cost employers more than $17 billion annually and they lose 157 million workdays each year. American business loses an estimated $50 billion per year to absenteeism and the payment of medical benefits attributable to headache. Billions more are spent on physician appointments, emergency room visits, laboratory and radiographic studies, and prescription drugs, over-the-counter medications, herbs, and nutritional supplements.

What can healthcare providers do to improve the quality of life for headache sufferers?

Today, with a greater understanding of the causes and consequences of headache, as well as more treatment options than ever before, it is possible to control headache symptoms in the majority of patients. The guidelines that are included in the NHF’s Standards of Care will assist practitioners in making decisions that restore patients’ functional status.

These guidelines will help physicians and other healthcare professionals to:

• Rule out secondary headache and establish a primary headache diagnosis

• Set reasonable goals with each patient, identifying expectations and individual needs by tailoring the educational component to the patient’s level of active participation and desire

• Design a treatment plan, combining non-pharmacologic with pharmacologic approaches as necessary to:

1. Minimize symptomatology

2. Reduce disability

3.Improve quality of life

• Provide follow-up care for long-term headache management to:

1. Reassess how well the treatment plan is achieving established goals

2. Reevaluate patient needs and specific headache patterns

• Recognize indications for appropriate and timely referrals to specialists.