Prescription practices and reasons for referral to tertiary care among patients with headache in India.

OBJECTIVE

To evaluate prescription patterns, referral reasons, patient profiles, diagnostic accuracy, treatment adequacy, and satisfaction in headache patients referred to tertiary care centre.

METHODS

A prospective observational hospital-based study was conducted from March 2019 to May 2023. A detailed clinician-administered questionnaire assessed headache characteristics, medication adherence, depression, and anxiety. Referral slips and previous medical records were reviewed. All patients were clinically assessed by two neurologists, provided appropriate treatment, and followed up after 8 weeks.

RESULTS

A total of 274 referred patients were included (mean age 32.1 ± 7.8 years; 74.8% female). Treatment non-response (67.9%) was the most common cause of referral. Analgesic was prescribed in 82.8% of patients and migraine prophylactics were used in 27.4%. Primary care physicians showed low discernment for diagnosis of migraines and classification-based headache subtypes. Triptan and beta-blocker use was uncommon. 8 Follow up showed significant reduction in severity and impact of headache and improved medication adherence.

CONCLUSION

Primary care management of headache showed overuse of analgesics and less discernment for ICHD-3 based classification. Referred patients were mostly chronic daily headache patients with significant pill burden and other neuropsychiatric comorbidities.