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Topic: Delay in making CH diagnosis (Read 297 times) |
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Bob_Johnson
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Delay in making CH diagnosis
« on: Jul 26th, 2003, 8:56am » |
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This article shows that the problem is not restricted to the U.S. & it suggests why the diagnosis is not always straight forward.
: J Neurol Neurosurg Psychiatry. 2003 Aug;74( :1123-5.
Features involved in the diagnostic delay of cluster headache.
Van Vliet JA, Eekers PJ, Haan J, Ferrari MD.
Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands Department of Neurology, Het Spittaal, Zutphen, Netherlands Department of Neurology, Rijnland Hospital, Leiderdorp, Netherlands.
BACKGROUND: Cluster headache (CH) is a comparatively rare, very severe primary headache. Although circumscript and recognisable criteria are available, the diagnosis is often missed or delayed. Besides, while adequate and evidence based treatment is available in diagnosed cases, CH seems to be poorly managed. The authors performed a nationwide survey among CH patients, and looked for factors involved in the diagnostic delay. METHODS: The authors performed a nationwide mailing to all Dutch general practitioners (about 5800), and neurologists (about 560) and invited them to refer patients in whom the diagnosis CH was made or considered. Patients could also apply via the Dutch Headache Patients Society. A variety of clinical characteristics were assessed by means of questionnaires. Specifically, patients were asked about the time between their first episode and the diagnosis. RESULTS: The IHS criteria for CH were met by 1429 of 2001 responders, and 1163 of these filled in an extended questionnaire. The male to female ratio was 3.7:1. Mean age at onset was 32 (SD 14) years. Seventy three per cent had episodic CH, 21% had chronic CH, and in 6% the periodicity was undetermined. The time between the first episode and the diagnosis ranged from 1 week to 48 years (median 3 years): 34% had consulted a dentist and 33% an ENT specialist before the diagnosis was established. Among factors that increased the diagnostic delay were the presence of photophobia or phonophobia, nausea, an episodic attack pattern and a low age at onset (p<0.01). Sex or presence of restlessness during episodes did not influence the diagnostic delay. CONCLUSION: CH remains unrecognised or misdiagnosed in many cases for many years. Photophobia or phonophobia and nausea were in part responsible for this delay, and should be recognised as part of the clinical spectrum of CH. Many patients were first seen by a dentist or ENT specialist for their CH episodes, so more attention should be paid to educate first line physicians to recognise CH, to improve the diagnostic process and so to expose patients to earlier and better treatment of CH.
PMID: 12876249 [PubMed - in process]
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