Headache and migraine in primary care

Family doctors are almost twice as likely to prescribe drugs to middle aged women with headache as they are to men of the same age, reveals research in the Journal of Neurology Neurosurgery and Psychiatry.

Headache ranks among the top 10 reasons for consulting a family doctor and is the most common neurological symptom seen by family doctors and neurologists. It also accounts for around 20 per cent of sick leave.

The findings are based on nine years of consultations and referrals up to the year 2000 at 253 general practices across the UK.

In all, there were 570,795 consultations for headache made by 413,221 patients during the nine years of the study.

Women were three times as likely to see their family doctor about headache symptoms as men. Their consultation rate was 6.4 out of every 100 per year compared with 2.5 for men.

The peak period for consultations for both sexes was between the ages of 15 and 24, with women again roughly three times as likely to consult for headache as men.

There were 15.8 consultations for headache out of every 100 women registered with the practices compared with 5.8 in every 100 for men.

Drugs for migraine were prescribed to around one in three women and to one in four men.

But middle aged women were significantly more likely to be given headache medicine than any other female age group or middle aged men. In men the prescribing pattern varied little with age.

In all, 6% of patients with headache were referred to a specialist, but these referrals were more likely among men.

Over half of these referrals were to neurologists, but the authors note that the proportion of neurologists in the UK is around one tenth of that in other developed countries.