Posted by Bob Johnson (184.108.40.206) on September 14, 2001 at 11:18:34:
Over the years, we have read too many messages about encounters with physicians who do not understand how to diagnose and treat headache conditions. In this article we have some evidence of how often these problems occur. While the focus of the article is migraine, we know that the much less frequent occurrence of Cluster implies that it will be poorly diagnosed and treated at an even higher rate.
Regularly, we see messages encouraging folks to print out medical information (found under buttons on the left of the page), taking it to the physician. I suggest that this is only half of the needed response: the other half is for every cluster sufferer to have a working knowledge of the disorder. Without this working knowledge it's very hard to know whether we are being well diagnosed and effectively treated. And since there is a ample variety of material from which to learn about Cluster there is hardly any reason for not knowing enough to be able to negotiate good treatment with your doc.
"Cluster Resources", last posted on 8/4/01, is now in its 13th edition. The section on articles from medical journals and the section on books lists some of the best single source materials to learn about cluster. Bottom line: the best way to avoid being victimized by poor medical care is to know about your condition.
Title: Migraines Go Undiagnosed, Untreated in Emergency
Archives of Internal Medicine, 2001; 161: 1969-1973. "Headache Evaluation and Treatment by Primary Care Physicians in an Emergency Department in the Era of Triptans"
09/11/2001 07:56:56 AM
By Elda Hauschildt
Migraines are under-diagnosed and under-treated in emergency departments.
"Many patients with migraine, chronic daily headache or medication overuse are not accurately diagnosed," says Dr. Morris Maizels of the department of family medicine at Kaiser Permanente in Woodland Hills, California. "Need for prophylaxis is not usually assessed."
He notes that treatment is migraine-specific in the minority of patients seen. "Tension-type headache is rarely an accurate diagnosis in this emergency department population."
Dr. Maizels says evaluation of emergency department patients with headache suggests that most diagnosed as having migraine have transformed migraine. He adds that medication overuse is common in emergency department patients with headache. "Most emergency department patients with headache are not undergoing prophylaxis, even those who experience daily headache or who consume analgesic agents daily," he points out.
Dr. Maizels documented 518 headache patients who made 1,004 visits to one emergency department over six months. A total of 464 patients (90 percent) made one or two visits, with a total of 502 visits.
He reviewed 174 charts in which doctors had diagnosed migraine. He found that the need for prophylaxis was determined in only 40 (31 percent) of patients who were not already undergoing prophylaxis.
"Treatment in the emergency department was migraine-specific in 46 patients (26 percent) or otherwise appropriate in 45 (25 percent)," Dr. Maizels reports.
In reviewing 90 charts with non-migraine diagnoses, he also found that only 30 (33 percent) included adequate history documentation to exclude migraine. "That this is not just a documentation failure is confirmed by patients who returned headache surveys," Dr. Maizels says. He notes that 24 of 27 patients (89 percent) not diagnosed with migraine were found to have either migraine or transformed migraine, with or without medication overuse.
Dr. Maizels: "Many cases of chronic daily headache occur in patients with a history of episodic migraine that has evolved into daily headache, so-called transformed migraine.
"It seems than that many doctors are not familiar with the diagnostic criteria for migraine published by the International Headache Society or the importance of recognizing transformed migraine and medication overuse."
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