One of the commonest symptoms that the clinicians encounter regularly in general OPD and Neurology is “Headache”. In most cases headache is Primary symptom and a non fatal disorder,many a times it can be a secondary symptom of an underlying cause like intracranial neoplasms, epileptic seizures and intracranial infections. Migraine and tension type headache is the second leading cause of disability world wide(Ref:The Global Burden of Disease Study 2017). Though it is a very common disorder, there are no organized services for its cure.
It is being treated under general health care system which does not have a structured treatment procedure for headaches. Headache simply requires trained personnel who give appropriate medication and counsel the patients rather than the use of any sophisticated devices for diagnosis and treatment as it is for other neurological disorders. Structured headache services, especially in the primary care, along with educational initiatives are most efficient, equitable and cost effective solution. This places the responsibility of managing headache in the majority of affected people , upon the healthcare providers, who presebtly lack special expertise in headache management.
Along with this, medical management of headache disorders requires only diagnostic and management skills that are usually available to all physicians and other heath care providers in primary care. Through out the world, there may be limited training in the application of these basic skills to headache diagnosis and treatment among the practitioners.
Readiness is the state of preparedness of persons, systems, or organizations to meet a situation and carry out a planned sequence of actions.
Readiness is based on the planning, adequacy and training of the personnel, and supply and reserve of support services or systems. A readiness assessment identifies the potential challenges that might arise when implementing new procedures, structures, and processes within a current organizational context. Furthermore, through the identification of the gaps within the existing organization, the readiness assessment affords the opportunity to remedy these gaps either before, or as part of, the implementation plan.
Of all GBD causes of disease, tension-type headache was the third most prevalent, and migraine the sixth. In terms of years of life lived with disability, migraine ranked second globally, and was among the ten most disabling disorders in each of the 21 GBD regions. Particularly burdensome among young and middle-aged women. Headache showed no clear relation to sociodemographic development, as measured by the Socio-demographic Index. No risk factors have yet been established in the GBD studies for headache disorders. Thus, primary headache disorders are an important health priority.
· In GBD 2000, migraine was included as the only headache subtype. Since then, TTH was added to the GBD study, and some of the limitations in the previous estimates were addressed by using more comprehensive and reliable epidemiologic data based on population-based surveys from countries without previous available data. Estimating the burden of headache is the first step to implement further measures to reduce its burden such as educating health care providers, developing primary care management, and allocating resources.Effective strategies to modify the course of headaches and alleviate pain exist, but many people affected by headache are not benefiting from this knowledge
The International Classification of Headache Disorders (ICHD) is a detailed hierarchical classification of all headache-
Some primary headaches can be triggered by lifestyle factors, including:
Complete History and Examination
Assess Headache and Signs and Symptoms and look for atypical features Yes
Screen for Red Flags SNOOP Evaluate for Secondary
If headache frequency and severity are progressing, watch for and warn No Headache against risk for chronic migraine
Identify primary headache syndrome Assess for Acute medication overuse
Episodic headache of Chronic headache of long duration long duration
Frequency < 15 days/month Frequency > 15 days/month
Lasting >4 hours lasting > 4 hours
Migraine Chronic migraine
Migrainous Chronic tension type
Tension Type NDPH
Primary headache do not require sophisticated devices for diagnosis.it simply require fully trained personnel who can give proper medication and counsel the patients.
Headache disorders, especially migraine and tension-type headache (TTH), are collectively cause substantial levels of public ill health and disability. Yet, throughout the world, they are under-recognized . This misperception is not easily explained, but it is now slowly changing. On the initiative of LTB and the Global Campaign against Headache , new studies are filling the gaps in our knowledge of the burdens attributable to headache disorders , which had embraced half the world These studies confirm, in all regions of the world, that these burdens weigh heavily not only on people with headache but also on their families, friends, work colleagues and, ultimately, society itself. The Atlas of Headache Disorders published by the World Health Organization (WHO) in collaboration with LTB, although not a population-based survey, collates corroborative evidence on the impact of headache from over 100 countries .
The recognizable consequences not only of public ill health but also of high socioeconomic cost . coupled with the large numbers of people affected by headache disorders, give rise to the need for organized, structured and adequately-resourced health services to alleviate them . Effective and cost-effective treatments exist for most people with headache ; however, they often fail to reach those who need them . Delivering these treatments is, from any sensible perspective, a public-health priority . The indirect costs of headache, arising mostly from lost productivity secondary to disability, vastly outweigh direct treatment costs ; consequently, from a societal perspective, headache-untreated costs a great deal more than headache-treated . Even if importance is not attached to the individual burdens attributable to headache , society should wish to mitigate the huge financial burden upon itself which headache imposes
Assessing readiness for headache services in district of Kolar.
Study area /Setting: : the present study will conduct in district of Kolar, which is located 70km away from Bangalore. The Centre for Public Health NIMHANS has established a public health observatory in Kolar to strengthen public health aspect for control of Non Communicable diseases, mental health and neurological disorders.
Diagnosis and Treatment PHC Medical Officer
Study participants: Health personnel with in administrative limits of Kolar district
Simple Random Sampling
10% of all stratified staff in each PHC are selected
Section B: Readiness of the system with respect to planning, training, personnel and support services including availability of drugs in district of kolar:
Section C: Knowledge, Attitude and Practice of health personnel regarding management of primary headaches assessed by case vignettes:
Method of collection of data: Permission shall be taken from District Health Office. After prior appointment , informed consent shall be taken from health personnel and the questionnaire will be administered either individually or in groups
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