Opšta Medicina (Jan 2020)
Approach to a patient with a headache in the general practice setting
Abstract
Introduction: Headaches are defined as the pain localized above the orbital-meatal line. They are often underdiagnosed and undertreated. Objective: We wanted to find out how much general physicians (GPs) know about the diagnostic and treatment approach to headaches, and whether there was a difference in relation to their gender and regional location. Method: At our annual meeting, General medicine days, held in Belgrade, March 30th, 2019, we organized the testing of the participants (GPs) on the subject of Approach to a patient with a headache in the general practice setting. The test had 50 questions with different clinical problems, concerning different types of headaches. It was successfully passed if 60% of the answers were correct. The data were processed with statistical software package SPSS 20. Statistical significance was defined at p<0.05 level. Results: 432 GPs took the test and there were 98.4% of the correct answers. Stratified care approach used 29.5% (p=0.746) of the participants. Antiemetics were advised by 7.2% of GPs. Indomethacin as a diagnostic-therapeutic test was known to 38.4%. Corticosteroid therapy in giant cell arteritis was properly used by 57.7%. The answers to questions concerning vascular headaches got 56.9% of correct answers. Internal carotid artery dissection was correctly diagnosed by 31.7% (p=0.631). To diagnose an intracranial tumor, 40% said they needed MRI. The correct approach to the hypertensive crisis had 87.2%. Bacterial meningitis was correctly recognized by 83.3% of the participants. Headaches due to the use or discontinuation of some substances are successfully diagnosed and treated by 74.2%, and due to some medications 51.9%. There were no significant differences in their answers in relation to gender, but the physicians from Central Serbia gave more correct answers (p=0.005). Conclusion: GPs showed high levels of knowledge concerning diagnosis and treatment of headaches. What is missing is the knowledge on the matter of headaches caused by cranial or cervical vascular events.
