Expectations of patients attending a combined headache clinic

We audited the expectations of patients referred to a combined headache clinic from a specialist headache clinic and a pain relief unit due to the intractable nature of their headache. Our aim was to assess the expectations of definitive diagnosis for the cause of headache, as well as the acceptance of its symptomatic management. We reviewed the notes of all patients referred to the combined clinic over a 2-year period from January 1998 to January 2000. It has been standard practice in the clinic to document patients’ expectations of definitive diagnosis for the cause of their headache and for its symptomatic treatment. Fifty-two patients (29 women, 23 men; mean age, 40.5 years; range, 15–76 years) were referred to the combined clinic over the two years. These patients had been selected from a total of 460 new patients seen in the specialist headache clinic over this period. All patients had been reviewed by at least one consultant neurologist. Nearly all suffered chronic daily headache of mean duration 8.25 years (range, 1–40 years). Only three patients suffered from migraine as well. Forty patients (77%) were still concerned about the cause of their headaches; 13 (33%) of these wanted further investigations. Fourteen (27%) of the original 52 patients were discharged from the clinic, 9 (17%) were satisfied and accepted symptomatic management of their headache, 5 patients (10%) were unsatisfied and were still looking for a cause for their pain. Five more patients (10%) who demanded further investigations failed to keep follow-up appointments. The remaining 33 patients (64%) accepted symptomatic management within the clinic. One in five patients (20%) attending a tertiary referral clinic for symptomatic treatment of chronic headache did not want symptomatic treatment. They wanted to know the cause of the headache and be provided with a cure. This observation is important when one is assessing outcome measures, because 20% of these patients did not want symptomatic management, the only treatment on offer.