Analgesic therapy for headache: consumption, appropriateness and costs

Headache represents not only an individual disease, but also an important pathology for society because its prevalence in the population is about 50.0%. Its physical, emotional, social and economic impacts are often neglected and it is only recently that headache is being considered in a public health perspective, especially its disabling burden, its treatment and its costs. The aim of this work was to investigate the pharmacological treatment of headache and its costs. An anonymous questionnaire on headache was distributed in a waiting room of a general hospital in Rome, Italy. Both patients and visitors were included in the sample with the exclusion of those who had an appointment at Headache Centre of the hospital. The study was conducted on 294 subjects; the mean age was 46.7 years (SD=16.1). The prevalence of headache was 65.6% (95% CI, 60.0%–71.0%). There was no statistically significant difference between patients and visitors, while there was between men and women (53.0% vs. 79.4%; p<0.05). In the age group 30–49 years, the prevalence was significantly higher than in the other age groups (86.0%; p<0.05). Drugs only to treat headache were used by 67.9% of the sample and Aulin was the most used drug, followed by Novalgina and aspirin used, respectively, by 41.6%, 11.0% and 9.7% of the subjects. The economic evaluation of the pharmacological treatment of headache was conducted on the 101 patients (65.6%) who gave complete information on posology. Since the distribution of costs was strongly skewed to the right due to a few expensive treatments, the mean annual pharmaceutical expenditure per patient is not a good indicator, and we also calculated the median and the mode, the maximum and the minimum. Attention was focused also on two subgroups: those who used self-prescription and those who turned to healthcare specialists. The median annual pharmaceutical expenditure per patient was euro 4.30 for the whole group who used drugs and euro 3.93 and 8.51 for the self-prescription and the prescribed by specialist groups, respectively. In conclusion, considering the possible danger which may arise from inappropriate use of drugs and the costs of therapy, our data suggest that consultation with a specialist would be particularly helpful in patients with headache.