(206) IHS Headache Diagnostic Patterns in Pain Facility Patients

Objective: To characterize pain facility headaches according to IHS diagnostic criteria. Design: Pain facility consecutive admissions complaining of headache completed a questionnaire reflecting IHS criteria, a physical and neurological examination, and headache interview. IHS diagnoses were arrived at utilizing questionnaire data. As many IHS diagnoses as possible were assigned. Statistical analysis included a frequency distribution for headache precipitants; and neck associated symptoms were evaluated by discriminant analysis to determine their diagnostic value in relationship to each IHS diagnostic group. Setting: Pain facility. Patients: Patients with chronic pain. Results: Of 1466 PWCP, 154 or 10.5% had headache interfering with function. Of these, 55.8% related their headaches to an injury and 83.7% had neck pain. Migraine headache was most common (90.3%) with cervicogenic being second (33.8%). Of total group, 44.2% had more than one headache diagnosis. Cervicogenic patients had the greatest percentage of overlap (94.2%) with migraine being second (68.3%). The most frequent headache precipitants were mental stress, neck positions and activity/exercise. The migraine and cervicogenic headache groups had a statistically significant greater number of neck associated symptoms. Of the total group, 74.6% had a neck tender point. Cervicogenic, migraine and tension PWCP had the greatest frequency of head or neck tender points. The discriminant analysis found the following symptoms as the most common predictors of headache: clues to onset severe headache begins at the neck or tender point and numbness in arms and legs; headache brought on by, neck positions and arms overhead; and neck symptoms, have a tender point in neck and feel severe headache in neck. Conclusions: Headache is a frequent comorbid condition in PWCP. These headaches are mostly migraines. More precise diagnostic criteria are required to separate cervicogenic from migraine headache. Neck associated symptoms are important to migraine PWCP. This issue may need to be addressed in future IHS criteria.