Demographic and clinical profile of headache in a low income population at headache center in Bogotá -Colombia Marta Liliana Ramos Romero Neurologist athospital Occidente de Kennedy University of La Sabana Colombian Neurology Association Conflicts of interest statements *Marta Ramos a,b, Stephania Bohórquez a, Julia Cuenca a, Luisa Echavarria a, Fidel Ernesto Sobrino Mejía a, b a University of La Sabana, School of Medicine, Postgraduate program in Neurology, Bogotá-Colombia b Hospital Occidente de Kennedy, Bogotá-Colombia, Neurology department No conflict of interests Introduction Headache is prevalent 47 / 1.000 Social and economic impact $14.4 billions in te US Indiret Costs: Work absenteeism, etc 90% At the Hospital Occidente de Kennedy : 3.2 patients/ day with headache Jensen R Lancet neurol 2008 Stovner Lj Cephalalgia 2007 Headache is a common complaint of patients presenting to external consultation Very few studies describe the demographic and clinical profile of headache in low-income populations 1
Introduction http://www.bogota.gov.co/localidades/kennedy Kennedy Introduction Kennedy, or Ciudad Kennedy, is the eighth locality of Bogotá Itislocatedinthesouthwestofthe cityandisthemostpopulousofall localities beinghometo14% of the city's residents. Unemployment rate : 16,3% Poverty: 53% Methods: Aim To describe social and clinical profile of headache in a low income population at headache center in Bogota-Colombia 2
Methods We conducted an observational, descriptive, and cross-sectional study Population : Patients attending external consultation at the Headache center in Hospital Occidente de Kennedy Bogotá- Colombia from June to December of 2016 The data were prospectively registered Methods Diagnosis of headache was made according to the International classification of headache disorders, 3rd edition(ichd-iii) Data were analyzed using descriptive epidemiology tools SPSS V 21 Results 3
Results: Demographic profile A total of 277 patients were evaluated Female 83% Middle age was 50.4 (±13.9) Results: Demographic profile Marital status Single Married Widower Separated Results: Demographic Educational stage 29,6% did not have any type of education Percentage 44.8 29.6 21.3 Elementary school None Secondary school Higher education Series1 44.8 29.6 21.3 4.4 4.4 4
Results: Demographic profile Subsidized : 99,3% Contributory : 0,7% Population without employment, work contract or economic income Considered poor and vulnerable Who does not have payment capacity that allows him to contribute to the system (income less than two current legal minimum wages) The System for the Selection of Beneficiaries for Social Programs (El Sistema de Seleccion de Beneficiarios para Programas Sociales- SISBÉN) - It is the national system of identification of beneficiaries for social subsidy - Classifies the people according to their socio-economic level Results: Demographic profile Socio-economic level 9,7% are special populations victims of armed conflict and forced displacement 87% belongs to risk social population 5
The mean time of pain prior to fist consult in our center was 13.25 years Chronic daily headache Headache duration Yes > 4 hrs < 4 hrs Features Type of pain n (%) Pressing Pulsating Stabbing Others Pain localization n(%) Hemicranea Occipital Frontal Temporal Parietal Others Value 151 (54,5%) 53 (19,6%) 35 (12,9%) 32 (11,6%) 120 (43,3%) 42 (15,2%) 33 (11,9%) 20 (7,2%) 22 (7,9%) 34 (12,2%) Unilateral n(%) 156 (56,3%) Pain intensity Intensity 6
Associatedsymptoms Valuen% Photophobia 180 (65%) Phonophobia 175 (63.2%) Nausea 165 (59,6%) Osmophobia 136 (49,1%) Allodynia 82 (29,6%) Vertigo 57 (20,6%) Sleep Alteración complaints del sueño Snoring RONCADOR No 47,9% Yes 52,1 % No 66,4% Yes 33,6 % MEDICATION OVERUSE Analgesic Simple Analgesic % n 54.7% (52) -Acetaminophen -Acetylsalicylic -NSAID 34.7% (33) 0 % (0) 20% (19) Combination 35.9% (34) Opioids 6.3% (6) Ergotamine 3.1% (3) Triptans 0 (0%) 7
Painful cranial neuropathies Not classified Primary Secondary Primary headache Chronic migraine Tensiontype hedache Trigeminal Other autonomic primary cephalalgia hedache 8
The demographic and social profile in our headache center is characterized by single women, at social risk and poor education level Almost 10% are special populations victims of armed conflict and forced displacement 87% belongs to risk social population More than a half of patients have sleep complaints (difficulties in getting to sleep or staying asleep) and snoring (33,6%), supporting the relationship between headache and sleep disorders 1. Queiroz LP. Et al.headache 2015 Medication overuse was found in 36.6% of the patients (mostly simple and combination analgesic), much more than is described in literature(1,2) This significant prevalence of medical overuse could be related with free analgesic sale in our country 1.Cha Mj, J Clin Neurol. 2016 Jul;12(3):316-22 2. Alvarez M. Et al. Acta Neurol Colomb Vol 26 N 4. Dic 2010 9
57,5% meet the criteria to Chronic daily headache being chronic migraine (41%) the main diagnosis. This is a high percentage compared with populations like Brazil( 6,1% CDH)1. About patients with Chronic migraine, we did not find differences in prevalence of chronic migraine between no educated and educated population because of the higher proportion of patients with low educational status( p 0.17) 1. Queiroz LP. Et al.headache 2015 Additional Analysis In patients with chronic migraine the statistic significant variables were: Osmophobia (70%), medication overuse (51,4%), allodynia (47,7%), aura (46.4%), emesis (31.8%), depression (28,8%) and vertigo (28,4%) ( p< 0,05) 1. Queiroz LP. Et al.headache 2015 Conclusion The social profile of the patients evaluated in this study shows a special group of vulnerable population, and at social risk and poor education level The clinical profile of the patients includes high percentage of Chronic daily headache, medication overuse and sleep complaints 10
Conclusion The elevated mean time prior neurological evaluation and significant prevalence of medical overuse could be related with the social features and health care barriers in the analyzed population. Limitations This study can not be extrapolated to the general population Thank you 11