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Non-clinical factors associated with headache presentations in patients with psychological co-morbidities: a 7-year retrospective study

Chris O Ifediora


Background: Multiple factors potentially influence doctors’ decisions regarding neuroimaging for headaches in general practice and psycho-morbidities are one of such. Unfortunately, other non-clinical factors at play among psychological patients with headaches are poorly known and the need to identify these factors has become important in view of recent findings on the impact of psychological issues in managing headaches in primary care. The findings from this study are expected to help improve efficiency and confidence in managing headaches in this subset of patients.

Method: This is a 7-year retrospective study exploring headache presentations of patients aged ≥18 in an Australian general practice setting from 1 January 2010 to 1 April 2017.

Results: A total of 517 patients were identified, with an average age of 45.5 +/- 16.2 years (range of 18 to 94 years).  Psycho-morbidities were reported among 190 (36.8%) patients. The female to male ratio was 72% to 28%. Most cases of headaches were among those aged 40 to 59 years (199 or 38.5%), while the least presentations were among the 18 to 24-year-olds (47 or 9.1%). It was found that 40% fewer males had psycho-morbidities relative to females (OR 0.6; CI 0.39 to 0.91; p -0.02), while those aged between 40 and 59 years were more likely to have associated psycho-morbidities compared to other age groups (OR 1.68; CI 1.17 to 2.42; p -0.01).

Conclusion: General Practitioners should properly evaluate the psychosocial issues of all patients presenting with headaches for which neuroimaging is being considered, particularly middle-aged females. This is important given the recent report that neuroimaging for headache presentations among patients with associated psycho-morbidities are ordered more disproportionately and yet were less likely to have findings that can explain the headaches. A larger national or international study may be needed to further explore the identified associations.


Decision-making, general practice, headache, mental health, person-centered healthcare, psychological, psychological co-morbidities, primary care

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