Study Population
fits, headaches, ICHD-3, headache, migraine, type headache
TENSION-TYPE HEADACHES, SECONDARY, CHRONIC HEADACHES, MIGRAINE, CLUSTER HEADACHES
We primarily recruited from general practices, but people could self-refer. Participating general practices ran computer searches to identify people who had, in the previous 2 years, consulted with headaches or who had been given a prescription for a migraine-specific drug (triptans/pizotifen). After screening for those whom it would be inappropriate to approach, practices sent letters, with 1 reminder, inviting people to find out more about the trial. The study team contacted interested responders by phone to confirm eligibility and posted baseline questionnaires, paper or electronic headache diary instructions, and consent forms. When these were returned, we arranged a headache classification telephone interview with a research nurse. To exclude people with ineligible headache types requiring specific treatment, for example, cluster headaches, and to describe our study population, we used a previously validated headache classification interview.Our population of interest were adults meeting an epidemiologic definition of chronic headaches (≥15 headache days per month for at least 3 months) with migraine or tension-type headaches. For reporting, we identified 3 phenotypes, people with:
ICHD-3 criteria for chronic migraine; that is, at least 8 days per month with a migraine attack with or without aura,less than 8 migraine attacks per month, or any number of attacks meeting ICHD-3 criteria for episodic migraine and chronic tension–type headache, andchronic tension–type headache.The target population for this trial was people managed in primary care, many of whom do not have a formal headache diagnosis. Diagnostic advice was part of the intervention. This fits the point in the care pathway at which this intervention would be delivered. In this study, we report on these groups together reflecting the information needed by those who might want to commission this service in primary care. We excluded those unable to attend the group self-management sessions, without access to a telephone, not fluent in English, or unable to participate in the group intervention for health reasons.Our original objective was to test the effectiveness of an education and self-management support program for people meeting the epidemiologic definition of chronic headaches, with its effect on people with chronic migraine and those with chronic tension–type headache and episodic migraine as a secondary analysis. However, our feasibility study found that 95% of those recruited had either episodic or chronic migraine.