• T Weinschütz, H Engel, U Niederberger, and D Soyka.
• Abteilung Neurologie, der Christian-Albrechts-Universität Kiel, Niemannsweg 147, W-2300, Kiel, Bundesrepublik Deutschland.
• Schmerz. 1991 Dec 1;5(4):226-32.

AbstractThe chronic headache patients in our neurological outpatient department treated between 1985 and 1987 were retrospectively studied. One-third (n=44) were examined and questioned about the efficacy of treatment. Initial treatment in the outpatient department had been at least 2 years before the study, thus allowing evaluation of the long-term course of the illness. Age distribution, sex ratio, distance to the therapy center, duration of illness, and the extent and results of the diagnosis are reported. The most common form apart from migraine and tension headache was drug-induced headache. The range of medical and non-medical therapy applied is presented. The therapeutic response (free of pain/distinct improvement) was 43.2% directly following therapy, 40.9% after 1 year, and 34.1% 2 years after therapy. Although the results correspond with those of other studies, they also indicate, however, a high level of resistance to therapy. Long-term medical side effects, as well as psychosocial factors, especially appear to exacerbate chronic headache in the non-responders. Further investigations are necessary to explore this factor. The practical consequences are discussed for outpatient therapy of headache patients. In addition to the exact clinical classification of the headache syndrome, we consider it important to identify the exacerbating factors before starting multidimensional therapy. Adequate consideration of the non-medical therapeutic elements should be ensured in such structures headache therapy. A uniform classification of headache and records of the course in the form of headache diaries are essential for comparing the results. A sufficiantly long post-therapy observation period should be allowed in order to facilitate evaluation of the therapeutic response.

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