Brazilian headache registry: methods and preliminary data of the pilot study

Evaluation and treatment of primary and secondary headaches is a global public health challenge. Recognizing the epidemiological impact of headaches, a group of researchers linked to the Brazilian Headache Society proposed the Brazilian Headache Registry and drew up its initial protocol.

Objective

Here we describe the methods and preliminary data obtained from the pilot study.

Methods

This was a multicenter longitudinal observational study conducted between September 2020 and August 2021. Prospective data were collected in three specialist centers for headache care in states in southern and southeastern Brazil. Patients aged 18 years or older who sought care for headache in tertiary centers and who agreed to participate in the study, were considered eligible.

Results

Sixty-six patients were included in the pilot study: 43 (65%) from Rio Grande do Sul state and 23 (35%) from Minas Gerais state. Overall, 90% were female, and the subjects' mean age was 38.2 ± 11.2 years. Primary headaches accounted for 85.3% of the diagnoses made. Among secondary headaches, medication overuse headache was the most frequent type (7.1%).

Conclusions

The pilot study showed the feasibility of the research protocol developed for tertiary centers. The Brazilian Headache Registry will form a source of longitudinal data with the aim of contributing to better characterization of the various phenotypes of patients with primary and secondary headaches, and to detailing the use of health resources and identifying predictors of better clinical outcomes.

Keywords
Headache; Migraine Disorders; Routinely Collected Health Data; Epidemiology

State	Rio Grande do Sul (N = 43)		Minas Gerais (N = 23)
City	Porto Alegre (N = 33)	Passo Fundo (N = 10)	Barbacena (N = 23)
Health Insurance	Supplementary healthcare	Private clinic	Brazilian National Health System
Loss of follow-up	3/66 (4.5%)	4/66 (6.1%)	7/66 (10.6%)
Time of loss of follow-up	First interview (N = 2) Second interview (N = 1)	First interview (N = 4)	Second interview (N = 7)
Reasons to loss of follow-up	Patient-related (N = 2) Research team-related (N = 1)	Research team-related (N = 4)	Patient-related (N = 7)

Variables		N	%
Sex	Female	54	90.0
Sex	Male	6	10.0
Ethnicity	White	50	83.3
	Brown	9	15.0
	Black	1	1.7
Marital status	Married	32	53.3
	Single	20	33.3
	Separated/divorced	7	11.7
	Widower	1	1.7
Education	12 years or more	43	71.7
	9 to 11 years	11	18.3
	5 to 8 years	3	5.0
	1 to 4 years	3	5.0
Occupation/profession	Employee	23	38.3
	Civil servant	7	11.7
	Self-employed	7	11.7
	Housewife/househusband	7	11.7
	Student	6	10
	Business owner/employer	4	6.7
	Retired	3	5.0
	Unemployed	3	5.0
Working in shifts	No	37	61.7
Working in shifts	Yes	23	38.3
Monthly family income	< US$ 200	8	13.3
	US$ 220 to US$ 1100	24	40.0
	US$ 1100 to US$ 2200	13	21.7
	US$ 2200 to US$ 4400	13	21.7
	> US$ 4400	2	3.3
Family history of headaches	First-degree family member	27	45.0
	Second-degree family member	9	15.0
	No family history of headaches	19	31.7
	Unknown	5	8.3
Age (mean/SD)	38.2 ± 11.2
PHQ-9 (mean/SD)	8.42 ± 6.15
GAD-7 (mean/SD)	8.75 ± 5.42
Epworth (mean/SD)	6.65 ± 4.56
Atenas (mean/SD)	9.1 ± 5.37

Diagnoses		N	Percentage (%)
Primary headaches	Migraine without aura	31	55.4
	Migraine with aura	11	19.6
	Chronic migraine	6	10.7
	Probable migraine	2	3.6
	Infrequent episodic tension-type headache	1	1.8
	Frequent episodic tension-type headache	3	5.4
	Chronic tension-type headache	2	3.6
	Primary stabbing headache	1	1.8
	New daily persistent headache	1	1.8
Secondary headaches	Medication overuse headache	4	7.1
	Cervicogenic headache	3	5.4
	Headache attributed to chronic or recurring rhinosinusitis	1	1.8
	Headache attributed to temporomandibular disorder	1	1.8
	Headache attributed to cervical myofascial pain^* * Diagnosis made in accordance with the Appendix of the third edition of the International Classification of Headache Disorders (ICHD-3).18	1	1.8

		Initial	Quarterly	p
Headache intensity	Severe	69.2%	28.8%	<0.001 ^* * Wilcoxon test;
	Moderate	28.9%	55.8%
	Mild	1.9%	13.5%
	Missing data	0	1.9%
MIDAS, median (IQR)		14.0 (4-35)	10.5 (3-30)	0.502^* * Wilcoxon test;
WHOQol-8, mean ± SD		19.58 ± 5.21	21.4 ± 5.32	0.007 ^ Student test;
Headache frequency	Low frequency (1-7 days per month)	40.4%	61.5%	0.27^* ***** Mac Nemar.
	High frequency (8-14 days per month)	13.5%	19.2%
	Chronic (≥ 15 days per month)	30.8%	15.4%
	Missing data	15.3%	3.9%
Medication overuse	Yes	59.1%	36%	0.005 ^* ***** Mac Nemar.
Medication overuse	No	40.9%	64%	0.005 ^* ***** Mac Nemar.

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[1] Address for correspondence Vanise Grassi (e-mail: vanisegrassi@gmail.com).