Abdul Malik, Safia Awan, Aziz Sonawalla, Fayyaz Ahmed, Mohammad Wasay.
Awareness and Approach To Headache: a Survey of Family Physicians in Pakistan.
Pak J Neurological Sci Jan ;13(4):05-10.

Background & Objective: Headache is one of the most common complaints in the general population and the most common symptom for a neurology out-patient visit. According to the WHO, the prevalence of adults complaining of recent headache (at least one episode within the last year) is 47%. Despite the large burden of disease, headaches are often overlooked, underdiagnosed and under-resourced. There are several reasons that include lack of awareness among the general public and healthcare professionals and lack of training at both undergraduate and post-graduate level. There is limited data available from many third world countries including Pakistan. Family Physicians (FPs) equivalent to primary care physician in the UK (GP) see the vast majority of headache disorders in Pakistan, their competency in recognizing headache disorders bears huge impact on the care received by the patients. Methods: This is the first cross sectional survey of Family Physician's (FPs) randomly selected from four provinces i.e. Punjab & Sindh 200 each, KPK/ Baluchistan 150 & 50 FPs respectively were randomly selected of which 449 family physicians consented to participate during 2013. Data was collected from FPs through questionnaire contained 27 items. Results: Of the 600 randomly selected FPs approached, 449 responded to a questionnaire. On the basis of history alone 278 (62%) responders were able to differentiate between migraine, tension type and cluster headache(s),305 (68%) were able to identify migraine, 337 (75%) were able to identify tension type headache and 233 (52%) were able to identify cluster headaches. Triptans as being the most effective treatment for acute migraine identified by 157 (35%) while 229 (51%) respondents chose NSAIDs, 72 (16%) chose ergotamine while 85 (19%) choose topiramate. For the base line investigations, 292 (65%) mentioned that they ordered in less than 10 percent of their headache patients. When looking at referrals for refractory headaches, 287 (63%) would refer to a neurologist. Conclusion: This is the first study of family physicians awareness and approach to headache in Pakistan. Majority of FPs can differentiate between migraine, tension type and cluster headaches. These findings may have important implications for undergraduate and post graduate curriculum development, continued medical education priorities and for advocacy and policy making.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com