EPIDEMIOLOGY

Objective: To determine the level and types of medication used to treat headache in the general population and to compare this with current recommendations. Methods: Cross‐sectional survey to an adult general population sample. A questionnaire gathered information on occurrence, characteristics of, and medication use for headaches in the previous 3 months. Setting: Patients aged 18 years and over registered with five general practices in North Staffordshire, England. Key findings: The response rate was 56%. Eighty‐five percent of headache sufferers (60% of all questionnaire respondents) reported using medication for their headaches in the 3 months prior to the survey. Medication use was more likely to be reported by women, respondents aged 36 to 50 years, those reporting more painful and more disabling headaches, those experiencing at least five associated symptoms, and those whose untreated headaches lasted 4 to 24 hours. Paracetamol was by far the most widely used medication, with 74% of medication users taking it in the 3‐month period. Fifty‐eight percent of acute medication users took only one single therapy for their headaches. Only a small number of medication users (3%) took their headache medication before the pain began, with most (63%) taking it when the pain started and the remainder waiting until the pain was unbearable. Half of medication users (47%) reported that the medication completely relieved their headache, 51% obtained partial relief, and 2% did not obtain relief. Conclusion: Medication use for headache appears to be appropriate for most patients. Although only a minority used combination therapy, the high prevalence of headache means that this translates to substantial numbers in the population as a whole. Some headache sufferers might benefit from advice to make better use of the treatments available. Comment: This study shows that OTC usage (paracetamol, which is the British name for acetaminophen), is the most frequently used class of medication for headache, similar to what Lipton et al found in terms of medication usage for migraine in the general population in the American Migraine II studies (Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001;41(7):646‐657). I would assume that because of the robust response to acetaminophen demonstrated here that the majority of the patients surveyed by Boardman et al had episodic tension‐type headache, which is, after all, the most common headache in the general population (Lipton RB, Stewart WF, Liberman JN. Self‐awareness of migraine: interpreting the labels that headache sufferers apply to their headaches. Neurology. 2002;58(suppl 6):S21‐S26), and for which patients do not need to seek medical attention. Disabling migraine, on the other hand, does lead to patients seeking help from practitioners, and I doubt that acetaminophen, even if taken early, would result in half of those patients pain free at an early time point.—Stewart J. Tepper