Public policies in headache disorders: needs and possibilities

Socioeconomic and geographic inequalities in headache disability in Brazil: The 2019 National Health Survey

OBJECTIVE

To map the socioeconomic and geographic inequalities in headache disability in Brazil.

BACKGROUND

Headache disability and its social determinants are poorly investigated in Brazil.

METHODS

This is a secondary, cross-sectional analysis of the 2019 National Health Survey database, a representative sample of the Brazilian population. Working-aged Brazilians (aged ≥14 years) were included in the analyses (n = 225,563). Headache disability was inquired through questions on the number of days the respondent was unable to perform customary daily activities in the past 2 weeks. Proportion estimates and the mean days lost were compared between socioeconomic categories. Sample weights were used.

RESULTS

Among 14 disease-related disability groups, headache disability (n = 1228) was the second most prevalent disability in adolescents and fifth among adults aged <50 years. In the headache disability sample, there was a higher proportion of females at 72.4% (95% confidence interval [CI] 68.5%-75.9%), with a mean (95% CI) age of 41.1 (40.1-42.0) years and days lost due to disability of 3.4 (3.2-3.6) days. The sociodemographic distribution across income strata (quartiles) of the headache disability sample showed the highest proportions at the lowest income quartile in the Northeast region (15.4%, 95% CI 12.8%-18.4%), for people of Brown color (17.5%, 95% CI 14.7%-20.7%), and with the lowest education level (l3.6%, 95% CI 11.3%-16.2%). Black people, those from the North region, and those with the lowest education level had more days lost than White people (mean [95% CI] 4.1 [3.5-4.6] vs. 3.1 [2.8-3.4] days, p = 0.008), those from the Southeast region (mean [95% CI] 3.8 [3.4-4.2] vs. 2.8 [2.4-3.3] days, p = 0.022), and people with the highest education level (mean [95% CI] 3.9 [3.6-4.2] vs. 2.8 [2.3-3.3] days, p = 0.005), respectively.

CONCLUSION

In Brazil, headache disability is one of the leading causes of disability and it is characterized by socioeconomic inequalities.

Store-and-forward teleneurology results in a large Brazilian city

Background Neurology is a high-demand specialty with long waiting lines. Some pathologies require rapid decision-making. Through technology, telemedicine can allow neurological patients to have faster access to specialized assessment. In store-and-forward telemedicine, the specialist physician evaluates data collected by a general practitioner and optimizes screening.

Objective The aim of the present study is to evaluate the effectiveness of asynchronous telemedicine, used to refer patients from primary care to neurology, in the city of Curitiba, in southern Brazil.

Methods A retrospective analysis of all patients referred from primary care to neurology between September 2019 and February 2020. After a request is made by a general medical doctor for a specialist's opinion, 5 neurologists with complete access to patients' records are tasked with the decision-making. The main variables analyzed were clinical reasons for telemedicine request, neurologist decision, final diagnosis, indication for diagnostic procedures, and subsequent follow-up.

Results Between September 2019 and February 2020, 1,035 asynchronous telemedicine consultations were performed. Headache (30.43%), epilepsy (19.03%), and dementia (15.85%) accounted for almost two-thirds of the primary care requests; one-third of the cases (33.62%) required a complementary diagnostic procedure. More than 70% of the cases did not require face-to-face assessment by a neurologist.

Conclusions In this study, store-and-forward teleneurology successfully reduced the need for in-visit consultation in 70% of cases. Further studies should identify the best opportunities for teleneurology in the city of Curitiba to facilitate better integrated care between primary care providers and neurologists.

Headache disability, lifestyle factors, health perception, and mental disorder symptoms: a cross-sectional analysis of the 2013 National Health Survey in Brazil

OBJECTIVE

To evaluate the past 2-week headache disability and explore its association with lifestyle factors, health perception, and mental disorder symptoms in the PNS 2013 survey.

BACKGROUND

The prevalence of headache disorders has been associated with lifestyle factors, mental disorders, and health perception. However, less is known regarding their influence on headache-related disability.

METHODS

In a cross-sectional analysis, chi-squared tests and logistic regression models computed the associations between headache-related disability (defined as days lost from work, school, or household chores in the past 2 weeks) and the variables of interest, compared to other disease-related disabilities groups or no day lost group. The adjusted models controlled for the effects of age, sex, income, and educational levels.

RESULTS

In the sample aged ≥ 18 years (n = 145,580), 10,728 (7.4%) participants reported any disease-related disability in the past 2 weeks (median interquartile range (IQR) for age = 47 (33-59) years, 62% women), with the median (IQR) days lost = 5 (2-14). Headache disability represented 5.3% (572/10,728) of all diseases, constituting the 4th most prevalent disease-related disability [median (IQR) days lost = 3 (3-4)]. Among people aged 18-25 years, headache disorders ranked 2nd as the most prevalent disability (13%), headache-related disability positively associated with physical inactivity, poorer health perception, and frequent mental disorders symptoms, and negatively associated with overweight, obesity, and alcohol consumption.

CONCLUSION

Headache disability represents a leading cause of disease-related disability in Brazil and associates with unhealthy lifestyle factors, poorer health perception, and frequent mental disorder symptoms.

Telemedicine in neurology: current evidence

BACKGROUND

Telemedicine was first introduced in Neurology as a tool to facilitate access to acute stroke treatment. More recently, evidence has emerged of the use of telemedicine in several other areas of Neurology. With the advent of the COVID-19 pandemic and the need for social isolation, Brazilian authorities have expanded the regulation of the use of telemedicine, thus allowing the treatment of many patients with neurological diseases to be conducted with less risk of SARS-CoV-2 contamination.

OBJECTIVE

This study aimed to critically review the current evidence of the use, efficacy, safety, and usefulness of telemedicine in Neurology.

METHODS

A review of PubMed indexed articles was carried out by searching for the terms "telemedicine AND": "headache", "multiple sclerosis", "vestibular disorders", "cerebrovascular diseases", "epilepsy", "neuromuscular diseases", "dementia", and "movement disorders". The more relevant studies in each of these areas were critically analyzed.

RESULTS

Several articles were found and analyzed in each of these areas of Neurology. The main described contributions of telemedicine in the diagnosis and treatment of such neurological conditions were presented, indicating a great potential of use of this type of assistance in all these fields.

CONCLUSION

Current evidence supports that teleneurology can be a tool to increase care for patients suffering from neurological diseases.