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Objective: To analyze the incidence and characteristics of the first 1000 headaches in an outpatient clinic., Background: Headache is a common cause of medical consultation, both in primary care and in specialist neurology outpatient clinics. The International Classification of Headache Disorders, 2nd Edition (ICHD-II), enables headaches to be classified in a precise and reproducible manner., Methods: In January 2008, an outpatient headache clinic was set up in Hospital Clínico Universitario, a tertiary hospital in Valladolid, Spain. Headaches were classified prospectively in accordance with ICHD-II criteria. In each case we recorded age and sex, duration of headache, ancillary tests required, and previous symptomatic or prophylactic therapies., Results: In January 2010, the registry included 1000 headaches in 682 patients. The women/men ratio was 2.46/1 and the mean age of the patients was 43.19 ± 17.1 years (range: 14-94 years). Patients were referred from primary care (53.4%), general neurology clinics (36.6%), and other specialist clinics (9%). The headaches were grouped (ICHD-II classification) as follows: group 1 (Migraine), 51.4%; group 2 (Tension-type headache), 16%; group 3 (Trigeminal autonomic cephalalgias), 2.6%; group 4 (Other primary headaches) and group 13 (Cranial neuralgias), 3.4%. The diagnostic criteria of chronic migraine were satisfied in 8.5% of migraines. Regarding secondary headaches, 1.1% of all cases were included in group 5 (Headaches attributed to trauma) and 8.3% in group 8 (Headaches attributed to a substance or its withdrawal). Only 3.4% of headaches were classified in group 14 (Unspecified or not elsewhere classified), and 5.2% were included in the groups listed in the ICHD-II research appendix., Conclusion: This registry outlines the characteristics of patients seen in an outpatient headache clinic in a tertiary hospital; our results are similar to those previously reported for this type of outpatient clinic. Migraine was the most common diagnosis. Most headaches can be classified using ICHD-II criteria., (© 2011 American Headache Society.)

Background and Objective: Different studies have shown pain to be one of the most frequent causes of health-care resource utilization, and a major public health concern because of its social repercussions. In Spain there are no recent data on the prevalence and management of neuropathic pain in the general primary-care setting., Methods: This study aimed to gain epidemiological insight into neuropathic pain in the Spanish primary-care setting. This was a cross-sectional, one-day, multicentre, observational epidemiological study involving 623 primary-care physicians in Spain. Patients who experienced pain were classified into three groups: pure neuropathic pain, mixed neuropathic pain or nociceptive pain. Pain intensity was evaluated on a visual analogue scale (VAS), range 0-10. Information on the location, duration, aetiology and current treatment of pain was obtained, together with data on whether the patients were referred to specialized care and to which type of specialist., Results: In a single day, 23 529 patients received primary care, and of these, 7220 experienced pain (30.7% [95% CI 29.5, 31.7]). Patients with pure neuropathic pain comprised 11.8% (95% CI 10.5, 13.2) of the 3044 patients for whom pain was the reason for consultation and the type of pain was documented, patients with mixed neuropathic pain accounted for 13.4% (95% CI 12.0, 14.8) of this group, and patients with nociceptive pain for 74.9% (95% CI 73.1, 76.7). Patients with pure neuropathic pain mostly received exclusively pharmacological treatment (84.6% [95% CI 80.3, 89.0]), with antiepileptic drugs being the most widely used substances (52.5% [95% CI 47.3, 57.7]), followed by non-opioid analgesics (35.2% [95% CI 30.2, 40.1]) and NSAIDs (26.8% [95% CI 22.2, 31.4]). The mean duration of neuropathic pain was 11.7 +/- 23.3 months. The mean pain intensity on the VAS exceeded 6 in all groups. Over half of the patients were diagnosed in the primary-care centre, and a large proportion in turn were referred to a specialist, most frequently an orthopaedist., Conclusions: The results of the present study show the high prevalence of neuropathic pain at the primary-care level in Spain. In addition, the data presented here point to a need to improve the management of outpatients with neuropathic pain in the Spanish primary-care setting, particularly in relation to the higher than recommended use of NSAIDs (which are not indicated for neuropathic pain) and the lower than recommended use of antiepileptic drugs with an analgesic indication for pain with a neuropathic component.