PROBLEMS OF RATIONAL PHARMACOTHERAPY OF CHRONIC HEADACHE IN PRIMARY HEALTH CARE (Review article)

Abstract

Background. Chronic headache is one of the most common causes of medical consultations in outpatient neurological practice. Despite the availability of international clinical guidelines, pharmacotherapy of chronic headache in primary health care remains heterogeneous and is associated with variability of medical prescriptions, polypharmacy and excessive use of analgesics. Objective. To discuss the main problems of rational pharmacotherapy of chronic headache in primary health care and to analyze organizational factors influencing prescription patterns in outpatient practice. Materials and methods. The article was prepared as an analytical review based on publications devoted to chronic headache, medication-overuse headache, polypharmacy and organizational aspects of outpatient neurological care. International Classification of Headache Disorders, 3rd edition (ICHD-3), international clinical guidelines and publications relevant to primary health care practice were used. Results. The main problems of pharmacotherapy of chronic headache in outpatient practice include excessive use of analgesics, insufficient use of preventive therapy, polypharmacy and variability of medical prescriptions. Medication-overuse headache is considered one of the most important consequences of irrational use of pain-relieving drugs. The potential role of structured decision-support approaches in conditions of limited consultation time and high physician workload is discussed. Conclusion. Problems of rational pharmacotherapy of chronic headache have not only clinical but also organizational aspects. Further investigation of outpatient prescription patterns and organizational approaches to support medical decision-making appears to be a promising direction for improving outpatient neurological care.