Use of complementary and alternative medicine by patients with cluster headache: Results of a multi-centre headache clinic survey

Summary

Objectives

To evaluate the rates, pattern, satisfaction with, and presence of predictors of complementary and alternative medicine (CAM) use in a clinical population of patients with cluster headache (CH).

Design and setting

One hundred CH patients attending one of three headache clinics were asked to undergo a physician-administered structured interview designed to gather information on CAM use.

Results

Past use of CAM therapies was reported by 29% of the patients surveyed, with 10% having used CAM in the previous year. Only 8% of the therapies used were perceived as effective, while a partial effectiveness was reported in 28% of CAM treatments. The most common source of recommendation of CAM was a friend or relative (54%). Approximately 62% of CAM users had not informed their medical doctors of their CAM use. The most common reason for deciding to try a CAM therapy was that it offered a “potential improvement of headache” (44.8%). Univariate analysis showed that CAM users had a higher income, had a higher lifetime number of conventional medical doctor visits, had consulted more headache specialists, had a higher number of CH attacks per year, and had a significantly higher proportion of chronic CH versus episodic CH. A binary logistic regression analysis was performed and two variables remained as significant predictors of CAM use: income level (OR = 5.7, CI = 1.6–9.1, p = 0.01), and number of attacks per year (OR = 3.08, CI = 1.64–6.7, p < 0.0001).

Conclusion

Our findings suggest that CH patients, in their need of and quest for care, seek and explore both conventional and CAM approaches, even though only a very small minority finds them very satisfactory.

Introduction

Compared with other primary headaches, such as migraine and tension-type headache, cluster headache (CH) is uncommon. However, in the two most recent epidemiological studies,1, 2 the estimated prevalence was about 0.3%, suggesting that CH is probably more common than previously thought.

The therapeutic management of CH is based exclusively on pharmacological measures.3, 4, 5 The therapeutic interventions can quickly abort attacks and prevent the recurrence of pain attacks but some CH patients are unable to achieve optimal control of their headache, or do so only at the expense of unacceptable side effects.3, 4 Highly selected, treatment-resistant chronic patients may be cautiously considered for surgical therapies.3, 6

Evidence of the efficacy, safety and quality of CAM for headaches is lacking or at best empirical, since CAM therapies are rarely the subject of rigorous, prospective, randomized controlled trials (RCTs).⁷ Theoretically, it should be easy to discount CAM as a treatment option for CH, in which the extraordinary intensity of the pain warrants prompt and rational use of effective evidence-based treatments.⁸ Yet there are several important reasons why physicians involved in the care of patients with CH should give this branch of medicine some consideration. First, physicians continue to prescribe many conventional CH treatments even though they are not supported by RCT results.3, 5, 9 In addition, many patients using appropriate conventional treatments still experience a significant impairment of their quality of life,¹⁰ which suggests that focusing on pain as the only therapeutic target does not allow complete control of the CH-related disability. Second, in western countries, a growing number of individuals use the internet to obtain health-related information and most of them judge this information useful and relevant.¹¹ Web sites devoted to CH actively publicize and promote CAM remedies, and by so doing possibly create or reinforce a specific interest in and demand for these therapies for CH.¹² Finally, CAM is already widely used, and there are signs that the use of this unconventional approach is still growing.13, 14, 15 Headache syndromes are among the conditions that most frequently prompt visits to practitioners of unconventional medicine.16, 17 In several recent headache clinic surveys, a widespread use of CAM was reported among migraine and chronic tension-type headache patients,18, 19, 20 and there is evidence of a similar pattern in CH. Indeed, Bahra et al.⁸ reported that 63% of a large, mainly non-clinic-based population of CH sufferers in the UK had paid for costly alternative therapies. In a nationwide survey conducted in the Netherlands, 33% of CH patients had already consulted an alternative therapist before the diagnosis.²¹ In both these studies8, 21 CAM use was considered a priori among the factors leading to incorrect diagnosis and management of CH, but no specific attention was paid to the pattern and predictors of CAM use. The aim of this study was therefore to investigate the rates, pattern and predictors of CAM use in a clinical population of CH patients.