ICNC Abstracts, ICNC 2018

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Barriers to Care among Indian Children with Recurrent Headache
Charu Jain, Devendra Mishra, Monica Juneja, V Pavithra, Deepti Chawla

Last modified: 2018-09-09


Introduction: Reasons which prevent headache patients from seeking healthcare are labelled Barriers to Care. There is little information on these in the context of pediatric headache. This study was done to identify various barriers to care among children with recurrent headache attending a general pediatric OPD.

Methods: After IEC clearance and informed consent, consecutive children attending Pediatric department with either Migraine or Tension-type headache (as per ICHD-3) were enrolled between April, 2014 and February, 2015. Barriers to care were explored during a one-to-one interview with the parents using a list of previously described factors categorized as Clinical, Social, and Others, along with open-ended questions.

Results: Forty children (24 males) with mean (SD) age of 10.6 (1.7) year were enrolled. Migraine was diagnosed in 24.

Majority of the headache patients (83.3% migraine, 100% TTH) had more than two barriers to care identified, and none was without an identified barrier. The major group was Clinical barriers, with ‘wrong diagnosis’ (90%) and ‘improper treatment’ (75%) being common. The Social barriers were also frequent, with ‘Wrong expectations’ observed in all patients, and ‘Frequent change of doctors’ being more in those with TTH (P=0.039).

Delayed referral was significantly higher (P<0.001) among TTH patients than migraine.

Conclusion: Identification of barriers is a step towards appropriate strategies for addressing these, provided similar community-based data is generated. Clinical barriers are amenable to intervention by improving teaching during clinical training and by CME programs for clinicians, though Social barriers will require more sustained public health awareness campaigns.


Migraine, TTH, Wrong diagnosis, Improper treatment

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