Non-compliance with follow-up and improvement after treatment at a headache center

Two telephone surveys were conducted at a major headache center into patient compliance with follow-up and perceived treatment efficacy. The first survey addressed compliance with the recommendation to follow-up after the initial evaluation. Of a group of 316 consecutive patients, 40.5% had not complied with the recommended follow-up visit. Reasons for the non-compliance were given by 60.3%; most frequently mentioned were dislike of the clinician seen and seeking care elsewhere. The second survey concerned 75 patients who had returned at least once to the center for follow-up. When asked about the efficacy of the treatment received, 76.0% reported improvement of their headaches, with 32.0% reporting more than 75% improvement. In addition, 87.5% of the patients reported a decrease in the use of analgesic and/or ergotamine medications. We conclude that treatment of chronic headache is not a priori a hopeless situation and that in the patient compliance with the recommendation to follow-up, in particular the patient-clinician relationship is a critical factor.