Original article
Sociodemographic characteristics of a cohort of patients with chronic migraine from a health district in Asturias
Características sociodemográficas de una cohorte de pacientes con migraña crónica en un área sanitaria de Asturias
C. García-Cabo Fernández
, P. Sánchez-Lozano, A. Pérez-Álvarez, J.M. Martínez-Ramos, L. Martínez-Rodríguez, J. Pascual
Corresponding author
Área de Neurociencias, Hospital Universitario Central de Asturias e Ineuropa, Oviedo, Asturias
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The stem extract showed anticonvulsant activity similar to that of DZP. (a) **<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001 vs all groups; <span class="elsevierStyleSup">#</span><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001 vs VEH, MSE 400, and MSE 800; <span class="elsevierStyleSup">▾</span><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001 vs VEH. 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García-Cabo Fernández, P. Sánchez-Lozano, A. Pérez-Álvarez, J.M. Martínez-Ramos, L. Martínez-Rodríguez, J. Pascual" "autores" => array:6 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "García-Cabo Fernández" "email" => array:1 [ 0 => "C.garciacabo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Sánchez-Lozano" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Pérez-Álvarez" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Martínez-Ramos" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Martínez-Rodríguez" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Pascual" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Área de Neurociencias, Hospital Universitario Central de Asturias e Ineuropa, Oviedo, Asturias" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características sociodemográficas de una cohorte de pacientes con migraña crónica en un área sanitaria de Asturias" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1388 "Ancho" => 1510 "Tamanyo" => 64142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Employment rates for the CM group and the general Asturian population, broken down by age. Note that the percentage of employed CM patients is not less than that of the Asturian population.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic migraine (CM) is the most incapacitating type of migraine. The annual rate of progression to CM is estimated at 2.5%.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> According to the criteria of the International Classification of Headache Disorders (ICHD-IIIβ), CM is a type of headache presenting in patients with a history of migraine and no medication overuse and occurring on at least 15 days per month, for at least 3 months, with the features of migraine headache on at least 8 days per month.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although the aetiology of CM is unclear, certain risk factors are statistically associated with headache chronification. Among those considered non-modifiable are such sociodemographic characteristics as sex, race, marital status, and education level.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,4</span></a> Considering these factors, the classic profile of a CM patient is a middle-aged woman with a low level of education.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Migraine pain may appear at early ages (even during childhood or adolescence), limiting patients’ educational or professional development. Studying and analysing these factors is therefore of particular importance because of the socio-economic and personal impact that CM can have.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Following this line of thinking, we conducted a descriptive analysis of a cohort of patients with CM in a health district in Asturias.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our study compares CM patients with the general Asturian population, of which 65% had not completed secondary education and over 20% were unemployed.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">Ad hoc telephone interviews allowed us to build a cohort of 150 patients who had previously been diagnosed with CM according to ICHD-IIIβ criteria at the headache unit in the neurology department of the Hospital Universitario Central de Asturias.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The survey took place during the first half of 2014 and was carried out by third- and fourth-year neurology residents who had been trained at the headache unit. They systematically registered such patient data as marital status, education level, and occupational status. Our data was descriptively compared with data from the Third Health Survey of Asturias.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> In this 2012 survey, detailed sociodemographic data were collected on 2100 residents of Asturias.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Demographic data</span><p id="par0040" class="elsevierStylePara elsevierViewall">The majority (142; 95%) of the CM patients included in this study were women. Mean age was 45 years (range, 17-74).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Marital status</span><p id="par0045" class="elsevierStylePara elsevierViewall">Regarding marital status, 89 patients (59.3%) were married, 33 (22%) single, 19 (12.6%) divorced or separated, and 9 (6%) widowed. According to data from the Third Health Survey of the region, 51.3% of Asturians were married, 30% single, 6.7% divorced or separated, and 12% widowed. Due to the high percentage of women in our sample, we analysed them separately and found that 59.9% were married, 19.3% single, 6.3% widowed, and 11.97% divorced or separated. According to the results of the Third Health Survey for the same subgroup, in 2012 48.8% of women in Asturias were married, 24.8% were single, 18.9% widowed, and 7.4% divorced or separated.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Education level</span><p id="par0050" class="elsevierStylePara elsevierViewall">A total of 38 (25.3%) patients had finished primary school; 54 (36%) had completed secondary school, and 55 (36.7%) had attained university studies. In Asturias in general, 49% of those surveyed had completed primary school, 24% had secondary education, and 19.4% had finished university.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Considering the subgroup of women with CM in our sample, 26.1% had finished primary school, 37.3% had a secondary education, and 34.5% had concluded university studies, whereas according to the health survey, 36.8% of Asturian women had completed primary education, 42.9% had finished secondary school, and 20.3% had obtained university studies.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Employment status</span><p id="par0060" class="elsevierStylePara elsevierViewall">Ninety (60%) of the CM patients interviewed were employed, 14 (9.3%) unemployed, 9 (6%) retired, 2 (1.3%) students, and 32 (21.3%) did unpaid domestic work.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Of the Asturians interviewed for the Third Health Survey,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> 33% were employed, 19% unemployed, 29% retired, 7% students, and 10% did unpaid domestic work.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Breaking down by age, we find that 33.3% of CM patients from 16 to 19 years of age were unemployed, while in the general Asturian population that figure was 44.9%. For people aged 20 to 24, 50% of CM patients and 47.4% of the general Asturian population were unemployed, and from 25 to 54 years of age, 26% of CM patients and 21% of the general population were unemployed. Lastly, 55.5% of CM patients aged 55 and older were unemployed vs 13.8% of the general population for that age range.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding the subgroup of women, 59.9% of our female patients were employed, 9.9% unemployed, and 22.5% did unpaid domestic work. For the same subgroup in the general Asturian population, 29.7% were employed, 19% unemployed, and 19% did unpaid domestic work (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Migraine is a complex pathology which requires a multidisciplinary approach. Multiple risk factors have been shown to be involved in the progression and chronification of migraine.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,4,6–8</span></a> Early detection and management of these factors, when possible, is of vital importance to effectively treat CM.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A number of studies have examined the association between such non-modifiable risk factors as patient sociodemographic status and the progression and transformation of migraine. All of them describe a link between CM and the following factors: female sex, low socio-cultural level, low economic status, and being single or divorced.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6–8</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The present study analyses the sociodemographic characteristics of a large number of adult patients matching the diagnostic criteria for CM who visited a headache unit in our setting. The type of patient attending our headache unit coincides with the classic picture of a CM patient as a middle-aged woman.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> However, contrary to the typical picture of patients with this disorder having a low level of education, in our sample a large majority had secondary studies or higher. In fact, the percentage was higher in our sample than in the general population of Asturias.</p><p id="par0095" class="elsevierStylePara elsevierViewall">According to some articles, a low socio-economic level and unemployment are not non-modifiable risk factors but rather risk factors which are difficult to modify.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,4,10,11</span></a> Currently, the unemployment rate in Spain is among the highest in the European Union. Nonetheless, a detailed analysis of our cohort by age and sex shows that: (1) for all age groups, the employment rate is higher in our sample than in the general population, and (2) the employment rate among women in our sample doubles that of the general Asturian population.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Several studies of the epidemiological characteristics of patients with migraine have found that this disorder is more likely to become chronic if the patient was previously married, that is, currently divorced, separated, or widowed. In our sample, though, the tendency is the opposite. Also, the percentage of patients who were married, single, or divorced is comparable to that of the control population.</p><p id="par0105" class="elsevierStylePara elsevierViewall">In this study we provide data about the marital status, education level, and employment status of a cohort of patients with CM and compare them to data from a health survey including a sample representative of the general population. It would have been interesting to statistically analyse any potential differences between the distributions of each variable evaluated in both samples, but we do not have access to the raw data from the Third Health Survey.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Over the years, many authors have supported the necessity for educational campaigns about CM aimed at the general population<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> because of the negative impact of this disabling condition on patients’ quality of life.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> The campaign to raise awareness of this disease has resulted in the creation of specialist clinics, with professionals trained in CM patient management. The patient sample analysed in this study came from a clinic specialising in refractory migraine. The greater sociocultural status and employment rate observed in this sample may be linked to these patients’ higher cultural background, which resulted in greater resources to find solutions to a specific problem (in this case, headache). Seeking solutions in a highly specialised clinic normally leads to improvements in patients’ quality of life and sociocultural level,<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">13–15</span></a> which may also partially explain the results of our descriptive study. In addition, the majority of studies analysing the relationship between CM and sociodemographic variables have been conducted in North America, so it may not be possible to extrapolate their results to our setting. Future studies should compare the sociodemographic characteristics of patients who go to specialised clinics and those who do not.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">14,15</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres627195" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec640280" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres627194" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec640281" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Demographic data" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Marital status" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Education level" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Employment status" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-03-19" "fechaAceptado" => "2015-06-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec640280" "palabras" => array:6 [ 0 => "Demographic data" 1 => "ICHD-IIIβ" 2 => "Chronic migraine" 3 => "Episodic migraine" 4 => "Occupational status" 5 => "Educational level" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec640281" "palabras" => array:6 [ 0 => "Datos sociodemográficos" 1 => "International classification of headache disorders-III beta" 2 => "Migraña crónica" 3 => "Migraña episódica" 4 => "Situación laboral" 5 => "Nivel educacional" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chronic migraine (CM), with or without medication overuse, is a common condition in the general population. It has traditionally been assumed that suffering CM has an impact on a patient's socio-occupational and educational level. Our goal was to analyse these characteristics in a cohort of patients with CM and compare them to the general population.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We used a telephone interview and an ad hoc questionnaire to record and analyse the sociodemographic characteristics of 150 patients with a diagnosis of CM according to the criteria of the International Headache Classification. Results were compared to those obtained by the Third Health Survey of Asturias, conducted in 2012.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 150 patients, 142 were women (95%). Married patients accounted for 59.3% of the total interviewees, while 22% were single, 12.6% divorced, and 6% were widowed. Regarding educational level, we found that 73% of our patients had completed secondary or higher education and 25% had completed only primary education. Sixty per cent of these patients are occupationally active, while the rest are not actively employed. Overall, these figures do not differ from those published by the Third Health Survey of Asturias.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The classic idea that CM has a negative impact on patients’ educational, personal, and occupational situations was not confirmed in our series. In fact, most patients with CM reported a medium-high educational level and a good socio-occupational status. However, since our series includes only CM patients attended in a specialist clinic, our results are not necessarily applicable to all patients with CM.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La migraña crónica (MC) con o sin abuso de fármacos es una patología frecuente en la población general. Tradicionalmente se ha asumido que presentarla conlleva un detrimento del nivel socio-laboral y educacional. Nuestro objetivo ha sido analizar descriptivamente estas características en una cohorte de pacientes con MC y compararlas con las de nuestra población.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Analizamos, mediante una entrevista telefónica y una encuesta diseñada ad hoc, las características sociodemográficas de 150 pacientes diagnosticados de MC en nuestra consulta de cefaleas según los criterios de la Clasificación Internacional de Cefaleas. Los resultados se compararon con los obtenidos en la III Encuesta de Salud de Asturias llevada a cabo en el año 2012.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 150 pacientes, 142 (95%) eran mujeres. El 59,3% de los pacientes entrevistados estaban casados, 22% solteros, 12,6% divorciados y 6% eran viudos. Con respecto al nivel educacional encontramos que un 73% de nuestros pacientes habían cursado estudios secundarios o superiores frente a un 25% que habían cursado solo estudios primarios. Un 60% de los pacientes está activo laboralmente, mientras que el resto se encuentra inactivo. En global, estas cifras no difieren de las arrojadas por la III Encuesta de Salud de Asturias.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La idea clásica de que la MC causa un deterioro en la situación laboral, personal y educacional de los pacientes que la presentan no se confirma en nuestra serie, en la que la mayoría de pacientes con MC tienen un nivel educacional medio-alto y una buena situación socio-laboral. Es posible que estos resultados se deban a que nuestra serie comprende solo a pacientes con MC que acuden a una consulta especializada y, por tanto, no sean necesariamente aplicables al global de pacientes con MC.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Cabo Fernández C, Sánchez-Lozano P, Pérez-Álvarez A, Martínez-Ramos JM, Martínez-Rodríguez L, Pascual J. Características sociodemográficas de una cohorte de pacientes con migraña crónica en un área sanitaria de Asturias. Neurología. 2016;31:157–160.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1388 "Ancho" => 1510 "Tamanyo" => 64142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Employment rates for the CM group and the general Asturian population, broken down by age. Note that the percentage of employed CM patients is not less than that of the Asturian population.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic daily headache with analgesic overuse: epidemiology and impact on quality of life" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Colás" 1 => "P. Muñoz" 2 => "R. Temprano" 3 => "C. Gómez" 4 => "J. 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| 2024 February | 8 | 3 | 11 |
| 2024 January | 22 | 2 | 24 |
| 2023 December | 25 | 4 | 29 |
| 2023 November | 15 | 4 | 19 |
| 2023 October | 12 | 10 | 22 |
| 2023 September | 10 | 3 | 13 |
| 2023 August | 3 | 3 | 6 |
| 2023 July | 12 | 5 | 17 |
| 2023 June | 7 | 2 | 9 |
| 2023 May | 7 | 6 | 13 |
| 2023 April | 6 | 0 | 6 |
| 2023 March | 12 | 3 | 15 |
| 2023 February | 9 | 4 | 13 |
| 2023 January | 8 | 4 | 12 |
| 2022 December | 17 | 3 | 20 |
| 2022 November | 9 | 6 | 15 |
| 2022 October | 11 | 6 | 17 |
| 2022 September | 9 | 15 | 24 |
| 2022 August | 12 | 8 | 20 |
| 2022 July | 12 | 8 | 20 |
| 2022 June | 13 | 4 | 17 |
| 2022 May | 19 | 7 | 26 |
| 2022 April | 17 | 8 | 25 |
| 2022 March | 12 | 8 | 20 |
| 2022 February | 8 | 6 | 14 |
| 2022 January | 10 | 6 | 16 |
| 2021 December | 15 | 7 | 22 |
| 2021 November | 8 | 8 | 16 |
| 2021 October | 12 | 11 | 23 |
| 2021 September | 20 | 9 | 29 |
| 2021 August | 16 | 3 | 19 |
| 2021 July | 13 | 7 | 20 |
| 2021 June | 13 | 9 | 22 |
| 2021 May | 19 | 10 | 29 |
| 2021 April | 25 | 11 | 36 |
| 2021 March | 21 | 13 | 34 |
| 2021 February | 15 | 8 | 23 |
| 2021 January | 18 | 10 | 28 |
| 2020 December | 13 | 7 | 20 |
| 2020 November | 12 | 11 | 23 |
| 2020 October | 14 | 11 | 25 |
| 2020 September | 16 | 9 | 25 |
| 2020 August | 16 | 4 | 20 |
| 2020 July | 12 | 7 | 19 |
| 2020 June | 19 | 6 | 25 |
| 2020 May | 19 | 11 | 30 |
| 2020 April | 9 | 4 | 13 |
| 2020 March | 12 | 4 | 16 |
| 2020 February | 19 | 12 | 31 |
| 2020 January | 14 | 8 | 22 |
| 2019 December | 19 | 8 | 27 |
| 2019 November | 12 | 11 | 23 |
| 2019 October | 20 | 2 | 22 |
| 2019 September | 10 | 2 | 12 |
| 2019 August | 15 | 10 | 25 |
| 2019 July | 19 | 9 | 28 |
| 2019 June | 46 | 20 | 66 |
| 2019 May | 126 | 20 | 146 |
| 2019 April | 48 | 5 | 53 |
| 2019 March | 3 | 1 | 4 |
| 2019 February | 10 | 5 | 15 |
| 2019 January | 10 | 3 | 13 |
| 2018 December | 13 | 5 | 18 |
| 2018 November | 12 | 14 | 26 |
| 2018 October | 12 | 10 | 22 |
| 2018 September | 8 | 3 | 11 |
| 2018 August | 6 | 3 | 9 |
| 2018 July | 3 | 0 | 3 |
| 2018 June | 2 | 2 | 4 |
| 2018 May | 3 | 0 | 3 |
| 2018 April | 6 | 1 | 7 |
| 2018 March | 4 | 0 | 4 |
| 2018 February | 4 | 1 | 5 |
| 2018 January | 6 | 1 | 7 |
| 2017 December | 9 | 5 | 14 |
| 2017 November | 10 | 1 | 11 |
| 2017 October | 7 | 2 | 9 |
| 2017 September | 7 | 0 | 7 |
| 2017 August | 10 | 1 | 11 |
| 2017 July | 12 | 1 | 13 |
| 2017 June | 6 | 10 | 16 |
| 2017 May | 7 | 2 | 9 |
| 2017 April | 9 | 3 | 12 |
| 2017 March | 17 | 4 | 21 |
| 2017 February | 9 | 0 | 9 |
| 2017 January | 18 | 1 | 19 |
| 2016 December | 3 | 4 | 7 |
| 2016 November | 7 | 4 | 11 |
| 2016 October | 19 | 4 | 23 |
| 2016 September | 14 | 1 | 15 |
| 2016 August | 27 | 3 | 30 |
| 2016 July | 28 | 2 | 30 |
| 2016 June | 37 | 11 | 48 |
| 2016 May | 34 | 12 | 46 |
| 2016 April | 35 | 18 | 53 |
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