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Background: Reliable population-based data on the prevalence and characteristics of primary headache across the lifespan are essential. However, robust data are lacking. Methods: We utilized questionnaire data from a random general population sample in Germany, that comprised 2,478 participants aged ≥14 years. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey. Results: The 6-month prevalence of self-reported headache in the total sample amounted to 39.0% (known diagnosis of migraine 7.2%; tension-type headache 12.4%; another diagnosis or unknown diagnosis 23.4%). Age-specific prevalence rates were 37.9% (14-34 years), 44.6% (35-54 years), 38.5% (55-74 years), and 26.9% (≥75 years). Compared to age group 14-34, participants aged 35-54 were more (OR = 1.29, 95%-CI 1.05-1.60, p = 0.018) and those aged ≥75 were less (OR = 0.55, 95%-CI 0.40-0.76, p 14 days per month. The frequency of headache did not differ significantly between age groups in men [χ2(3, N = 384) = 1.45, p > 0.05], but in women [χ2(3, N = 651) = 21.57, p 14 days per month: 1.8 (14-34 years), 2.5 (35-54 years), 3.2 (55-74 years), and 3.4 (≥75 years), respectively 7.9 (14-34 years), 11.4 (35-54 years), 18.4 (55-74 years), and 22.8 (≥75 years). Conclusions: In general, the prevalence of headache decreases with age. However, older women suffer from more frequent attacks and older participants take analgesics on more days per month than younger participants. This might put them at risk of medication overuse which may lead to medication overuse headache. More research is needed to understand these specifics in headache frequency and treatment behavior in older people.

Background: Headache sufferers in need of professional health care often do not utilize the care available, and factors influencing headache-specific physician consultation are not yet understood. Objectives of this study are (1) to assess self-reported headache-specific physician consultations and (2) to identify headache-related and sociodemographic predictors. Methods: Data of a random sample of the general population in Germany aged ≥14 years were analyzed (N = 2461). A multivariate binary logistic regression was conducted to identify a parsimonious model to predict physician consultation. Results: 50.7% of the participants with headache reported at least one headache-specific physician consultation during lifetime. Of these, 53.6% had seen one, 26.1% two, and 20.3% more than two physicians because of their headaches. The odds of physician consultation increased with the number of headache days per month (HDM) (reference HDM 1) HDM 1–3 (OR = 2.29), HDM 4–14 (OR = 2.41), and HDM ≥15 (OR = 4.83) and increasing Headache Impact Test score (HIT-6) (reference "no or little impact") moderate impact (OR = 1.74), substantial impact (OR = 3.01), and severe impact (OR = 5.08). Middle-aged participants were more likely to have consulted than younger and older ones (reference 14–34 years) 35–54 years (OR = 1.90), 55–74 years (OR = 1.96), ≥75 years (OR = 1.02). The odds of physician consultation among self-employed subjects were lower than among employed manual workers (OR = 0.48). The living environment (rural versus urban) did not have an influence on the consultation frequency. Conclusion: The results indicate that apart from burden-related factors (headache frequency; headache impact), health care utilization patterns are also influenced by patients' occupational status and age. Further research is needed to analyze whether the lower consultation rate means that the self-employed have a higher risk of chronification or that they have more effective self-management strategies regarding headache.

In dem vorliegenden Evaluationsbericht wird der Stand der Doppik-Einführung in den 133 betroffenen Gebietskörperschaften Sachsen-Anhalts untersucht. Hierzu wurden eine quantitative Online-Befragung, vertiefende Interviews und weitere Analysen durchgeführt. Die flächendeckende Einführung der Doppik in den Kom-munen Sachsen-Anhalts zum 01.01.2013 - bzw. 01.01.2014 - konnte nicht realisiert werden. Ein großer Teil der Kommunen - ca. zwei Drittel der über 100 Kommunen, die in der Untersuchung erfasst wurden - hat nach eigenen Angaben die Doppik-Einführung noch nicht abgeschlossen. Die Überschreitung der Stichtage ist aber im Gesamtblick der Reform ein eher nachrangiges Versäumnis. Es ist zu erwarten, dass alle Kommunen, die noch nicht auf die Doppik umgestellt haben, dies in einem angemessenen Zeitraum tun werden. Wie auch in anderen Bundesländern zu beobachten, haben die Kommunen ein Jahr nach dem gesetzlichen Stichtag (zunächst nur) ihr Rechnungswesen umgestellt, während das Ziel einer Verbesserung der kommunalen Steuerung bzw. des kommunalen Managements noch nicht erreicht wurde. Nur in einigen wenigen Kommunen Sachsen-Anhalts lassen sich erste Ansätze für eine Verbesserung der Steuerung ausmachen. Verschiedene Hinweise aus der quantitativen Befragung und den Interviews legen darüber hinaus die Folgerung nahe, dass ein "zweiter Schritt" der Reform, eine systematische Umsetzung einer neuen kommunalen Steuerung, allein aus der Initiative der Kommunen heraus nicht wahrscheinlich ist. Hierdurch entsteht ein erhebliches Risiko, den eigentlichen Nutzen der Reform nicht zu realisieren.