Abstract
BackgroundThe burden of headache disorders, and of migraine in particular, is multifaceted and fragmented. The aim of this narrative review is to provide a description the main topics underlying the concepts of burden and impact of migraine disorders.Main resultsMedLine has been searched for publications covering the period 1990–2018 dealing with the terms burden or impact of migraine, including both episodic and chronic migraine. The main results and themes are reported in a descriptive way, and were grouped by similarity of content into overarching categories. A total of 49 papers, published over 25 years (1994–2018), were retained for the qualitative analysis. Six main themes were identified: prevalence of migraine disorders, overall impact of migraine disorders, impact on work or school activities, family impact, interictal burden, and disease costs. Majority of included studies concluded that patients with migraine reported an higher burden or impact in one or more of the six main themes herein identified, compared to non-headache patients or to patients with tension-type headache, with a tendency towards worse outcomes consistently with higher headache frequency.ConclusionsThe results of this narrative review show that the meaning of a sentence like “migraine is a burdensome condition” is not univocal: rather, it may refer to different concepts and meanings. In our opinion, future research should focus on understanding and facing the impact of migraine on work-related activities and on everyday life activities, as these aspects are highly connected to some tangible (i.e. cost) and less tangible (i.e. interictal burden and reduced quality of life) facets of migraine burden. Disease-specific measures have been implemented and should be exploited to enhance our understanding of migraine burden. This approach would allow to better understand the real impact on people’s life of such a burdensome disease.
Highlights
The recent report from the Global Burden of Disease (GBD) 2015 Neurological Disorders Collaborator Group shows that a broad group of neurological disorders – i.e. a set of disease categories in which stroke, brain cancers, tetanus, encephalitis and meningitis were added to the usual set of neurological disorders – accounts for 250.7 million Disability-Adjusted Life Years (DALYs), i.e. 10.2% of global DALYs, and it increased by 7.4% in the last 25
As a consequence, addressing the impact of migraine disorders is made difficult by the intrinsic nature of migraine headaches, and by issues connected to the daily tasks patients carry out and that can be to different extents impaired by migraine headaches: patients may be limited in their daily life functioning during ictal phases, and able to perform daily duties with higher capacity during interictal ones
Results show that patients with Episodic Migraine (EM) or Chronic Migraine (CM) reported an higher burden or impact compared to non-headache patients or to patients with tension-type headache (TTH), with a tendency towards worse outcomes that is consistent with headache frequency
Summary
The recent report from the Global Burden of Disease (GBD) 2015 Neurological Disorders Collaborator Group shows that a broad group of neurological disorders – i.e. a set of disease categories in which stroke, brain cancers, tetanus, encephalitis and meningitis were added to the usual set of neurological disorders – accounts for 250.7 million Disability-Adjusted Life Years (DALYs), i.e. 10.2% of global DALYs, and it increased by 7.4% in the last 25A considerable portion of the burden of neurological disease is due to headache disorders: data from GBD 2015 show that tension-type headache (TTH) and migraine are the most common conditions and they account for 60.3% of YLD associated to brain conditionsLeonardi and Raggi The Journal of Headache and Pain (2019) 20:41(respectively, 7.2 and 44.5 million YLDs in 2015). The most used disability measure in migraine, the Migraine Disability Assessment (MIDAS), includes questions on work, homework and leisure time [11] Each of these macro-areas – and the work-related ones in particular – are constituted by several sub-components dealing with specific activities connected to body movements (e.g. lifting objects, walking or driving) as well as skills connected to communication and entering into relation with others [12–14]. These difficulties clearly depend on migraine features, in terms of frequency as well as of symptoms severity, but are highly dependent on several person-level features, e.g. patients’ lifestyle, and on the features of their jobs and of the environment in which they live. Majority of included studies concluded that patients with migraine reported an higher burden or impact in one or more of the six main themes identified, compared to non-headache patients or to patients with tension-type headache, with a tendency towards worse outcomes consistently with higher headache frequency
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