Abstract
BackgroundMigraine, tension-type headache (TTH) and medication-overuse headache (MOH) are disabling lifelong illnesses. The Eurolight project, a partnership activity within the Global Campaign against Headache, assessed the impact of headache disorders in ten countries in Europe using a structured questionnaire coupled with various sampling methods. Here we present the findings from the Italian population.MethodsQuestionnaires were distributed to a stratified sample (N = 3500) of the adult (18–65 years) inhabitants of Pavia province (1.05 % of the general population), randomly selected in cooperation with the local health service. Questions included demographic and diagnostic enquries, and assessment of various aspects of impact and health-care utilisation.ResultsAltogether 500 questionnaires were returned of which 487 were adequately completed for analysis (58 % female, 42 % male). Among these, gender-adjusted lifetime prevalence of headache was 82.5 %, higher in females than in males (91.2 % vs 72.4 %; p < 0.0001). Gender-adjusted 1-year prevalence was 74.2 % (females 87.7 %, males 61.1 %; p < 0.0001). The most prevalent headache type was migraine (gender-adjusted 1-year prevalence 42.9 %; females 54.6 %, males 32.5 %; p < 0.0001), followed by TTH (28.6 %; no gender-related difference); all causes of headache on ≥15 days/month were reported by 7.0 % of participants (females 10.6 %, males 2.0 %; p = 0.0002), of whom 2.1 %,, all female (p = 0.0064) concomitantly overused acute medications (therefore probable MOH). Only 16.6 % of responders reporting headache had received a diagnosis from a doctor, and very few (2.4 %) were taking preventative medications. Headache had negative impacts on different aspects of life: education, career and earnings, family and social life. Each person with headache had lost, on average, 2.3 days from paid work and 2.4 days from household work, and missed social occasions on 1.2 days, in the preceding 3 months. An increasing gradient for impact was observed from episodic to chronic forms of headache.ConclusionsOur study reveals that in Italy, as in other countries, migraine, TTH and MOH are highly prevalent and are associated with significant personal impact. These findings have important implications for health policy in Italy.
Highlights
Migraine, tension-type headache (TTH) and medication-overuse headache (MOH) are disabling lifelong illnesses
On a clinical level it has long been evident that primary headache disorders, migraine and tension-type headache (TTH) in particular, are often lifelong illnesses which, as well as directly causing pain and disability, hinder family and social relationships and impoverish quality of life
Spread between the entire sample of 487, this would represent a huge 3.1 % loss to gross domestic product (GDP). Much of this was attributable to the highly-disabled small minority – the 20 people (4.1 % of the sample) losing >10 days and, the eight of these (1.6 %) losing >30 days. We suspect this finding was influenced by interest bias; since losses at individual level were greater from migraine than from TTH, we suggest a conservative downrating of the estimate by one third, in line with the prevalence estimate of Ferrante et al [24] rather than our own
Summary
Tension-type headache (TTH) and medication-overuse headache (MOH) are disabling lifelong illnesses. On a clinical level it has long been evident that primary headache disorders, migraine and tension-type headache (TTH) in particular, are often lifelong illnesses which, as well as directly causing pain and disability, hinder family and social relationships and impoverish quality of life. Population-based studies in China [8], India [9] and Russia [10] in time for inclusion in the Global Burden of Disease study 2010 (GBD2010) [11] saw migraine recognised as the seventh cause of disability worldwide, with a mean estimated global prevalence of 14.7 % among adults [11, 12]. TTH was considered relatively non-disabling but, collectively, headache disorders ranked third [14]
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