Abstract
BackgroundHeadache disorders are common worldwide, causing pain and disability. India appears to have a very high prevalence of migraine, and of other headache disorders in line with global averages. Our objective was to estimate the burdens attributable to these disorders in order to inform health policy.MethodsIn a door-to-door survey, biologically unrelated adults (18–65 years) were randomly sampled from urban and rural areas of Bangalore and interviewed by trained researchers. The validated structured questionnaire enquired into several aspects of burden.ResultsOf 2,329 participants (non-participation rate 7.4 %), 1,488 (63.9 %; 621 male, 867 female) reported headache in the preceding year. Symptom burden was high. Migraine (1-year prevalence 25.2 %) occurred on average on 28 days/year but, in 38.0 % of cases (ie, 9.6 % of adults), on ≥3 days/month (≥10 % of days). All causes of headache on ≥15 days/month (prevalence 3.0 %) occurred on a mean of 245 days/year. Both these and migraine were rated severe in intensity.Participants with headache lost 4.3 % of productive time; those with migraine lost 5.8 % (equating to 1.5 % from the adult population). Lost paid worktime accounted for 40 % of this, probably detracting directly from GDP.We estimated population-level disability attributable to migraine using the disability weight from GBD2010 for the ictal state (0.433). Mean disability per person with migraine was 1.8 %, reducing the functional capacity of the entire adult population by 0.46 %.Fewer than one quarter of participants with headache had engaged with health-care services for headache in the last year. Actual expenditure on headache care was greatest among those with headache on ≥15 days/month (especially probable medication-overuse headache), but otherwise not high. Expressed willingness to pay for effective treatment for headache was higher, signalling dissatisfaction with current treatments.ConclusionsIn Karnataka State, southern India, prevalent headache disorders, especially migraine, give rise to commensurately heavy burdens. Limited access to health care fails to alleviate these. Structured headache services, with their basis in primary care, are the most efficient, effective, affordable and equitable solution. They could be implemented within the health-care infrastructure of India and are likely to be cost-saving. This solution requires political will, itself dependent on awareness.
Highlights
Headache disorders are common worldwide, causing pain and disability
The headache screening question (“Have you had headache during the last year?”) and diagnostic questions based on ICHD-II [16] were followed, for those reporting headache, by multiple question sets enquiring into various aspects of burden: symptom burden, lost productive time, health-care utilisation, personal expenditure on health care and willingness to pay for effective care
Migraine was in almost all cases a moderate-to-severe headache, tension-type headache (TTH) mostly mild-to-moderate; headache on ≥15 days/month, including probable MOH (pMOH), was rated severe by two thirds of those affected (Table 1)
Summary
Headache disorders are common worldwide, causing pain and disability. India appears to have a very high prevalence of migraine, and of other headache disorders in line with global averages. The Global Burden of Disease Study 2010 (GBD2010) reported tension-type headache (TTH) as the second most prevalent disorder worldwide and migraine as the third [1], but migraine far outweighs TTH as a cause of disability. The review of surveys by Stovner et al estimated the mean global prevalence of all causes of headache on ≥15 days/month at 3.0 % [7]. It is likely, that very high burdens are attributable to headache in India; but, if so, they are largely disregarded by health services because knowledge of them is not available to inform health policy
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