WHO Finds Headache Disorders Neglected Worldwide

Emma Hitt, PhD

May 09, 2011

May 9, 2011 — Worldwide, headache disorders are prevalent but not sufficiently recognized, diagnosed, and treated, according to a new report released by the World Health Organization (WHO).

The WHO and the group called Lifting the Burden: The Global Campaign Against Headache published outcomes of their collaborative investigation as "Atlas of Headache Disorders and Resources in the World 2011" on the WHO Web site.

"This first global enquiry…illuminates the worldwide neglect of a major public-health problem, and reveals the inadequacies of responses to it in countries throughout the world," the authors write in their description of the burden, diagnosis, and management of headache disorders in 101 countries.

Information was obtained in a questionnaire survey of neurologists, general practitioners, and patient representatives conducted from 2006 to 2009. These findings were combined with epidemiologic data from published studies and from population-based studies of the Global Campaign.

Underdiagnosis, Self-Treatment

Findings show that 10% of adults worldwide suffer from migraine, and 1.7% to 4% of adults have headache on more than 15 days per month. Yet, only 40% of patients with migraine and tension-type headache and 10% of patients with medication-overuse headache are professionally diagnosed.

Half of all patients with headache use self-treatment. In 55% of responding countries, those seeking professional care are managed according to guidelines, but such care is much less common in low-income countries.

In addition, despite there being a "range of drugs with efficacy against headache, countries in all income categories identify non-availability of appropriate medication as a barrier to best management," the authors note. Furthermore, "lack of education is seen as the key issue impeding good management of headache" — worldwide, only 4 hours of undergraduate and 10 hours of specialist training are committed to headache disorders.

National professional headache organizations exist in most high- and upper-middle-income countries (71%-76%) but in few low-income countries (16%). However, only 10% and 20% of organizations participate in formulating undergraduate and postgraduate curricula on headache, respectively.

Information on the societal impact of headache exists in 18% of countries that responded. Headache disorders appear in annual health reporting systems of 12% of countries and in national expenditure surveys of 7% of countries. However, according to the study, the financial costs to society through lost productivity are "enormous — far greater than the health-care expenditure on headache in any country," the authors write.

"Health-care providers need better knowledge of how to diagnose and treat the small number of headache disorders that contribute substantially to public ill-health," the authors conclude. "Given the very high indirect costs of headache, greater investment in health care that treats headache effectively, through well-organized health services and supported by education, may well be cost-saving overall."

Headache Education Inadequate

Randolph W. Evans, MD, clinical professor of neurology at Baylor College of Medicine in Houston, Texas, noted that the report is a compilation of epidemiologic studies on the worldwide prevalence of migraine, tension, and medication overuse headaches and new studies on diagnosis and treatment patterns (acute and preventive medications) by primary care physicians and neurologists.

"The studies detail the high global burden of primary headaches such as migraine, underdiagnosis, and undertreatment," he told Medscape Medical News.

According to Dr. Evans, physicians worldwide, including in the United States, have only several hours of medical school education on headaches.

"Even in neurology, headache education may be inadequate. In addition, cost may be a barrier for access to physicians and medications in much of the world, whereas increasing use of treatment guidelines worldwide may improve care," he said.

"Growing awareness of the huge global scope of primary headache will hopefully lead to more headache education of physicians and other healthcare providers and allocation of more research funds," he added.

The report was not commercially funded. Dr. Evans has disclosed no relevant financial relationships; he is an uncompensated member of the editorial advisory board for Medscape Neurology.

WHO Atlas of Headache Disorders and Resources in the World 2011

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