Migraine and Headache Burden: New WHO Report

Patient Expert

A new report from the World Health Organization (WHO) and Lifting the Burden (LTB) has been released with statistics and information about the world-wide burden of Migraine and other headache disorders. The 35-page report is titled "Atlas of Headache Disorders and Resources in the World 2011."

Dr. Shekhar Saxena of the WHO said,

"Headache and migraine disorders are greatly underrated and underreported by health systems and receive too little attention... Headaches can be debilitating for many people, rendering them unable to work. During migraine attacks, 90 percent of people postpone household chores, almost three-quarters have limited ability to work and half of them miss work entirely... Governments must take the issue more seriously, train health personnel in headache disorder diagnosis and treatment, and ensure appropriate medication is available and used properly."2

Key findings of the report

The burden of Migraine and headache:

  • "Headache disorders, including migraine and tension-type headache, are among the most prevalent disorders of mankind."1
  • One-half to three-quarters of the world's adults aged 18 to 65 have experienced a headache or Migraine in the past year.
  • Ten percent of the world's population have Migraine disease.
  • Between 1.7 and 4% of the adult population have a headache or Migraine 15 or more days a month.
  • "Worldwide, migraine on its own is the cause of 1.3 % of all years of life lost to disability (YLD s). The burden of all headache disorders is substantially higher according to a systematic review of the published literature. Health-policy makers everywhere therefore need to be well informed about headache disorders in their countries. Yet, in many countries, and at least four of the six WHO regions, there are gaps in the knowledge needed to inform health-care policy. More high-quality epidemiological studies are required in order to fill these."1

Diagnosis of Migraine and headache:

  • Most people with Migraine and other headache disorders are not diagnosed by a doctor.

Management of Migraine and headache:

  • Worldwide, it's estimated that 50% of people are self-treating without seeking care from a doctor.
  • Up to 10% of people are treated by neurologists, with the number being lower in Africa and South-East Asia.
  • Migraine, tension-type headache, and the combination of the two are the top three reasons people consult a doctor for headache.
  • The rate at which people consult a specialist for medication overuse headache is related to the income of the country in which they live.
  • Among Migraine abortive medications, ergotamines are more widely available than triptans. Triptans are considered less toxic, but are more expensive.
  • Non-availability of appropriate medications was found to be a barrier to Migraine and headache management in all countries, regardless of income categories. This was most likely referring to limited reimbursement by insurance.

Physician education:

  • "Lack of knowledge among health-care providers is the principal clinical barrier to effective headache management. This problem begins in medical schools where there is limited teaching on the subject, a consequence of the low priority accorded to it."1
  • Worldwide, formal undergraduate medical training included just four hours about headache and Migraine; specialist training included 10 hours.

National professional organizations:

  • National professional organizations dedicated to headache disorders exists in tow-thirds of the countries responding with a marked difference between high- and upper middle-income and low-income countries.

Suggested changes:

The following major changes were suggested to improve Migraine and headache care:

  • professional education was highest on the list
  • raising awareness was second highest
  • improved availability of health care
  • management aids
  • improved reimbursements for care
  • research
  • professional societies
  • advocacy / lobbying
  • creation of lay support groups

The Way Forward

The authors state:

"Headache disorders are ubiquitous, prevalent, disabling and largely treatable, but under-recognized, under-diagnosed and under-treated. Illness that could be relieved is not, and burdens, both individual and societal, persist. Financial costs to society through lost productivity are enormous - far greater than the health-care expenditure on headache in any country.

The following messages, offering guides to the way forward, emerge from the survey reported here.

  • Political Will Is Needed.
  • Knowledge Gaps Must Be Filled.
  • Health Care for Headache Must Be Improved.
  • Headache Services Must Be Organized.
  • Education is Central to Remedial Action.
  • National Professional Organizations Should be Supported.
  • Greater Investment in Headache Services Is Sensible."1

Summary and comments:

None of the information released in this report comes as a surprise. All of it serves as validation of what patients and experts in the field have been saying. What's discouraging is that so little has changed since the WHO issued their report, "Headache Disorders and Public Health: Education and Management Implications," in 2000.

One would think that, given the prevalence and horrible personal burden of Migraine and other headache disorders, more importance would be placed on their treatment. Failing that, one would think that the financial burden these disorders place on our society would cause more attention to be paid. In the long run, I suspect it's going to take a great deal more. I suspect we're going to have to become the noisy, "greasy wheel" and make more and more noise everywhere and every way we can. As opportunities arise to make noise, I'll be sure to blog about them so you can join me. In the meantime, I urge you to click the link below to the "Atlas," download a copy, read it, and familiarize yourself with some of the statistics. Whenever you have a chance to inform others, please take it. Let's work on educating the rest of the world, one person at a time.

About Lifting the Burden:

Lifting the Burden is a nonprofit organization started in 2009. Their stated object is:

"for the benefit of the public, to relieve the suffering caused by headaches of all kinds to people around the world, in particular but not exclusively by

  • measuring and raising awareness of the burdens attributable to headache disorders;
  • planning and helping to plan and implement health-care and educational initiatives that will mitigate these burdens wherever in the world they occur;
  • and collaborating with the World Health Organization and other organizations.

Lifting The Burden pursues these objects by leading the Global Campaign against Headache."

You can find more information about Lifting the Burden on their web site.


Resources:

1 World Health Organization, Lifting the Burden. "Atlas of Headache Disorders and Resources in the World 2011." Geneva. World Health Organization. May, 2011.

2 Kelland, Kate. "WHO report finds headaches have 'enormous' costs." Reuters. May 3, 2011.

3 World Health Organization. "Headache Disorders and Public Health: Education and Management Implications." Geneva. World Health Organization. March, 2000.

Medical review by John Claude Krusz, PhD, MD

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