The burden attributable to headache disorders in India: estimates from a community-based study in Karnataka State View Full Text


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Article Info

DATE

2015-12

AUTHORS

Girish N. Rao, Girish B. Kulkarni, Gopalkrishna Gururaj, Lars J. Stovner, Timothy J. Steiner

ABSTRACT

BACKGROUND: 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. Our objective was to estimate the burdens attributable to these disorders in order to inform health policy. METHODS: In 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. RESULTS: Of 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. CONCLUSIONS: In 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. More... »

PAGES

94

References to SciGraph publications

  • 2010-12. Lifting The Burden: the first 7 years in THE JOURNAL OF HEADACHE AND PAIN
  • 2011-08. Recommendations for headache service organisation and delivery in Europe in THE JOURNAL OF HEADACHE AND PAIN
  • 2014-12. The methodology of population surveys of headache prevalence, burden and cost: Principles and recommendations from the Global Campaign against Headache in THE JOURNAL OF HEADACHE AND PAIN
  • 2014-12. Diagnosis, prevalence estimation and burden measurement in population surveys of headache: presenting the HARDSHIP questionnaire in THE JOURNAL OF HEADACHE AND PAIN
  • 2015-12. Cost-effectiveness analysis of interventions for migraine in four low- and middle-income countries in THE JOURNAL OF HEADACHE AND PAIN
  • 2012-01. Will (or can) people pay for headache care in a poor country? in THE JOURNAL OF HEADACHE AND PAIN
  • 2013-12. Migraine: the seventh disabler in THE JOURNAL OF HEADACHE AND PAIN
  • 2015-12. Headache disorders and public ill-health in India: prevalence estimates in Karnataka State in THE JOURNAL OF HEADACHE AND PAIN
  • 2011-06. The Global Campaign, World Health Organization and Lifting The Burden: collaboration in action in THE JOURNAL OF HEADACHE AND PAIN
  • 2015-12. The burden of primary headache disorders in Zambia: national estimates from a population-based door-to-door survey in THE JOURNAL OF HEADACHE AND PAIN
  • 2012-10. The burden of headache disorders in India: methodology and questionnaire validation for a community-based survey in Karnataka State in THE JOURNAL OF HEADACHE AND PAIN
  • 2005-10. Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide in THE JOURNAL OF HEADACHE AND PAIN
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    http://scigraph.springernature.com/pub.10.1186/s10194-015-0574-9

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    http://dx.doi.org/10.1186/s10194-015-0574-9

    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/26553066


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        "description": "BACKGROUND: 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. Our objective was to estimate the burdens attributable to these disorders in order to inform health policy.\nMETHODS: In 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.\nRESULTS: Of 2,329 participants (non-participation rate 7.4\u00a0%), 1,488 (63.9\u00a0%; 621 male, 867 female) reported headache in the preceding year. Symptom burden was high. Migraine (1-year prevalence 25.2\u00a0%) occurred on average on 28\u00a0days/year but, in 38.0\u00a0% of cases (ie, 9.6\u00a0% of adults), on \u22653\u00a0days/month (\u226510\u00a0% of days). All causes of headache on \u226515\u00a0days/month (prevalence 3.0\u00a0%) occurred on a mean of 245\u00a0days/year. Both these and migraine were rated severe in intensity. Participants with headache lost 4.3\u00a0% of productive time; those with migraine lost 5.8\u00a0% (equating to 1.5\u00a0% from the adult population). Lost paid worktime accounted for 40\u00a0% 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\u00a0%, reducing the functional capacity of the entire adult population by 0.46\u00a0%. 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 \u226515\u00a0days/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.\nCONCLUSIONS: In 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.", 
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