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The bigger picture

MIGRAINE AND HEADACHE IN ADULTS – A GLOBAL CHALLENGE

Migraine and headache in adults – a global challenge

The World Health Organization (WHO) ranks migraine among the world’s most disabling illnesses. Yet migraine stigma persists. Many people are skeptical about migraine and other headache disorders, which they consider to be “all in your head”, subjective ailments rather than actual clinical entities that can be detected by science. To address the suffering of people with the condition and tackle the crippling global burden of what is a complex clinical entity, there is a huge unmet need for an unbiased, science-led platform.

 

Headache is a global problem

A new review of global headache prevalence shows that more than one in two people globally are affected by migraines or headaches (52%). A limitation is that most of the more than 350 papers included in the review relate to high-income countries. That said, the statistics suggest a global migraine prevalence of 14%. Tension-type headaches affect about 26% of the world population studied. This data is consistent with the latest findings presented in the 2019 Global Burden of Disease study showing that headaches and migraines are by no means imaginary ailments that society should ignore. In light of this latest data, it is reasonable to assume that nearly 16% of people on the planet suffer from headaches on any given day.

 

Significant gender gap

A recent paper by Swiss researchers investigating the gender distribution of migraine and tension headache found significant differences between male and female sufferers – not only in prevalence, but also in terms of comorbidities, disease co-factors and response to treatment. Migraine is significantly more common in women, the research says. Female sufferers are badly affected by the knock-on effects, too. Very commonly, female patients withdraw from society and do not feel that their suffering is taken seriously. In fact, almost 40% of women with the condition avoid telling other people about their headaches. Female migraine patients are also more likely to experience anxiety or depression between attacks. Moreover, women have a consistently higher pain burden than male patients. Similar results have not been uncovered for tension headache.

Migraine often goes undetected in men

Women who see a doctor about migraine symptoms are much more likely than men to be diagnosed correctly with migraine. The authors of the study believe this may be due to the (false) assumption that migraine is a typical "women's disease".

 

Young adults

Health data from more than 50,000 young people analyzed and compared over a period of approximately ten years indicates that the period of transition from adolescence to adulthood presents unique challenges for migraine sufferers. Subjects diagnosed with migraine were two times more likely to develop additional affective or mood disorders in adulthood than subjects in the migraine-free control group. Similarly disturbing findings were made with respect to behavioral disorders and general stress-related susceptibility to illness. The authors urge that these interrelationships should be given greater consideration in the medical management of these patients.

 

Prevention and treatment without pharmaceuticals

Although many studies show that preventive behavioral interventions can be very effective in addressing headache disorders and migraine, patients and healthcare professionals don’t know enough about these options. In a survey of US primary care physicians, one-third of respondents were unaware that the institution responsible for developing guidelines for the prevention and treatment of headache (the American Academy of Neurology) had issued evidence-based guidelines on non-pharmacological treatment methods. Many were equally unfamiliar with the American Headache Society's training materials for clinicians on individual behavioral approaches to headache management.

 

Education and awareness are fundamental

The best thing about behavioral prevention is that education – health literacy – is all you need to implement it effectively and make a lasting impact on people’s lives. If we can improve health literacy to a level where healthcare professionals and patients are making full use of the spectrum of behavior-based migraine and headache prevention strategies, we can prevent a great deal of suffering. Not just the actual physical pain, but the crippling impact on people’s lives. The other beautiful thing is that prevention hinges far less on the resources of national healthcare systems or individual socioeconomic status – paving the way for a truly global approach to the global plague of headache and migraine.

 

  • Caponnetto V, Deodato M, Robotti M, Koutsokera M, Pozzilli V, Galati C, Nocera G, De Matteis E, De Vanna G, Fellini E, Halili G, Martinelli D, Nalli G, Serratore S, Tramacere I, Martelletti P, Raggi A; European Headache Federation School of Advanced Studies (EHF-SAS). Comorbidities of primary headache disorders: a literature review with meta-analysis. J Headache Pain. 2021 Jul 14;22(1):71. doi: 10.1186/s10194-021-01281-z.

    GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020 Oct 17;396(10258):1204-1222. doi: 10.1016/S0140-6736(20)30925-9. Erratum in: Lancet. 2020 Nov 14;396(10262):1562.

    Gerstl L, Tadych N, Heinen F, Kainz C, Bonfert MV, Hannibal I, Huss K, Ruscheweyh R, Straube A, Obermeier V, von Kries R, Landgraf MN. Migraine and the development of additional psychiatric and pain disorders in the transition from adolescence to adulthood. Cephalalgia. 2021 Nov;41(13):1342-1347. doi: 10.1177/03331024211021792. Epub 2021 Jun 23.

    Langenbahn D, Matsuzawa Y, Lee YSC, Fraser F, Penzien DB, Simon NM, Lipton RB, Minen MT. Underuse of Behavioral Treatments for Headache: a Narrative Review Examining Societal and Cultural Factors. J Gen Intern Med. 2021 Oct;36(10):3103-3112. doi: 10.1007/s11606-020-06539-x. Epub 2021 Feb 1.

    Neumeier MS, Pohl H, Sandor PS, Gut H, Merki-Feld GS, Andrée C. Dealing with Headache: Sex Differences in the Burden of Migraine- and Tension-Type Headache. Brain Sci. 2021 Oct 5;11(10):1323. doi: 10.3390/brainsci11101323.

    Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice? J Headache Pain. 2018 Feb 21;19(1):17. doi: 10.1186/s10194-018-0846-2. 2021 Jul 25.

    Stovner LJ, Hagen K, Linde M, Steiner TJ. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain. 2022 Apr 12;23(1):34. doi: 10.1186/s10194-022-01402-2.

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