The second phase of Lifting The Burden is to use knowledge of the burden of headache acquired from these studies to raise awareness of these disorders, not just among those who suffer but, more importantly, targeting health-care providers and policy makers, ensuring that headache disorders are recognised for their huge economic and humanitarian impact.

The third phase is to work with local agencies in the pursuit and achievement of beneficial change, so those with headache get access to the services and treatment they need to alleviate their personal headache burdens.

To facilitate these, Lifting The Burden has been involved in several initiatives to improve knowledge and understanding of headache disorders. One such activity is the Masters Degree course in headache medicine, an annual train-the-trainers programme at La Sapienza University, Rome. In addition, proposals for the delivery and organisation of headache services across Europe have been developed.⁶

Lifting the Burden has also created a series of tools to help health-care professionals provide support for headache sufferers:

• diagnostic criteria for headache in primary care - these are a cut down version of the International Classification of Headache Disorders (ICHD-II)

• an impact measure - The Headache-Attributed Lost Time (HALT) index - to help health-care professionals assess individual headache burden in a sufferer before devising a management plan⁷

• an outcome measure - the Headache Under-Response to Treatment (HURT) index - a vital management aid for the primary health-care provider in determining when treatment is sub-optimal and how it should be improved. This is currently undergoing clinical utility evaluation in Denmark, Italy, Germany, Saudi Arabia and the UK

• cornerstone management principles for common headache disorders in primary care. These have initially been produced for Europe only⁸

• an information sheet on headache disorders for primary care physicians

• a set of peer-reviewed patient information leaflets for distribution by primary care physicians to patients at the time of diagnosis and follow-up. These so far cover: migraine, tension-type headache, cluster headache, chronic daily headache, headache and female hormones and self-help.

Work in planning

• The first interventional project, consisting of three headache clinics in Georgia, where there have previously been no headache services available. These will run in three areas: the capital Tbilisi, a small town and a rural area, and will be a testing ground for projects elsewhere.

• Studies to produce empirical evidence that provision of effective health care for headache reduces indirect costs. Such evidence is essential to persuade policy makers and Governments that headache service expenditure delivers economic as well as health benefits.

• Creation of a computer-assisted diagnostic algorithm for primary care, tested for clinical utility.

• Field-testing in UK (a well-resourced country) and in Republic of Georgia (a medium-resourced country) of European proposals for headache service delivery and organisation.

• Proposals for headache service delivery and organisation in countries in Africa, a poorly-resourced area.

• Validated methodology for evaluating the quality of headache services.

Information about all of these initiatives will be covered in more detail in future issues of this newsletter.

References

⁶ Antonaci F, Valade D, Lanteri-Minet M, Láinez JM, Jensen J, Steiner TJ on behalf of the European Headache Federation and Lifting The Burden: the Global Campaign to Reduce the Burden of Headache Worldwide. Proposals for the organisation of headache services in Europe. Eur J Int Med (in press).

⁷ Steiner TJ. The HALT and HART indices. J Headache Pain 2007; 8 suppl 1: S22-S25.

⁸ Steiner TJ, Paemeleire K, Jensen R, Valade D, Savi L, Lainez MJA, Diener H-C, Martelletti P, Couturier EGM on behalf of the European Headache Federation and Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide. European principles of management of common headache disorders in primary care. J Headache Pain 2007; 8 suppl 1: S3-21.