The first priority for the campaign has been to know and understand the global burden of headache. This, groundwork for securing recognition that headache disorders are a real and serious problem everywhere, has required multiple initiatives. Key among these has been including headache disorders in the World Health Organization's Neurological Disorders: public health challenges, published in 2007.¹ This detailed policy-supporting review provided confirmation for sufferers, healthcare professionals and policy makers that headache disorders pose a major public health challenge that should no longer be overlooked.

A further publication collating all the available evidence on headache burden in the world found:²

• 46% of adults have an active headache disorder, with 1-year prevalences of 42% for tension-type headache, 11% for migraine and 3% for chronic daily headache

• headache disorders collectively are among the top ten most disabling conditions to live with - and the top five in women

• at a population level, tension-type headache imposes an even greater disability burden than migraine.

The lack of data for some of the world's most populous regions, such as China, India, Russia and the former states of the USSR, and most of Africa, made it apparent that new population-based research was essential to determine the full global impact of headache. So far, Lifting The Burden has completed the first ever headache epidemiology studies in Moldova and Georgia, with data revealing:^3-5

• 54% of the Moldovan population and 58% of the Georgian population had experienced headache within the past year

• In Moldova, 17.5% of the population had migraine, compared with 15.6% in Georgia. For tension-type headache, these figures were 17.9% and 37%, respectively

• Chronic daily headache affected 4.7% of Moldovans and 7.6% of Georgians.

The prevalence of migraine in both countries is on a par with that in other parts of Europe, of chronic daily headache much higher in Georgia, and of tension-type headache considerably lower in Moldova than is reported elsewhere. This last disparity may be a direct result of the low regard in which tension type headache is held in Moldova.

Work in progress

A number of other initiatives have been started to continue cataloguing the impact of headache around the globe:

• In Europe - while prevalence data are readily available in much of Europe, and the number of people suffering from headache is known, the impact of headache upon everyday living is less well documented. Eurolight, a partnership activity within Lifting The Burden, supported by a grant of the EC Public Health Executive Agency, is underway to survey the impact of headache throughout Europe, qualitatively as well as quantitatively

• In Russia - a pilot study has been completed and the full study to measure the population burden of headache is well advanced

• In China - the pilot stage of a similar study, replicating other Lifting The Burden population-based surveys, is also in the completion phase and the main study is commencing now.

Lifting The Burden will review and submit all of these data for inclusion in the Global Burden of Disease Study 2005 (GBD 2005). GBD provides comparative assessments of lost health due to disease and injuries for all regions of the world. Burden of disease is calculated using the Disability-Adjusted Life Year (DALY), a time-based measure that combines years of life lost to premature mortality and years of healthy life lost because of time lived in states of less than full health. Inclusion in GBD 2005 of the burden of all headache, not just migraine as in GBD 2000, is crucial to show the level of priority that headache disorders should be given.

Another WHO initiative that the campaign has supported is a global survey of headache and health care for headache for WHO's Atlas of Headache Disorders. So far, data have been collected from over 100 countries.

Work in planning

Further population-based burden of headache surveys in India, Pakistan, Zambia and Brazil.

• The development of consensus-based guidelines, to be used by researchers everywhere, for the conduct of population-based burden of headache surveys.

• A central WHO database of individual patient data from all the various burden of headache surveys, to be freely available for academic purposes.

• The creation of a headache-specific question set for WHO's International Classification of Functioning, Disease and Health (ICF).

For more information on all these initiatives, see future issues of this newsletter.

References

¹ WHO. Neurological disorders: public health challenges, Geneva: WHO 2007; Martelletti P, Steiner TJ, Bertolote JM, Dua T, Saraceno B. The definitive position of headache among the major public health challenges. An end to the slippery slope of disregard [editorial]. J Headache Pain 2007; 8: 149-151.

² Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher AI et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007;27:193-210.

³ Moldovanu I, Pavlic G, Odobescu S, Rotaru L, Craciun C, Ciobanu L, Corcea G, Steiner T, Katsarava Z. The prevalence of headache disorders in the Republic of Moldova: a population-based study. Cephalalgia 2007; 27: 673.

⁴ Kukava M, Dzagnidze A, Mirvelashvili E, Djibuti M, Fritsche G, Jensen R, Stovner LJ, Steiner TJ, Katsarava Z. Validation of a Georgian language headache questionnaire in a population-based sample. J Headache Pain 2007; 8: 321-324.

⁵ Katsarava Z, Kukava M, Mirvelashvili E, Tavadze A, Dzagnidze A, Djibuti M, Steiner T. Prevalence of headache disorders in the Republic of Georgia: a population based study. Cephalalgia 2007; 27: 699.