First Georgian headache service on its way this summer

Eastern Europe has been identified as a key area where information on the burden of headache is lacking, hence the decision to select Georgia for a path-finding study in the former USSR. Results were reported in the previous issue of LTB News.

Now it has been found that 13% of the population suffers from migraine, 33% from tension-type headache and 8% from chronic daily headache, with sufferers neglecting their condition as they do not consider it a medical problem. In addition, sufferers experience a lack of medical support and access to suitable treatments.

As a result, Lifting The Burden is supporting the launch of the first headache service in Georgia, in collaboration with the Russian Linguistic Subcommittee of the International Headache Society, chaired by Dr Zaza Katsarava. It hopes to show that developing a headache service according to European Headache Federation (EHF) recommendations and standards requires a relatively low initial investment, but results in an effective and sustainable service that reduces headache-related disability among people with headache.

In total, three headache clinics will be established in separate urban and rural catchment areas:

• in the capital Tbilisi, with 1.5 million inhabitants, the main clinic will be a European Headache Federation level 2-3 clinic. In total, two consultant neurologists, a nurse and physiotherapist will provide care
• in Batumi, a city with 250,000 inhabitants, a level 1-2 clinic is being set up with one consultant neurologist, supported by a nurse
• in Sachkhere, a rural town of 20,000 inhabitants, a level 1 clinic will be run by a physician and nurse.

Each clinic will provide cost-free headache services for three months. Patients will then pay for their further care and medications. The service will be offered primarily to the inhabitants of the catchments areas (48,000 households in total, or 20,000 people).

During the three months' free care period, patients will receive:

• month 1: first contact with a doctor: history and examination, diagnosis, treatment plan, headache diary, educational materials, drugs if needed (domperidone and aspirin or ibuprofen)
• month 2: follow-up contact with doctor: review of headache diary, review of treatment, further drugs as required (domperidone, aspirin or ibuprofen, triptan tablets, atenolol or propranolol or amitriptyline)
• month 3: follow-up contact with nurse (or doctor if necessary): review of headache diary, drugs as for month 2.

Outcomes will be assessed on the basis of headache days per month (recorded in headache diaries), headache-related disability and outcome using Lifting The Burden's HALT and HURT indices, overall wellbeing assessed by SF 12, patient satisfaction (using a questionnaire developed in the Danish Headache Centre, University of Copenhagen), social benefit assessed in health economic terms, service quality measures developed within Lifting The Burden by the Department of Public Health and Primary Care, University of Oxford, and, finally, patients' willingness to pay for further care.

Initial results are expected next year.