Why Isn't Headache Better Treated?
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"Good health care can alleviate much of the symptom burden of most headache disorders ... [yet] very large numbers of people troubled or disabled by headache do not receive effective health care."
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Not surprisingly, headache is high among causes of consulting both general practitioners and neurologists.
Good health care can, in fact, alleviate much of the symptom burden of most headache disorders. Effective health care can thus mitigate both the humanitarian and the financial costs that arise from them.
The essential components of effective health care for headache are five-fold:
- awareness of the problem;
- correct recognition and diagnosis;
- avoidance of mismanagement;
- appropriate lifestyle modifications;
- informed use of cost-effective pharmaceutical remedies.
None of these is beyond the capabilities of primary care. For the vast majority of those who need it – people whose quality of life is spoiled by headache – effective treatment requires no expensive equipment, tests or specialists.
Health-care failure
Efficacious therapies exist, but this solution depends not only on the existence of these: health-care resources must be allocated and health-care systems put in place so that these therapies are delivered to all who need them.
There is good evidence that this happens partially at best, and in many places not at all [reference 1]. Very large numbers of people troubled or disabled by headache do not receive effective health care.
The barriers responsible for this vary throughout the world, but they may be classified as clinical, social or political/economic.
Clinical barriers
Lack of knowledge among health-care providers is the principal clinical barrier to effective headache management. This problem begins in medical schools, where there is limited teaching on the subject (on average, 4 hours in a course of 4-6 years' duration [reference 1]).
Clinical barriers are likely to be most pronounced in countries with least resources and, as a result, more limited access generally to health care.
Social barriers
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Failure of people affected by headache to seek medical care is the most common and perhaps highest barrier to effective care.
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Headache disorders are not seen by the public as serious since they are mostly episodic, do not cause death and are not contagious. In fact, headaches are often trivialized as "normal", a minor annoyance or an excuse to avoid responsibility. These social barriers deter people who might otherwise seek help from doctors for high levels of pain and disability.
Even people directly affected by headache disorders have poor understanding of them. In a Japanese study, for example, many were unaware their headaches were migraine, or that this was a specific illness requiring medical care [reference 2]. The low consultation rates in developed countries suggest many people with headache do not realise that effective treatments exist.
Again, the situation is unlikely to be better where resources are more limited.
Political/economic barriers
Many governments do not acknowledge the substantial burden of headache on society – and may even be unaware of it.
They fail to recognize that the costs of treating headache are small in comparison with the huge savings that might be made (for example, by reducing lost working days) if resources were allocated to treat headache disorders appropriately.
Once again, these barriers are likely to be greater in countries where resources generally are more limited.
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"The principal reason why the burdens attributable to headache persist, and indirect costs remain so high, is failure of health-care systems to provide the simple measures that effective headache management requires."
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Education failure
Thus the principal reason why the burdens attributable to headache persist, and indirect costs remain so high, is failure of health-care systems to provide the simple measures that effective headache management requires.
The key factor underlying this public-health disaster is education failure at every level [reference 1].
- Lack of awareness and understanding of headache disorders among the general public allows myths to persist that they are not real and not worthy of medical attention.
- Lack of inclusion of diagnosis and management of headache disorders in the training curricula of health-care providers leaves them unskilled and therefore unwilling to offer health care in this field.
- Lack of recognition of the humanitarian burden and socioeconomic cost attributable to headache disorders leads health-policy makers grossly to misjudge the priority due to them.
References
1. World Health Organization. Atlas of headache disorders and resources in the World 2011. Geneva: WHO 2011.
2. Takeshima T et al. Population-based door-to-door survey of migraine in Japan: the Daisen study. Headache 2004; 44: 8-19.