The burden of headache disorders in Nepal: estimates from a population-based survey

The Journal of Headache and Pain

Research Article

Ajay Risal¹  Kedar Manandhar¹  Timothy J. Steiner²  Mattias Linde³ 

[1] Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, 7489, Trondheim, NO, Norway;Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Dhulikhel, Nepal;Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, 7489, Trondheim, NO, Norway;Division of Brain Sciences, Imperial College London, London, UK;Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, 7489, Trondheim, NO, Norway;Norwegian Advisory Unit on Headache, St Olavs University Hospital, Trondheim, Norway;

关键词: Migraine;    Tension-type headache;    Medication-overuse headache;    Public health;    Population-based study;    Burden of disease;    Disability;    Nepal;    South-East Asia region;    Global campaign against headache;   

DOI  :  10.1186/s10194-016-0594-0

 received in 2015-12-15, accepted in 2016-01-21,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundHeadache disorders, particularly migraine and tension-type headache (TTH), are among the most prevalent global public-health problems. Medication-overuse headache (MOH) is a common sequela of mismanagement of these. Migraine and MOH are highly disabling. Formulation of responsive health policy requires reliable, locally-derived, population-based data describing both individual and societal impact of headache disorders. South-East Asia is the only one of WHO’s six world regions in which no such national data have yet been gathered.MethodsIn a nationwide population-based cross-sectional study, a representative sample of Nepalese-speaking adults (18–65 years) were randomly selected by stratified multistage cluster sampling. Trained interviewers made unannounced door-to-door visits and enquired into headache and its attributable burden using a culturally-adapted and validated Nepalese translation of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire.ResultsAmong 2100 participants, 1794 (85.4 %) reported headache during the preceding year (male: 689 [38.4 %], female 1105 [61.6 %]; mean age 36.1 ± 12.6 years). Mean headache frequency was 3.8 ± 6.2 days/month, mean headache intensity 2.1 ± 0.7 on a 0–3 scale, and mean attack duration 41.9 ± 108.5 h. All aspects of symptom burden (frequency, intensity and duration) were greater among females (p < 0.001). Participants with headache had poorer quality of life (QoL) than those without (p < 0.001); QoL was worst among those with probable MOH (pMOH).Mean proportions of total available time spent in the ictal state were 5.4 % among participants with migraine, 3.9 % among those with TTH and 44.7 % among those with pMOH, with headache-related disabilities of 2.4, 0.15 and 9.7 % respectively. At population level, these disorders were responsible for reduced functional capacities of 0.81, 0.06 and 0.20 %. Total lost productive time due to headache was 6.8 % for the 85 % of the population with headache. Males lost more paid worktime than females (p < 0.001); the reverse was so for household worktime (p < 0.001).ConclusionsHeadache disorders, very common in Nepal, are also highly burdensome at both individual and population levels. There is a substantial penalty in lost production. The remedy lies in better health care for headache; structured headache-care services are urgently needed in the country, and likely to be cost-saving.

【 授权许可】

CC BY   
© Manandhar et al. 2016