Barriers to headache care in low- and middle-income countries

Mortel, Dominique; Kawatu, Nfwama; Steiner, Timothy J.; Saylor, Deanna

doi:10.1016/j.ensci.2022.100427

Cited by 15 publications

(15 citation statements)

References 36 publications

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“…the trust in traditional healers and distrust in modern medicine) not just results in delayed, missed/ or mistaken diagnoses, but also results in individuals failing to receive medically proven treatments. 24 About 95% of headaches seen in practice are primary headaches, yet they are not considered a serious problem warranting attention because they are not life-threatening, and do not cause permanent disability. They are often neglected with no specific diagnosis and treatment and is managed sub optimally many a times.…”

Section: Burden Of Headachementioning

confidence: 99%

Deciphering optimal management options for headache

Bangale¹,

Erande²,

Sundar³

et al. 2023

IJN

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Headache is one of the most common, painful, and disabling conditions that affects people of all ages worldwide and can have a substantial impact on quality of life of those affected. Stress is one of their main aggravating factor for headache across geographies, more so in millennials and females. Headache disorders are most troublesome in the productive years of life with lost working days and reduced productivity. Majority of those with headache have primary headache disorder especially migraine, tension-type headache and medication-overuse headache. Without proper treatment, headaches can be severe and interfere with day-to-day activities and can also become chronic or recurring affecting the well-being of an individual and predispose them to other illnesses. Self-care with simple analgesics in managing primary headache disorders can help reduce frequency of attack and severity with positive effect on physical symptoms and functional capacity. Paracetamol (acetaminophen) is a safe analgesic with good gastrointestinal tolerance and is recommended as 1 line treatment option to reduce pain in various conditions including primary headache disorders. Caffeine, a common additive to analgesic drugs is known to increase the analgesic potency. The anti-nociception enhancing effect of caffeine when given with acetaminophen significantly improves efficacy over use of only paracetamol.

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Section: Burden Of Headachementioning

confidence: 99%

Deciphering optimal management options for headache

Bangale¹,

Erande²,

Sundar³

et al. 2023

IJN

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“…These studies all reflected practice in highincome countries. The literature is sparse on the usage of preventatives in low-to-middle-income countries, but it is likely to be much lower, and such evidence as there is supports this [46,51].…”

Section: Migraine Preventatives Are Greatly Underutilizedmentioning

confidence: 99%

The relationship between headache-attributed disability and lost productivity: 3 Attack frequency is the dominating variable

2023

Self Cite

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Background In an earlier paper, we examined the relationship between headache-attributed disability, measured as proportion of time in ictal state, and lost productivity. In a linear model, we found positive and significant associations with lost paid worktime, lost household worktime and total lost productivity (paid + household), but with high variance, which was increased when headache intensity was introduced as a factor. We speculated that analyses based on headache frequency alone as the independent variable, eliminating both the subjectivity of intensity estimates and the uncertainties of duration, might show stronger associations. Methods Focusing on migraine, we used individual participant data from 16 countries surveyed either in population-based studies or in the Eurolight project. These data included frequency (headache days/month), usual attack duration (hours), usual headache intensity (“not bad”, “quite bad”, “very bad”) and lost productivity from paid and household work according to enquiries using the Headache-Attributed Lost Time (HALT) questionnaire. We used multiple linear regressions, calculating regression equations along with unstandardized and standardized regression coefficients. We made line and bar charts to visualize relationships. Results Both frequency and intensity were significant predictors of lost productivity in all multiple linear regressions, but duration was a non-significant predictor in several of the regressions. Predicted productivity in paid work decreased among males by 0.75–0.85 days/3 months for each increase of 1 headache day/month, and among females by 0.34–0.53 days/3 months. In household chores, decreases in productivity for each added day/month of headache were more similar (0.67–0.87 days/3 months among males, 0.83–0.89 days/3 months among females). Visualizations showed that the impact of duration varied little across the range of 2–24 h. The standardized regression coefficients demonstrated that frequency was a much better predictor of lost productivity than intensity or duration. Conclusion In the relationship between migraine-attributed impairment (symptom burden) and lost productivity, frequency (migraine days/month) is the dominating variable – more important than headache intensity and far more important than episode duration. This has major implications for current practice in headache care and for health policy and health-resource investment. Preventative drugs, grossly underutilized in current practice, offer a high prospect of economic benefit (cost-saving), but new preventative drugs are needed with better efficacy and/or tolerability.

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“…These studies all re ected practice in high-income countries. The literature is sparse on the usage of preventatives in low-to-middleincome countries, but it is likely to be much lower, and such evidence as there is supports this [48,53].…”

Section: Migraine Preventatives Are Greatly Underutilizedmentioning

confidence: 99%

The relationship between headache- attributed disability and lost productivity. 3. Attack frequency is the dominating variable

Husøy

Katsarava²,

Steiner

2022

Preprint

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Background In an earlier paper, we examined the relationship between headache-attributed disability, measured as proportion of time in ictal state (pTIS), and lost productivity. In a linear model, we found positive and significant associations with lost paid worktime, lost household worktime and total lost productivity (paid + household), but with high variance, which was increased when headache intensity was introduced as a factor. We speculated that analyses based on headache frequency alone as the independent variable, eliminating both the subjectivity of intensity estimates and the uncertainties of duration, might show stronger associations. Methods Focusing on migraine, we used individual participant data (IPD) from 16 countries surveyed either in population-based studies or in the Eurolight project. These data included frequency (headache days/month), usual attack duration (hours), usual headache intensity (“not bad”, “quite bad”, “very bad”) and lost productivity from paid and household work according to enquiries using the Headache-Attributed Lost Time (HALT) questionnaire. We used multiple linear regressions, calculating regression equations along with unstandardized and standardized regression coefficients. We made line and bar charts to visualize relationships. Results There was no collinearity between the independent variables. Both frequency and intensity were highly significant predictors of lost productivity in all multiple linear regressions, with linear relationships in both genders between frequency and lost productivity from both paid and household work. Visualizations showed that relationships between intensity and lost productivity were more or less linear in both genders, while the impact of duration varied little across the range of 2–24 hours. The standardized regression coefficients demonstrated that frequency was a much better predictor of lost productivity from paid work than intensity or duration. Conclusion In the relationship between migraine-attributed impairment (symptom burden) and lost productivity, frequency (migraine days/month) is the dominating variable – more important than headache intensity and far more important than episode duration. This has major implications for current practice in headache care and for health policy and health-resource investment. Preventative drugs, grossly underutilized in current practice, offer a high prospect of economic benefit (cost-saving), but new preventative drugs are needed with better efficacy and/or tolerability.

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Barriers to headache care in low- and middle-income countries

Cited by 15 publications

References 36 publications

Deciphering optimal management options for headache

Deciphering optimal management options for headache

The relationship between headache-attributed disability and lost productivity: 3 Attack frequency is the dominating variable

The relationship between headache- attributed disability and lost productivity. 3. Attack frequency is the dominating variable

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