The burden of headache disorders in India: methodology and questionnaire validation for a community-based survey in Karnataka State

Abstract

Primary headache disorders are a major public-health problem globally and, possibly more so, in low- and middle-income countries. No methodologically sound studies of prevalence and burden of headache in the adult Indian population have been published previously. The present study was a door-to-door cold-calling survey in urban and rural areas in and around Bangalore, Karnataka State. From 2,714 households contacted, 2,514 biologically unrelated individuals were eligible for the survey and 2,329 (92.9 %) participated (1,103 [48 %] rural; 1,226 [52 %] urban; 1,141 [49 %] male; 1,188 [51 %] female; mean age 38.0 years). The focus was on primary headache (migraine and tension-type headache [TTH]) and medication-overuse headache. A structured questionnaire administered by trained lay interviewers was the instrument both for diagnosis (algorithmically determined from responses) and burden estimation. The screening question enquired into headache in the last year. The validation study compared questionnaire-based diagnoses with those obtained soon after through personal interview by a neurologist in a random sub-sample of participants (n = 381; 16 %). It showed high values (>80 %) for sensitivity, specificity and predictive values for any headache, and for specificity and negative predictive value for migraine and TTH. Kappa values for diagnostic agreement were good for any headache (0.69 [95 % CI 0.61–0.76]), moderate (0.46 [0.35–0.56]) for migraine and fair (0.39 [0.29–0.49]) for TTH.The survey methodology, including identification of and access to participants, proved feasible. The questionnaire proved effective in the survey population. The study will give reliable estimates of the prevalence and burden of headache, and of migraine and TTH specifically, in urban and rural Karnataka.

Headache yesterday in Europe

“…Few other data exist on headache on any single day; there is one recent study from mainland China specifically on headache yesterday, reporting an age-adjusted prevalence of 4.8% in the general population aged 18-65 years [13]. This is a little less than one third of our finding, but the estimated 1-year prevalence of headache in China (23.8% [18]) is also about a third of that in Europe [14]. Our finding of 15-17% for headache yesterday in Europe is consistent with the point prevalences (16 and 19%) found in two carefully conducted Danish studies [19,20].…”

Estimating prevalence and burden of major disorders of the brain in Nepal: cultural, geographic, logistic and philosophical issues of methodology

“…Similar studies to this in India [28] and Pakistan [29] have necessitated procedural modifications because of similar sociocultural issues. What is unique about Nepal is the extreme diversity of these, coupled with the equally extreme and highly challenging geoclimatic variation, with the attendant difficulties of transport and access.…”

Quality of life and psychiatric co‑morbidity in Indian migraine patients: A headache clinic sample

“…There is already a much needed population-based study underway investigating QoL in headache patients in Karnataka, India. [11] It shall be interesting to compare the HRQoL impairments of migraineurs in the general population and a headache clinic population.…”

“…Preliminary data from an ongoing population-based study from Karnataka, India suggest that this number could be as high as 23% for Indians. [11] Migraine may thus be a significant public health concern and defining the effect of migraine on HRQoL measures would further quantify the impact of this condition. Such measures are somewhat comparable across other chronic medical conditions and may serve as a guide to healthcare policy making.…”