title: The burden of headache disorders in Pakistan: methodology of a population-based nationwide study, and questionnaire validation.
abstract: BACKGROUND
  Large geographical gaps in our knowledge of the prevalence and burden of headache disorders include Pakistan, a country with major problems of poverty, illiteracy and security. We report implementation in this country of standard methods developed by Lifting The Burden (LTB) for population-based burden-of-headache studies.
  
  
  METHODS
  We surveyed six locations from the four provinces: Lahore and Multan (Punjab), Karachi and Sukkur (Sindh), Abbottabad (Khyber Pakhtunkhwa) and Gwadar (Baluchistan). We randomly selected rural and urban households in each, which were visited by trained non-medical interviewers from the same locations. One randomly selected adult member (18-65 years) of each household was interviewed using LTB's structured questionnaire translated into Urdu, the national language. Validation was performed among patients and accompanying attendants in three (urban and rural) medical facilities. After responding to the questionnaire, these participants were re-interviewed and diagnosed by a neurologist (gold standard).
  
  
  RESULTS
  The survey was completed by 4,223 respondents (1,957 [46.3%] male, 2,266 [53.7%] female, 1,443 [34.2%] urban, 2,780 [65.8%] rural, mean age 34.4 ± 11.0 years). The participation rate was 89.5%. There were 180 participants (46.1% male, 53.9% female, 41.7% urban, 58.3% rural, mean age 39.4 ± 14.2 years) in the validation sample, of whom 147 (81.7%) reported headache in the last year. The questionnaire was 100% sensitive in screening for headache and for headache on ≥15 days/month, and showed good agreement with the gold-standard diagnoses (kappa = 0.77). It was relatively insensitive for TTH. The questionnaire's default diagnosis of probable MOH when medication overuse accompanied headache on ≥15 days/month was not supported by evidence of causation in most cases seen by the neurologist. In public-health terms, precise diagnosis in these cases matters less than reliably detecting the coexistence of these disorders.
  
  
  CONCLUSIONS
  In conclusion, the methods developed by LTB were applied successfully in Pakistan, despite problems unique to this country.
authors: Arif D
authors: AD
authors: Herekar
authors: Akbar A
authors: AA
authors: Herekar
authors: Ali
authors: A
authors: Ahmad
authors: Umer L
authors: UL
authors: Uqaili
authors: Bilal
authors: B
authors: Ahmed
authors: Jahanzeb
authors: J
authors: Effendi
authors: Syed Z
authors: SZ
authors: Alvi
authors: Timothy J
authors: TJ
authors: Steiner
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003710:Demography; D005260:Female; D020773:Headache Disorders / Q000453:epidemiology*; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D011795:Surveys and Questionnaires
references: Psychol Med. 1998 May;28(3):551-8
references: 9626712
references: J Headache Pain. 2005 Oct;6(5):373-7
references: 16362709
references: J Headache Pain. 2011 Apr;12(2):141-6
references: 21452008
references: J Headache Pain. 2011 Jun;12(3):273-4
references: 21512775
references: Eur J Neurol. 2011 Mar;18(3):454-9
references: 20722704
references: Headache. 1991 May;31(5):290-5
references: 1860786
references: J Headache Pain. 2012 Oct;13(7):543-50
references: 22911168
references: Lancet. 2012 Dec 15;380(9859):2163-96
references: 23245607
references: Cephalalgia. 2013 Jul;33(9):629-808
references: 23771276
references: Cephalalgia. 2004;24 Suppl 1:9-160
references: 14979299
references: J Headache Pain. 2013 Jan 10;14:1
references: 23566305
references: Lancet Neurol. 2004 Apr;3(4):204-5
references: 15039030
references: Biometrics. 1977 Mar;33(1):159-74
references: 843571