title: The burden attributable to headache disorders in India: estimates from a community-based study in Karnataka State.
abstract: BACKGROUND
  Headache disorders are common worldwide, causing pain and disability. India appears to have a very high prevalence of migraine, and of other headache disorders in line with global averages. Our objective was to estimate the burdens attributable to these disorders in order to inform health policy.
  
  
  METHODS
  In a door-to-door survey, biologically unrelated adults (18-65 years) were randomly sampled from urban and rural areas of Bangalore and interviewed by trained researchers. The validated structured questionnaire enquired into several aspects of burden.
  
  
  RESULTS
  Of 2,329 participants (non-participation rate 7.4 %), 1,488 (63.9 %; 621 male, 867 female) reported headache in the preceding year. Symptom burden was high. Migraine (1-year prevalence 25.2 %) occurred on average on 28 days/year but, in 38.0 % of cases (ie, 9.6 % of adults), on ≥3 days/month (≥10 % of days). All causes of headache on ≥15 days/month (prevalence 3.0 %) occurred on a mean of 245 days/year. Both these and migraine were rated severe in intensity. Participants with headache lost 4.3 % of productive time; those with migraine lost 5.8 % (equating to 1.5 % from the adult population). Lost paid worktime accounted for 40 % of this, probably detracting directly from GDP. We estimated population-level disability attributable to migraine using the disability weight from GBD2010 for the ictal state (0.433). Mean disability per person with migraine was 1.8 %, reducing the functional capacity of the entire adult population by 0.46 %. Fewer than one quarter of participants with headache had engaged with health-care services for headache in the last year. Actual expenditure on headache care was greatest among those with headache on ≥15 days/month (especially probable medication-overuse headache), but otherwise not high. Expressed willingness to pay for effective treatment for headache was higher, signalling dissatisfaction with current treatments.
  
  
  CONCLUSIONS
  In Karnataka State, southern India, prevalent headache disorders, especially migraine, give rise to commensurately heavy burdens. Limited access to health care fails to alleviate these. Structured headache services, with their basis in primary care, are the most efficient, effective, affordable and equitable solution. They could be implemented within the health-care infrastructure of India and are likely to be cost-saving. This solution requires political will, itself dependent on awareness.
authors.affiliation: Department of Epidemiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
authors.forename: Girish N
authors.initials: GN
authors.lastname: Rao
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
authors.forename: Girish B
authors.initials: GB
authors.lastname: Kulkarni
authors.affiliation: Department of Epidemiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
authors.forename: Gopalkrishna
authors.initials: G
authors.lastname: Gururaj
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, NO-7491, Trondheim, Norway.|Norwegian Advisory Unit on Headaches, Nevrosenteret Øst, St Olavs University Hospital, Trondheim, Norway.
authors.forename: Lars J
authors.initials: LJ
authors.lastname: Stovner
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, NO-7491, Trondheim, Norway. t.steiner@imperial.ac.uk.|Division of Brain Sciences, Imperial College London, London, UK. t.steiner@imperial.ac.uk.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Steiner
mesh_terms: D000328:Adult; D000368:Aged; D017281:Cost of Illness; D005260:Female; D051270:Headache Disorders, Primary / Q000453:epidemiology*; D051271:Headache Disorders, Secondary / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Burden; Global campaign against headache; Headache disorders; Health policy; India; Medication-overuse headache; Migraine; South-East Asia; Tension-type headache; Willingness to pay