title: Impact of headache disorders in Italy and the public-health and policy implications: a population-based study within the Eurolight Project.
abstract: BACKGROUND
  Migraine, tension-type headache (TTH) and medication-overuse headache (MOH) are disabling lifelong illnesses. The Eurolight project, a partnership activity within the Global Campaign against Headache, assessed the impact of headache disorders in ten countries in Europe using a structured questionnaire coupled with various sampling methods. Here we present the findings from the Italian population.
  
  
  METHODS
  Questionnaires were distributed to a stratified sample (N = 3500) of the adult (18-65 years) inhabitants of Pavia province (1.05 % of the general population), randomly selected in cooperation with the local health service. Questions included demographic and diagnostic enquries, and assessment of various aspects of impact and health-care utilisation.
  
  
  RESULTS
  Altogether 500 questionnaires were returned of which 487 were adequately completed for analysis (58 % female, 42 % male). Among these, gender-adjusted lifetime prevalence of headache was 82.5 %, higher in females than in males (91.2 % vs 72.4 %; p < 0.0001). Gender-adjusted 1-year prevalence was 74.2 % (females 87.7 %, males 61.1 %; p < 0.0001). The most prevalent headache type was migraine (gender-adjusted 1-year prevalence 42.9 %; females 54.6 %, males 32.5 %; p < 0.0001), followed by TTH (28.6 %; no gender-related difference); all causes of headache on ≥15 days/month were reported by 7.0 % of participants (females 10.6 %, males 2.0 %; p = 0.0002), of whom 2.1 %,, all female (p = 0.0064) concomitantly overused acute medications (therefore probable MOH). Only 16.6 % of responders reporting headache had received a diagnosis from a doctor, and very few (2.4 %) were taking preventative medications. Headache had negative impacts on different aspects of life: education, career and earnings, family and social life. Each person with headache had lost, on average, 2.3 days from paid work and 2.4 days from household work, and missed social occasions on 1.2 days, in the preceding 3 months. An increasing gradient for impact was observed from episodic to chronic forms of headache.
  
  
  CONCLUSIONS
  Our study reveals that in Italy, as in other countries, migraine, TTH and MOH are highly prevalent and are associated with significant personal impact. These findings have important implications for health policy in Italy.
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia (I), Italy.
authors.forename: M
authors.initials: M
authors.lastname: Allena
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, NO-7491, Norway.|Division of Brain Sciences, Imperial College London, London, UK.
authors.forename: T J
authors.initials: TJ
authors.lastname: Steiner
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia (I), Italy.
authors.forename: G
authors.initials: G
authors.lastname: Sances
authors.affiliation: Azienda Sanitaria Locale (ASL), Pavia, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Carugno
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia (I), Italy.
authors.forename: F
authors.initials: F
authors.lastname: Balsamo
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia (I), Italy.
authors.forename: G
authors.initials: G
authors.lastname: Nappi
authors.affiliation: Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Andrée
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia (I), Italy. Cristina.tassorelli@mondino.it.|Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy. Cristina.tassorelli@mondino.it.
authors.forename: C
authors.initials: C
authors.lastname: Tassorelli
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D005260:Female; D020773:Headache Disorders / Q000453:epidemiology*; D051271:Headache Disorders, Secondary / Q000453:epidemiology; D006291:Health Policy; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015995:Prevalence; D011634:Public Health; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D018781:Tension-Type Headache / Q000453:epidemiology; D055815:Young Adult
keywords: Disability; Global campaign against headache; Health policy; Impact; Italy; Lost productivity; Medication-overuse headache; Migraine; Tension-type headache