title: The burden of headache disorders in Nepal: estimates from a population-based survey.
abstract: BACKGROUND
  Headache disorders, particularly migraine and tension-type headache (TTH), are among the most prevalent global public-health problems. Medication-overuse headache (MOH) is a common sequela of mismanagement of these. Migraine and MOH are highly disabling. Formulation of responsive health policy requires reliable, locally-derived, population-based data describing both individual and societal impact of headache disorders. South-East Asia is the only one of WHO's six world regions in which no such national data have yet been gathered.
  
  
  METHODS
  In a nationwide population-based cross-sectional study, a representative sample of Nepalese-speaking adults (18-65 years) were randomly selected by stratified multistage cluster sampling. Trained interviewers made unannounced door-to-door visits and enquired into headache and its attributable burden using a culturally-adapted and validated Nepalese translation of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire.
  
  
  RESULTS
  Among 2100 participants, 1794 (85.4 %) reported headache during the preceding year (male: 689 [38.4 %], female 1105 [61.6 %]; mean age 36.1 ± 12.6 years). Mean headache frequency was 3.8 ± 6.2 days/month, mean headache intensity 2.1 ± 0.7 on a 0-3 scale, and mean attack duration 41.9 ± 108.5 h. All aspects of symptom burden (frequency, intensity and duration) were greater among females (p < 0.001). Participants with headache had poorer quality of life (QoL) than those without (p < 0.001); QoL was worst among those with probable MOH (pMOH). Mean proportions of total available time spent in the ictal state were 5.4 % among participants with migraine, 3.9 % among those with TTH and 44.7 % among those with pMOH, with headache-related disabilities of 2.4, 0.15 and 9.7 % respectively. At population level, these disorders were responsible for reduced functional capacities of 0.81, 0.06 and 0.20 %. Total lost productive time due to headache was 6.8 % for the 85 % of the population with headache. Males lost more paid worktime than females (p < 0.001); the reverse was so for household worktime (p < 0.001).
  
  
  CONCLUSIONS
  Headache disorders, very common in Nepal, are also highly burdensome at both individual and population levels. There is a substantial penalty in lost production. The remedy lies in better health care for headache; structured headache-care services are urgently needed in the country, and likely to be cost-saving.
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, NO, 7489, Norway.|Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Dhulikhel, Nepal.
authors.forename: Kedar
authors.initials: K
authors.lastname: Manandhar
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, NO, 7489, Norway.|Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Dhulikhel, Nepal.
authors.forename: Ajay
authors.initials: A
authors.lastname: Risal
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, NO, 7489, Norway.|Norwegian Advisory Unit on Headache, St Olavs University Hospital, Trondheim, Norway.
authors.forename: Mattias
authors.initials: M
authors.lastname: Linde
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, NO, 7489, 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: D000293:Adolescent; D000328:Adult; D000368:Aged; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D020773:Headache Disorders / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Burden of disease; Disability; Global campaign against headache; Medication-overuse headache; Migraine; Nepal; Population-based study; Public health; South-East Asia region; Tension-type headache
references.citation: Headache. 2012 Apr;52(4):582-91
references.pmid: 22590713
references.citation: Lancet. 2015 Aug 22;386(9995):743-800
references.pmid: 26063472
references.citation: JNMA J Nepal Med Assoc. 2010 Apr-Jun;49(178):178-84
references.pmid: 21485610
references.citation: Soc Sci Med. 2014 Jun;110:31-40
references.pmid: 24713191
references.citation: J Headache Pain. 2015;16:67
references.pmid: 26197976
references.citation: J Headache Pain. 2011 Oct;12(5):501-3
references.pmid: 21874562
references.citation: Cephalalgia. 2015 Nov;35(13):1181-91
references.pmid: 25720767
references.citation: Eur J Neurol. 2012 May;19(5):703-11
references.pmid: 22136117
references.citation: J Headache Pain. 2014 Jan 08;15:3
references.pmid: 24400999
references.citation: Eur J Public Health. 2006 Aug;16(4):420-8
references.pmid: 16141303
references.citation: J Headache Pain. 2015 Feb 18;16:15
references.pmid: 25869942
references.citation: J Headache Pain. 2015;16:95
references.pmid: 26554602
references.citation: J Headache Pain. 2015;16:515
references.pmid: 25916334
references.citation: J Headache Pain. 2015;16:513
references.pmid: 25924792
references.citation: Eur J Neurol. 2014 May;21(5):758-65
references.pmid: 24520863
references.citation: Lancet Neurol. 2008 Apr;7(4):354-61
references.pmid: 18339350
references.citation: J Headache Pain. 2014 Aug 21;15:52
references.pmid: 25146939
references.citation: Cephalalgia. 2007 Mar;27(3):193-210
references.pmid: 17381554
references.citation: BMC Health Serv Res. 2006 Feb 20;6:12
references.pmid: 16504017
references.citation: J Headache Pain. 2014 Aug 15;15:51
references.pmid: 25127664
references.citation: J Headache Pain. 2012 Jan;13(1):67-74
references.pmid: 22045235
references.citation: J Headache Pain. 2014 Jan 27;15:5
references.pmid: 24467862
references.citation: J Headache Pain. 2007 Oct;8 Suppl 1:S2
references.pmid: 18700249
references.citation: Pain. 2000 Oct;88(1):41-52
references.pmid: 11098098
references.citation: J Headache Pain. 2015;16:94
references.pmid: 26553066
references.citation: J Headache Pain. 2015;16:58
references.pmid: 26109437
references.citation: J Headache Pain. 2011 Aug;12(4):419-26
references.pmid: 21380555
references.citation: Cephalalgia. 2013 Jul;33(9):629-808
references.pmid: 23771276
references.citation: Health Policy. 2005 May;72(2):149-56
references.pmid: 15802150
references.citation: Cephalalgia. 2014 May;34(6):409-25
references.pmid: 24293089