Migraine and headache in adults – a global challenge
Migraine is one of the world’s most disabling illnesses, says the World Health Organization (WHO). Yet in the minds of many, migraine is not an illness at all. People living with migraine often face a lack of support, even disdain. Migraine and other headache disorders are afflictions that many people in society refuse to take seriously. Misconceptions like these are generally rooted in a lack of information about the origin and effects of headache disorders.
An unbiased approach based on scientific evidence and advice is essential in order to acknowledge patient suffering and take preventive action against this multifaceted clinical entity and major global plague. This is the only way to combat the impact of the disease and give sufferers the help they need.
Headache is a truly global problem
A new review suggests that one in two people (52% of the global population) experience a migraine or other headache disorder every year. One limitation to acknowledge is that most of the more than 350 included publications relate to high-income countries. Of those experiencing a headache disorder, 14% reported a migraine and about 26% reported a tension-type headache. These figures are consistent with the latest findings presented in the Global Burden of Disease study in 2019, and show that headaches and migraines are by no means imaginary ailments that society can or should ignore. In light of this latest data, it is reasonable to assume that nearly 16% of people on the planet suffer from headaches on any given day.
Significant gender gap
A recent publication by Swiss researchers investigating the gender distribution of migraine and tension headache found significant differences between male and female sufferers – not only in frequency, but also in terms of comorbidities, disease co-factors and response to treatment. One outcome is that women are significantly more often affected by migraine and are significantly more likely to be affected by its wider impacts. One very common consequence is that women deliberately withdraw from the public eye, one reason being that they do not feel that their suffering is taken seriously; in fact, almost 40% of affected women do not even tell anybody about their headaches. Female migraine patients often experience anxiety and depression between attacks. In addition, their pain burden is consistently higher than that of male patients.
Migraine often goes undetected in men
When women see a healthcare professional about their migraine symptoms, they are much more likely than males to be diagnosed correctly with migraine. The authors of the study believe that the (false) assumption that migraine is a typical "women's disease" may still play a role. A lot of education is obviously needed around this as well.
Young adults also have issues
Health data from more than 50,000 young people analyzed and compared over a period of approximately ten years indicates that the special period of transition from adolescence to adulthood presents unique challenges for migraine sufferers. People diagnosed with migraine had a two-fold higher risk of developing emotional or mood disorders in adulthood than subjects in the migraine-free comparator group. Worryingly, these young people also had an increased risk of behavioral disorders and higher susceptibility to stress-related illnesses in general. The authors of the publication say that these connections should be given more consideration in patient care.
Prevention and treatment without pharmaceuticals
Although numerous studies show that preventive behavioral interventions can be very effective in fighting headache disorders and migraine, patients and healthcare professionals don’t know enough about them. A poll of primary care physicians in the United States found that one-third of the doctors responding to the survey did not know that officially approved guidelines on headache management without drugs even existed. Many were also unaware that the American Headache Society provided training materials for doctors on behavioral ways to treat headaches.
Education and awareness are fundamental
Education is the sharpest tool in headache prevention. If awareness about health improves to a point where healthcare professionals and patients are making full use of the spectrum of behavior-based migraine and headache prevention strategies, that would already be a big step in the right direction. Full use of preventive care would stop a lot of suffering – not just the pain itself, but the wider impacts on people’s lives. And here’s another thing. Preventive measures depend far less on the resources of a country’s healthcare system or how much money a patient has. A preventive approach has all it takes for a truly global and effective campaign against headache and migraine.
Caponnetto V, Deodato M, Robotti M, Koutsokera M, Pozzilli V, Galati C, Nocera G, De Matteis E, De Vanna G, Fellini E, Halili G, Martinelli D, Nalli G, Serratore S, Tramacere I, Martelletti P, Raggi A; European Headache Federation School of Advanced Studies (EHF-SAS). Comorbidities of primary headache disorders: a literature review with meta-analysis. J Headache Pain. 2021 Jul 14;22(1):71. doi: 10.1186/s10194-021-01281-z.
GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020 Oct 17;396(10258):1204-1222. doi: 10.1016/S0140-6736(20)30925-9. Erratum in: Lancet. 2020 Nov 14;396(10262):1562.
Gerstl L, Tadych N, Heinen F, Kainz C, Bonfert MV, Hannibal I, Huss K, Ruscheweyh R, Straube A, Obermeier V, von Kries R, Landgraf MN. Migraine and the development of additional psychiatric and pain disorders in the transition from adolescence to adulthood. Cephalalgia. 2021 Nov;41(13):1342-1347. doi: 10.1177/03331024211021792. Epub 2021 Jun 23.
Langenbahn D, Matsuzawa Y, Lee YSC, Fraser F, Penzien DB, Simon NM, Lipton RB, Minen MT. Underuse of Behavioral Treatments for Headache: a Narrative Review Examining Societal and Cultural Factors. J Gen Intern Med. 2021 Oct;36(10):3103-3112. doi: 10.1007/s11606-020-06539-x. Epub 2021 Feb 1.
Neumeier MS, Pohl H, Sandor PS, Gut H, Merki-Feld GS, Andrée C. Dealing with Headache: Sex Differences in the Burden of Migraine- and Tension-Type Headache. Brain Sci. 2021 Oct 5;11(10):1323. doi: 10.3390/brainsci11101323.
Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice? J Headache Pain. 2018 Feb 21;19(1):17. doi: 10.1186/s10194-018-0846-2. 2021 Jul 25.
Stovner LJ, Hagen K, Linde M, Steiner TJ. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain. 2022 Apr 12;23(1):34. doi: 10.1186/s10194-022-01402-2.