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1. The prevalence of headache disorders in children and adolescents in Iran: a schools-based study

Author: Mansoureh Togha, Pegah Rafiee, Zeinab Ghorbani, Alireza Khosravi, Tayyar Şaşmaz, Derya Akıcı Kale, Derya Uluduz, and Timothy J Steiner
Subjects: Adult, Male, Schools, Adolescent, Headache Disorders, Headache, Infant, Newborn, General Medicine, Iran, Cross-Sectional Studies, Surveys and Questionnaires, Headache Disorders, Secondary, Prevalence, Humans, Female, Neurology (clinical), Child
Abstract: Background While the Global Burden of Disease study reports headache disorders as the third-highest cause of disability worldwide, the headache data in this study largely come from adults. This national study in Iran, the first of its type in the Eastern Mediterranean Region, was part of a global schools-based programme within the Global Campaign against Headache contributing data from children (6–11 years) and adolescents (12–17 years). Methods We followed the generic protocol for the global study. In a cross-sectional survey, self-completed structured questionnaires were administered to pupils within their classes in 121 schools selected from across the country to be representative of its diversities. Headache diagnostic questions were based on ICHD-3 criteria but for the inclusion of undifferentiated headache. Results Of 3,357 potential participants, 3,244 (children 1,308 [40.3%], adolescents 1,936 [59.7%]; males 1,531 [47.2%], females 1,713 [52.8%]) satisfactorily completed the questionnaire. Children and males were therefore somewhat under-represented, with a participating proportion of 96.6%. Gender- and age-adjusted 1-year prevalence of any headache was 65.4%, of migraine 25.2%, of tension-type headache 12.7%, of undifferentiated headache 22.1%, of all headache on ≥15 days/month 4.1%, and of probable medication-overuse headache 1.1%. All headache types except undifferentiated headache were more prevalent among adolescents than children; probable medication-overuse headache increased five-fold between childhood and adolescence. Conclusions Headache disorders are common in children and adolescents in Iran, with undifferentiated headache accounting for over one third of cases. The increasing prevalence of probable medication-overuse headache with age is concerning. These findings are of importance to health and educational policies in Iran.
Published: 2022
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2. The relationship between headache-attributed disability and lost productivity: 2. Empirical evidence from population-based studies in nine disparate countries

Author: Hallie Thomas, Simple Futarmal Kothari, Andreas Husøy, Rigmor Højland Jensen, Zaza Katsarava, Michela Tinelli, and Timothy J. Steiner
Subjects: China, Disability, Migraine Disorders, Headache, Medizin, General Medicine, Association analysis, Health policy, HD Industries. Land use. Labor, Lost productivity, Global campaign against headache, Anesthesiology and Pain Medicine, Nepal, Impairment, HN Social history and conditions. Social problems. Social reform, Headache disorders, Headache Disorders, Secondary, RA Public aspects of medicine, Humans, Medicine, Neurology (clinical), Health economics, RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Abstract: Background Headache disorders are disabling, with major consequences for productivity, yet the literature is silent on the relationship between headache-attributed disability and lost productivity, often erroneously regarding the two as synonymous. We evaluated the relationship empirically, having earlier found that investment in structured headache services would be cost saving, not merely cost-effective, if reductions in headache-attributed disability led to > 20% pro rata recovery of lost productivity. Methods We used individual participant data from Global Campaign population-based studies conducted in China, Ethiopia, India, Nepal, Pakistan and Russia, and from Eurolight in Lithuania, Luxembourg and Spain. We assessed relationships in migraine and probable medication-overuse headache (pMOH), the most disabling common headache disorders. Available symptom data included headache frequency, usual duration and usual intensity. We used frequency and duration to estimate proportion of time in ictal state (pTIS). Disability, in the sense used by the Global Burden of Disease study, was measured as the product of pTIS and disability weight for the ictal state. Impairment was measured as pTIS * intensity. Lost productivity was measured as lost days (absence or Results For migraine, in a linear model, we found positive associations with lost paid worktime, significant (p p 2 (0–0.16) due to high variance. With lost household worktime and total lost productivity (paid + household), associations were highly significant in almost all countries, although still with low R2 (0.04–0.22). Applying the regression equations for each country to the population mean migraine-attributed disability, we found pro rata recoveries of lost productivity in the range 16–56% (> 20% in all countries but Pakistan). Analysing impairment rather than disability increased variability. For pMOH, with smaller numbers, associations were generally weaker, occasionally negative and mostly not significant. Conclusion Relief of disability through effective treatment of migraine is expected, in most countries, to recover > 20% pro rata of lost productivity, above the threshold for investment in structured headache services to be cost saving.
Published: 2021
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3. Premonitory symptoms in migraine: a systematic review and meta-analysis of observational studies reporting prevalence or relative frequency

Author: Anna K. Eigenbrodt, Rune Häckert Christensen, Håkan Ashina, Afrim Iljazi, Casper Emil Christensen, Timothy J. Steiner, Richard B. Lipton, and Messoud Ashina
Subjects: Anesthesiology and Pain Medicine, Clinical characteristics, Prodrome, Epidemiology, Migraine Disorders, Prevalence, Headache, Humans, Pain, International classification of headache disorders, Neurology (clinical), General Medicine
Abstract: Background Observational studies on the prevalence of premonitory symptoms in people with migraine, preceding the headache pain (or aura) phase, have shown conflicting results. We conducted a systematic review and meta-analysis to estimate the prevalence, and relative frequency among clinic populations, of premonitory symptoms in people with migraine, overall and of the multifarious individual symptoms, and to review the methodologies used to assess them. Methods We searched PubMed and Embase for studies published from database inception until 31st of May 2022. Two investigators independently screened titles, abstracts, and full texts. We retrieved observational studies that reported the prevalence/relative frequency of one or more premonitory symptoms in people with migraine. Two investigators independently extracted data and assessed risk of bias. Results were pooled using random-effects meta-analysis. Our main outcomes were the percentage of people with migraine who experienced at least one premonitory symptom and the percentages who experienced different individual premonitory symptoms. To describe our outcomes, we used the terms prevalence for data from population-based samples and relative frequency for data from clinic-based samples. We also descriptively and critically assessed the methodologies used to assess these symptoms. Results The pooled estimated prevalence in population-based studies of at least one premonitory symptom was 29% (95% CI: 8–63; I2 99%) and the corresponding pooled estimated relative frequency in clinic-based studies was 66% (95% CI: 45–82; I2 99%). The data from clinic-based studies only supported meta-analysis of 11 of 96 individual symptoms, with relative frequency estimates ranging from 11 to 49%. Risk of bias was determined as high in 20 studies, moderate in seven, and low in two. Conclusions The substantial between-study heterogeneity demands cautious interpretation of our estimates. Studies showed wide methodological variations, and many lacked rigor. Overall, the evidence was insufficient to support reliable prevalence estimation or characterization of premonitory symptoms. More data are needed, of better quality, to confirm the existence of a distinctive premonitory phase of migraine, and its features. Methodological guidelines based on expert consensus are a prerequisite.
Published: 2022
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4. The burden attributable to headache disorders in children and adolescents in Lithuania: estimates from a national schools-based study

Author: Derya Uluduz, Tayyar Şaşmaz, Çiçek Wöber-Bingöl, Aylin Yeniocak Tunç, Christian Wöber, Nerija Vaičienė-Magistris, Timothy J. Steiner, Diana Genc, and Apolinaras Zaborskis
Subjects: Adult, medicine.medical_specialty, Pediatrics, Neurology, Adolescent, Headache Disorders, Epidemiology, media_common.quotation_subject, Surveys and Questionnaires, medicine, Prevalence, Humans, Schools-based study, Ictal, Child, Migraine, media_common, Daughter, Schools, business.industry, Symptom burden, Burden of disease, Lithuania, General Medicine, medicine.disease, Mean frequency, Medication-overuse headache, Tension-type headache, Anesthesiology and Pain Medicine, Cross-Sectional Studies, Global campaign against headache, Child and adolescent headache, Medicine, Neurology (clinical), business, Research Article, Undifferentiated headache
Abstract: Background We recently showed headache to be common in children (aged 7–11 years) and adolescents (aged 12–17) in Lithuania. Here we provide evidence from the same study of the headache-attributable burden. Methods Following the generic protocol for Lifting The Burden’s global schools-based study, this cross-sectional survey administered self-completed structured questionnaires to pupils within classes in 24 nationally representative schools selected from seven regions of the country. Headache diagnostic questions were based on ICHD-3 beta criteria but for the inclusion of undifferentiated headache (UdH; defined as mild headache with usual duration Results Questionnaires were completed by 2505 pupils (1382 children, 1123 adolescents; participating proportion 67.4%), of whom 1858 reported headache in the preceding year, with mean frequency (±SD) of 3.7 ± 4.5 days/4 weeks and mean duration of 1.6 ± 1.9 h. Mean proportion of time in ictal state, estimated from these, was 0.9% (migraine 1.5%, probable medication-overuse headache [pMOH] 10.9%). Mean intensity on a scale of 1–3 was 1.6 ± 0.6 (mild-to-moderate). Symptomatic medication was consumed on 1.5 ± 2.8 days/4 weeks. Lost school time was 0.5 ± 1.5 days/4 weeks (migraine 0.7 ± 1.5, pMOH 5.0 ± 7.8) based on recall, but about 50% higher for migraine according to actual absences recorded in association with reported headache on the preceding day. More days were reported with limited activity (overall 1.2 ± 2.4, migraine 1.5 ± 2.2, pMOH 8.4 ± 8.5) than lost from school. One in 30 parents (3.3%) missed work at least once in 4 weeks because of their son’s or daughter’s headache. Emotional impact and quality-of-life scores generally reflected other measures of burden, with pMOH causing greatest detriments, followed by migraine and tension-type headache, and UdH least. Burdens were greater in adolescents than children as UdH differentiated into adult headache types. Conclusions Headache in children and adolescents in Lithuania is mostly associated with modest symptom burden. However, the consequential burdens, in particular lost school days, are far from negligible for migraine (which is prevalent) and very heavy for pMOH (which, while uncommon in children, becomes four-fold more prevalent in adolescents). These findings are of importance to both health and educational policies in Lithuania.
Published: 2021

5. Use of medicinal plants for headache, and their potential implication in medication-overuse headache: Evidence from a population-based study in Nepal

Author: Mattias Linde, Hallie Thomas, Kedar Manandhar, Ajay Risal, Timothy J. Steiner, and Elise Øien Sørnes
Subjects: Adult, Male, medicine.medical_specialty, Headache Disorders, Primary, Adolescent, Herbal Medicine, overuse, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Nepal, Headache Disorders, Secondary, Prevalence, medicine, Humans, Intensive care medicine, Medicinal plants, Aged, Plants, Medicinal, Global Campaign against Headache, business.industry, Headache, Original Articles, South-East Asia region, General Medicine, Middle Aged, Population based study, Cross-Sectional Studies, 030220 oncology & carcinogenesis, Herbal medications, Female, Plant Preparations, Neurology (clinical), pharmacodynamic activity, Medication overuse, business, 030217 neurology & neurosurgery
Abstract: Background In Nepal, traditional treatment using medicinal plants is popular. Whereas medication-overuse headache is, by definition, caused by excessive use of acute headache medication, we hypothesized that medicinal plants, being pharmacologically active, were as likely a cause. Methods We used data from a cross-sectional, nationwide population-based study, which enquired into headache and use of medicinal plants and allopathic medications. We searched the literature for pharmacodynamic actions of the medicinal plants. Results Of 2100 participants, 1794 (85.4%) reported headache in the preceding year; 161 (7.7%) reported headache on ≥15 days/month, of whom 28 (17.4%) had used medicinal plants and 117 (72.7%) allopathic medication(s). Of 46 with probable medication-overuse headache, 87.0% (40/46) were using allopathic medication(s) and 13.0% (6/46) medicinal plants, a ratio of 6.7:1, higher than the overall ratio among those with headache of 4.9:1 (912/185). Of 60 plant species identified, 49 were pharmacodynamically active on the central nervous system, with various effects of likely relevance in medication-overuse headache causation. Conclusions MPs are potentially a cause of medication-overuse headache, and not to be seen as innocent in this regard. Numbers presumptively affected in Nepal are low but not negligible. This pioneering project provides a starting point for further research to provide needed guidance on use of medicinal plants for headache.
Published: 2021
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6. The prevalence of headache disorders in children and adolescents in Ethiopia: a schools-based study

Author: Yared Zenebe Zewde, Mehila Zebenigus, Hanna Demissie, Redda Tekle-Haimanot, Derya Uluduz, Tayyar Şaşmaz, Fatma Bozdag, Timothy J. Steiner, and İÜC, Cerrahpaşa Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü
Subjects: Adult, Male, Rural Population, Adolescent, Headache Disorders, Epidemiology, Migraine Disorders, Clinical Neurology, lcsh:Medicine, DISEASE, Global Burden of Disease, Young Adult, Surveys and Questionnaires, Headache Disorders, Secondary, SYSTEMATIC ANALYSIS, Prevalence, Humans, Schools-based study, CAMPAIGN, Child, Migraine, 0604 Genetics, Schools, Science & Technology, Neurology & Neurosurgery, DISABILITY, lcsh:R, Headache, Neurosciences, 1103 Clinical Sciences, General Medicine, Middle Aged, GLOBAL BURDEN, Medication-overuse headache, Tension-type headache, Cross-Sectional Studies, Anesthesiology and Pain Medicine, Global campaign against headache, Child and adolescent headache, Female, INJURIES, Neurosciences & Neurology, Neurology (clinical), Ethiopia, Life Sciences & Biomedicine, Research Article, Undifferentiated headache
Abstract: Background: The Global Burden of Disease (GBD) study establishes headache as the second-highest cause of disability worldwide. Because most headache data in GBD are from adults, leading to underestimation of headacheattributed burden, a global schools-based programme within the Global Campaign against Headache is contributing data from children (7–11 years) and adolescents (12–17 years). This national study in Ethiopia is the first in this programme reported from sub-Saharan Africa. Methods: A cross-sectional survey following the generic protocol for the global study was conducted in six schools (urban and rural), in Addis Ababa city and three regions of Ethiopia. Structured questionnaires were self-completed under supervision by pupils within their classes. Headache diagnostic questions were based on ICHD-3 beta criteria but for the inclusion of undifferentiated headache (UdH). Results: Of 2349 potential participants, 2344 completed the questionnaire (1011 children [43.1%], 1333 adolescents [56.9%]; 1157 males [49.4%], 1187 females [50.6%]), a participation proportion of 99.8%. Gender- and age-adjusted 1- year prevalence of headache was 72.8% (migraine: 38.6%; tension-type headache: 19.9%; UdH: 12.3%; all headache on ≥15 days/month: 1.2%; probable medication-overuse headache: 0.2%). Headache was more prevalent in females (76.2%) than males (71.0%), a finding reflected only in migraine among the headache types. Headache was more prevalent among adolescents (77.6%) than children (68.4%), reflected in all types except migraine, although prevalence of UdH fell sharply after age 14 years to 3.9%. For headache overall, findings matched those in Turkey and Austria, obtained with the same questionnaire, but the high prevalence of migraine, not increasing with age, was surprising. The study highlighted diagnostic difficulties in young people, especially when poorly educated, with migraine diagnoses driven by improbably high proportions reporting nausea (44.8%) and vomiting (28.0%) as usual symptoms accompanying their headaches. Conclusions: Headache is very common in children and adolescents in Ethiopia. This has major public-health implications, since half the country’s population are aged under 18 years. © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Published: 2020
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7. Burden of headache in a HIV-positive population of sub-Saharan Africa

Author: Massimo Leone, Luca Giani, Monica Phaka, Derya Uluduz, Şaşmaz Tayyar, Maureen Kamponda, Victor Tamba Tolno, Giovanni Guidotti, Maria Cristina Marazzi, and Timothy J Steiner
Subjects: Adult, Male, Young Adult, Headache Disorders, Headache, Humans, Female, HIV Infections, Neurology (clinical), General Medicine, Middle Aged, Noncommunicable Diseases, Africa South of the Sahara
Abstract: Background About 26 million people are living with HIV in sub-Saharan Africa. The DREAM programme in sub-Saharan Africa provides free healthcare for HIV/AIDS and a range of chronic non-communicable diseases. HIV is a risk factor for neurological non-communicable diseases including stroke and epilepsy, which themselves are associated with headache, and HIV may be a direct risk factor for headache. We investigated the prevalence and burden of headache in a HIV+ population in sub-Saharan Africa. Methods At the DREAM Centre in Blantyre, Malawi, a low-income country with a population of 19 million and 9.2% HIV prevalence, a structured questionnaire was administered by a trained lay interviewer to consecutively attending HIV+ patients aged 6–65 years. All were monitored with regular viral load detection. Results Of 513 eligible patients invited, 498 were included (mean age 34.1 ± 12.8 years; 72% females; 15 declined). All were on antiretroviral treatment, with viral load undetectable in 83.9%. The 1-year prevalence of headache was 80.3% (females 83.6%, males 71.9%); 3.8% had ≥15 headache days/month, 1.4% had probable medication-overuse headache. Mean overall headache frequency was 4.4 ± 5.4 days/month. Those reporting headache lost means of 2.3% of paid workdays and 3.3% of household workdays because of headache. Only one third had sought advice for their headache. Conclusions Headache is very prevalent among HIV+ patients in Malawi, imposing additional burden and costs on individuals and the community. Management of headache disorders should be implemented in HIV centres, as it is for other chronic non-communicable diseases.
Published: 2022

8. One-quarter of individuals with weekly headache have never consulted a medical doctor: a Danish nationwide cross-sectional survey

Author: Thien Phu Do, Simon Stefansen, Mikala Dømgaard, Timothy J. Steiner, and Messoud Ashina
Subjects: Adult, Male, 0604 Genetics, Healthcare utilization, Neurology & Neurosurgery, Adolescent, Headache Disorders, Denmark, Headache, 1103 Clinical Sciences, General Medicine, Disease burden, Population survey, Middle Aged, Health Services Accessibility, Anesthesiology and Pain Medicine, Cross-Sectional Studies, Barriers to care, Headache disorders, Humans, Female, Neurology (clinical)
Abstract: Introduction Large numbers of people with headache who would benefit are not reached by headache services. Among the causes are poor or disorganized provision of headache services, but reluctance to seek healthcare has frequently been identified as a significant barrier. We conducted a national survey of people with headache to assess the extent of this problem in Denmark, a country with well organized, highly resourced, and readily accessible services. Methods We conducted a nationwide cross-sectional survey of adults ≥ 18 years old in Denmark reporting at least one headache day in the last year. We used social media (Facebook) to publicize and drive a recruitment campaign. The survey investigated five items: (1) disease burden, (2) social life, (3) presenteeism, (4) social support, and (5) healthcare utilization. Results We included 6,567 respondents from May 2021 to June 2021; 70.2% were female, 39.8% male, and mean age was 43.2 ± 13.4 years. Of the respondents, 54.2% reported headache at least once a week, 33.4% reported headache a couple of times a month, and 12.4% reported headache a couple of times a year. Two-thirds of respondents (66.6%) reported that headache limited their social lives occasionally or frequently. Most respondents (86.8%) reported going to work or attending educational activities occasionally or more frequently even though they had headache. Half of the respondents (49.5%) experienced lack of understanding of their headaches from people occasionally or more frequently. Almost half of respondents (43.7%) had never consulted a medical doctor for their headache; even of those with weekly headache, more than a quarter (28.3%) had never done so in their lifetimes. Conclusions Headache disorders continue to be a problem, even in a high-income country with free and easily accessible headache services. Further studies are needed to investigate and clarify why even people with the highest burden are hesitant to seek and make use of widely available headache services.
Published: 2022
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9. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates

Author: Lars Jacob Stovner, Knut Hagen, Mattias Linde, and Timothy J. Steiner
Subjects: Anesthesiology and Pain Medicine, Headache Disorders, Migraine Disorders, Tension-Type Headache, Headache, Prevalence, Humans, Neurology (clinical), General Medicine
Abstract: Background According to the Global Burden of Disease (GBD) study, headache disorders are among the most prevalent and disabling conditions worldwide. GBD builds on epidemiological studies (published and unpublished) which are notable for wide variations in both their methodologies and their prevalence estimates. Our first aim was to update the documentation of headache epidemiological studies, summarizing global prevalence estimates for all headache, migraine, tension-type headache (TTH) and headache on ≥15 days/month (H15+), comparing these with GBD estimates and exploring time trends and geographical variations. Our second aim was to analyse how methodological factors influenced prevalence estimates. Methods In a narrative review, all prevalence studies published until 2020, excluding those of clinic populations, were identified through a literature search. Prevalence data were extracted, along with those related to methodology, world region and publication year. Bivariate analyses (correlations or comparisons of means) and multiple linear regression (MLR) analyses were performed. Results From 357 publications, the vast majority from high-income countries, the estimated global prevalence of active headache disorder was 52.0% (95%CI 48.9–55.4), of migraine 14.0% (12.9–15.2), of TTH 26.0% (22.7–29.5) and of H15+ 4.6% (3.9–5.5). These estimates were comparable with those of migraine and TTH in GBD2019, the most recent iteration, but higher for headache overall. Each day, 15.8% of the world’s population had headache. MLR analyses explained less than 30% of the variation. Methodological factors contributing to variation, were publication year, sample size, inclusion of probable diagnoses, sub-population sampling (e.g., of health-care personnel), sampling method (random or not), screening question (neutral, or qualified in severity or presumed cause) and scope of enquiry (headache disorders only or multiple other conditions). With these taken into account, migraine prevalence estimates increased over the years, while estimates for all headache types varied between world regions. Conclusion The review confirms GBD in finding that headache disorders remain highly prevalent worldwide, and it identifies methodological factors explaining some of the large variation between study findings. These variations render uncertain both the increase in migraine prevalence estimates over time, and the geographical differences. More and better studies are needed in low- and middle-income countries.
Published: 2021

10. Headache service quality evaluation: implementation of quality indicators in primary care in Europe

Author: M. Sahin, G. Karelis, Zaza Katsarava, I. Varsberga-Apsite, E. Oliveira, Y. Z. Ural, B. Silva, S. T. Zengin, I. Rosendo, Timothy J. Steiner, B. Kaynarkaya, Derya Uluduz, B. Lenz, Raquel Gil-Gouveia, L. Zvaune, L. Meksa, and F. Palavra
Subjects: medicine.medical_specialty, Referral, Turkey, media_common.quotation_subject, Medizin, Quality indicators, 03 medical and health sciences, 0302 clinical medicine, Patient satisfaction, Quality of life (healthcare), Headache care, Germany, Headache disorders, Medicine, Humans, Service quality evaluation, Quality (business), 030212 general & internal medicine, Medical diagnosis, media_common, Quality Indicators, Health Care, Service (business), Service quality, 0604 Genetics, Neurology & Neurosurgery, Primary Health Care, business.industry, Headache, 1103 Clinical Sciences, General Medicine, Primary care, Europe, Anesthesiology and Pain Medicine, Global campaign against headache, Family medicine, Quality of Life, Neurology (clinical), business, 030217 neurology & neurosurgery, European Headache Federation and Lifting The Burden: the Global Campaign against Headache, Research Article, Patient education
Abstract: Background Lifting The Burden (LTB) and European Headache Federation (EHF) have developed a set of headache service quality indicators, successfully tested in specialist headache centres. Their intended application includes all levels of care. Here we assess their implementation in primary care. Methods We included 28 primary-care clinics in Germany (4), Turkey (4), Latvia (5) and Portugal (15). To implement the indicators, we interviewed 111 doctors, 92 nurses and medical assistants, 70 secretaries, 27 service managers and 493 patients, using the questionnaires developed by LTB and EHF. In addition, we evaluated 675 patients’ records. Enquiries were in nine domains: diagnosis, individualized management, referral pathways, patient education and reassurance, convenience and comfort, patient satisfaction, equity and efficiency of headache care, outcome assessment and safety. Results The principal finding was that Implementation proved feasible and practical in primary care. In the process, we identified significant quality deficits. Almost everywhere, histories of headache, especially temporal profiles, were captured and/or assessed inaccurately. A substantial proportion (20%) of patients received non-specific ICD codes such as R51 (“headache”) rather than specific headache diagnoses. Headache-related disability and quality of life were not part of routine clinical enquiry. Headache diaries and calendars were not in use. Waiting times were long (e.g., about 60 min in Germany). Nevertheless, most patients (> 85%) expressed satisfaction with their care. Almost all the participating clinics provided equitable and easy access to treatment, and follow-up for most headache patients, without unnecessary barriers. Conclusions The study demonstrated that headache service quality indicators can be used in primary care, proving both practical and fit for purpose. It also uncovered quality deficits leading to suboptimal treatment, often due to a lack of knowledge among the general practitioners. There were failures of process also. These findings signal the need for additional training in headache diagnosis and management in primary care, where most headache patients are necessarily treated. More generally, they underline the importance of headache service quality evaluation in primary care, not only to identify-quality failings but also to guide improvements. This study also demonstrated that patients’ satisfaction is not, on its own, a good indicator of service quality.
Published: 2021
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11. Structured headache services as the solution to the ill-health burden of headache. 2. Modelling effectiveness and cost-effectiveness of implementation in Europe: methodology

Author: Elena Ruiz de la Torre, Matilde Leonardi, Koen Paemeleire, Timothy J. Steiner, Dimos D. Mitsikostas, and Michela Tinelli
Subjects: Quality management, Cost estimate, Cost effectiveness, Headache Disorders, DISORDERS, IMPACT, Cost-Benefit Analysis, Population, Psychological intervention, Healthy Life Years, Tension-type-headache (TTH), Medicine and Health Sciences, Medicine, Humans, BRAIN, Quality improvement, Location, education, RUSSIA, Migraine, Healthy-life-years, education.field_of_study, Health economics, Actuarial science, business.industry, Healthy-life-years (HLYs), Headache, General Medicine, Medication-overuse-headache (MOH), economics, GLOBAL BURDEN, PREVALENCE, Europe, Anesthesiology and Pain Medicine, Global campaign against headache, MIGRAINE, Health, Structured headache services, RA Public aspects of medicine, Cost-effectiveness, Neurology (clinical), business, Delivery of Health Care, Research Article, (HLYs)
Abstract: Background Health economic evaluations support health-care decision-making by providing information on the costs and consequences of health interventions. No universally accepted methodology exists for modelling effectiveness and cost-effectiveness of interventions designed to close treatment gaps for headache disorders in countries of Europe (or elsewhere). Our aim here, within the European Brain Council’s Value-of-Treatment project, was to develop headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Methods We developed three headache-type-specific decision-analytical models using the WHO-CHOICE framework and adapted these for three European Region country settings (Luxembourg, Russia and Spain), diverse in geographical location, population size, income level and health-care systems and for which we had population-based data. Each model compared current (suboptimal) care vs target care (delivered in accordance with the structured headache services model). Epidemiological and economic data were drawn from studies conducted by the Global Campaign against Headache; data on efficacy of treatments were taken from published randomized controlled trials; assumptions on uptake of treatments, and those made for Healthy Life Year (HLY) calculations and target-care benefits, were agreed with experts. We made annual and 5-year cost estimates from health-care provider (main analyses) and societal (secondary analyses) perspectives (2020 figures, euros). Results The analytical models were successfully developed and applied to each country setting. Headache-related costs (including use of health-care resources and lost productivity) and health outcomes (HLYs) were mapped across populations. The same calculations were repeated for each alternative (current vs target care). Analyses of the differences in costs and health outcomes between alternatives and the incremental cost-effectiveness ratios are presented elsewhere. Conclusions This study presents the first headache-type-specific analytical models to evaluate effectiveness and cost-effectiveness of implementing structured headache services in countries in the European Region. The models are robust, and can assist policy makers in allocating health budgets between interventions to maximize the health of populations.
Published: 2021

12. Prevalence and burden of headache in children and adolescents in Austria – a nationwide study in a representative sample of pupils aged 10–18 years

Author: Christian Wöber, Çiçek Wöber-Bingöl, Julia Philipp, Andreas Karwautz, Gudrun Wagner, Timothy J. Steiner, and Michael Zeiler
Subjects: Male, Rural Population, Activities of daily living, Epidemiology, lcsh:Medicine, Global Health, 0302 clinical medicine, Quality of life, Cost of Illness, Surveys and Questionnaires, Prevalence, 030212 general & internal medicine, Child, Schools, Health Policy, Headache, General Medicine, ASSOCIATION, Medication-overuse headache, DISEASES, Austria, Female, Life Sciences & Biomedicine, MENTAL-HEALTH, Research Article, medicine.medical_specialty, Children and adolescents, Adolescent, Headache Disorders, Migraine Disorders, Clinical Neurology, Context (language use), SELF-REPORT, 03 medical and health sciences, medicine, Humans, Socioeconomic status, Migraine, 0604 Genetics, Science & Technology, Neurology & Neurosurgery, business.industry, Single parent, lcsh:R, Neurosciences, 1103 Clinical Sciences, GLOBAL BURDEN, medicine.disease, Mental health, Tension-type headache, Anesthesiology and Pain Medicine, Global campaign against headache, Cross-Sectional Studies, INJURIES, Neurology (clinical), Neurosciences & Neurology, business, 030217 neurology & neurosurgery, Demography, Undifferentiated headache
Abstract: Background Headache disorders are highly prevalent worldwide, but not so well investigated in children and adolescents as in adults: few studies have included representative nationwide samples. No data exist for Austria until now. In a representative sample of children and adolescents in Austria, we estimated the prevalence and attributable burden of headache disorders, including the new diagnostic category of “undifferentiated headache” (UdH) defined as mild headache lasting less than 1 hour. Methods Within the context of a broader national mental health survey, children and adolescents aged 10–18 years were recruited from purposively selected schools. Mediated self-completed questionnaires included sociodemographic enquiry (gender, age, socioeconomic status, family constellation, residence [urban or rural] and migration background). Prevalence and attributable burden of all headache, UdH, migraine (definite plus probable), tension-type headache (TTH: definite plus probable) and headache on ≥15 days/month (H15+) were assessed using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire for children and adolescents. Health-related quality of life (HrQoL) was assessed using the KIDSCREEN questionnaire. Results Of 7643 selected pupils, 3386 (44.3%) completed the questionnaires. The 1-year prevalence of headache was 75.7%, increasing with age and higher in girls (82.1%) than in boys (67.7%; p p p p Conclusions Headache disorders are both very common and highly burdensome in children and adolescents in Austria. This study contributes to the global atlas of headache disorders in these age groups, and corroborates and adds knowledge of the new yet common and important diagnostic category of UdH. The findings call for action in national and international health policies, and for further epidemiological research.
Published: 2019
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13. Problematic presentation and use of efficacy measures in current trials of CGRP monoclonal antibodies for episodic migraine prevention: A mini-review

Author: Hans-Christoph Diener, Peer Tfelt-Hansen, and Timothy J. Steiner
Subjects: persisting migraine days, medicine.drug_class, Medizinische Fakultät » Universitätsklinikum Essen » Klinik für Neurologie, Calcitonin Gene-Related Peptide, Migraine Disorders, Medizin, Calcitonin gene-related peptide, Monoclonal antibody, Mini review, Episodic migraine, Calcitonin Gene-Related Peptide Receptor Antagonists, medicine, Humans, ddc:610, 50% response rate, Receptor, CGRP antibodies, Randomized Controlled Trials as Topic, business.industry, Antibodies, Monoclonal, General Medicine, Treatment Outcome, Calcitonin, Immunology, episodic migraine, Neurology (clinical), Presentation (obstetrics), business
Abstract: Background In trials of monoclonal antibodies against calcitonin gene-related peptide or its receptor for prevention of episodic migraine, we observed two problematic aspects: a) The graphic presentations; b) the methods of calculating “response rates” (≥50% decrease of monthly migraine days from baseline). Observations Decrease in monthly migraine days is presented, over time, in figures on a downward (negative) scale from zero at baseline, with the ordinate stopped just beyond the maximum effect of the active drugs. In one trial, decreases in monthly migraine days were −1.8 after placebo, −3.2 after erenumab 70 mg and −3.7 after erenumab 140 mg, with the ordinate stopped at −4.5. The reader can perceive only a relative 2-fold benefit of erenumab versus placebo. If, however, treatment periods are compared with baseline in bar charts, MMDs persisting after treatment in the same trial can be illustrated as follows, creating a different perception: 78% for placebo, 61% for erenumab 70 mg, and 55% for erenumab 140 mg. In the nine trials, “response rates” defined as above were calculated in five different ways, taking different numbers of treatment months into account in comparisons with the one-month baseline. This makes comparisons impossible. Suggestions for improvements Mean monthly migraine days before and after treatment should be presented in a bar chart. Such figures, presenting persisting MMDs, are more clinically relevant and less misleading than decreases from baseline. The definition and methods of calculating and presenting “50% response rates” should be standardized by the Drug Trial Committee of the International Headache Society.
Published: 2019
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14. A universal outcome measure for headache treatments, care-delivery systems and economic analysis

Author: Mattias Linde, Petra Schnell-Inderst, and Timothy J. Steiner
Subjects: medicine.medical_specialty, Headache Disorders, Pain medicine, Psychological intervention, Global Burden of Disease, Outcome measure, 03 medical and health sciences, 0302 clinical medicine, Outcome Assessment, Health Care, medicine, Humans, 030212 general & internal medicine, Health technology assessment, Health policy, Modalities, Global Campaign against Headache, business.industry, Cost-effectiveness analysis, Tension-Type Headache, Headache, Construct validity, General Medicine, medicine.disease, Anesthesiology and Pain Medicine, Migraine, Structured headache services, Physical therapy, Medicine, Neurology (clinical), Metric (unit), business, 030217 neurology & neurosurgery, Research Article
Abstract: BackgroundThe first manuscript in this series delineated a model of structured headache services, potentially cost-effective but requiring formal cost-effectiveness analysis (CEA). We envisaged a need for a new outcome measure for this purpose, applicable to all forms of treatment, care and care-delivery systems as opposed to comparisons of single-modality treatments.Conception and delineationA literature review confirmed the lack of any suitable established measure. We prioritised construct validity, simplicity, comprehensiveness and expression in intuitive units. We noted that pain was the key burdensome symptom of migraine and episodic tension-type headache (TTH), that pain above a certain level was disabling, that it was difficult to put economic value to pain but relatively easy to do this for time, a casualty of headache leading to lost productivity. Alleviation of pain to a non-disabling level would be expected to bring restoration of function. We therefore based the measure on time spent in the ictal state (TIS) of migraine or TTH, either as total TIS or proportion of all time. We expressed impact on health, in units of time, as TIS*DW, where DW was the disability weight for the ictal state supplied by the Global Burden of Disease (GBD) studies. If the time unit was hours, TIS*DW yielded hours lived with (or lost to) disability (HLDs), in analogy with GBD’s years lived with disability (YLDs).Utility assessmentAcute treatments would reduce TIS by shortening attack duration, preventative treatments by reducing attack frequency; health-care systems such as structured headache services would have these effects by delivering these treatments. These benefits were all measurable as HLDs-averted. Population-level estimates would be derived by factoring in prevalence, but also taking treatment coverage and adherence into account. For health-care systems, additional gains from provider-training (promoting adherence to guidelines and, therefore, enhancing coverage) and consumer-education (improving adherence to care plans), increasing numbers within populations gaining the benefits of treatments, would be measurable by the same metric.ConclusionsThe new outcome measure expressed in intuitive units of time is applicable to treatments of all modalities and to system-level interventions for multiple headache types, with utility for CEA and for informing health policy.
Published: 2021
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15. If headache has any association with hypertension, it is negative. Evidence from a population-based study in Nepal

Author: Mattias Linde, Ajay Risal, Kedar Manandhar, Timothy J. Steiner, and Rajendra Koju
Subjects: Adult, Male, medicine.medical_specialty, business.industry, Public health, Headache, Negative evidence, General Medicine, Middle Aged, Population based study, Young Adult, Cross-Sectional Studies, Nepal, Hypertension, Prevalence, Medicine, Humans, Female, Neurology (clinical), Ill health, Headache Disorders, business, Psychiatry, Association (psychology)
Abstract: Background Hypertension and headache disorders are major contributors to public ill health, linked by a long-standing but questionable belief that hypertension is a conspicuous cause of headache. In Nepal, where hypertension is common and often untreated, we assessed the substance of this belief, hypothesising that, should hypertension be a significant cause of headache, a clear positive association between these disorders would exist. Methods In a cross-sectional, nationwide study, trained health workers conducted face-to-face structured interviews, during unannounced home visits, with a representative sample of the Nepalese adult population (18–65 years). They applied standard diagnostic criteria for headache disorders and measured blood pressure digitally. Hypertension was defined as systolic pressure ≥140 and/or diastolic ≥90 mm Hg. Results Of 2,100 participants (59.0% female, mean age 36.4 ± 12.8 years), 317 (15.1%) had hypertension (41.0% female) and 1,794 (85.4%) had headache (61.6% female; 728 migraine, 863 tension-type headache, 161 headache on ≥15 days/month [mutually exclusive diagnoses]; 42 unclassified headaches). All headache collectively was less prevalent among hypertension cases (78.9%) than non-cases (86.6%; p = 0.001). A negative association between hypertension and all headache was demonstrated in bivariate analysis (odds ratio: 0.6 [95% Confidence interval: 0.4–0.8]; p Conclusions If any association exists between hypertension and headache disorders, it is negative. From the public-health perspective, headache disorders and hypertension are unrelated entities: they need distinct policies and programs for prevention, control and management.
Published: 2021

16. Diagnosis and management of migraine in ten steps

Author: Mihails Arons, Anna K. Eigenbrodt, Patricia Pozo-Rosich, Christian Lampl, Messoud Ashina, Paolo Martelletti, Vladimir Romanenko, Alexandra J Sinclair, Aynur Özge, Koen Paemeleire, Oved Daniel, Sabrina Khan, Dimos D. Mitsikostas, Uwe Reuter, Håkan Ashina, Anne Ducros, Michel Lanteri-Minet, Mark Braschinsky, Zaza Katsarava, Margarita Sanchez del Rio, Gisela M. Terwindt, Henrik Winther Schytz, Hans-Christoph Diener, Timothy J. Steiner, Kirill Skorobogatykh, Ayten Mammadbayli, and Simona Sacco
Subjects: PROPHYLACTIC TREATMENT, medicine.medical_specialty, Consensus, Denmark, Migraine Disorders, Clinical Decision-Making, Population, MEDLINE, Placebo-controlled study, Medizin, PLACEBO-CONTROLLED TRIAL, Care provision, DOUBLE-BLIND, 03 medical and health sciences, Cellular and Molecular Neuroscience, 0302 clinical medicine, HEADACHE, EPISODIC MIGRAINE, Medicine and Health Sciences, Humans, Medicine, 030212 general & internal medicine, Medical diagnosis, education, POPULATION, Migraine, Societies, Medical, education.field_of_study, MEDICATION-OVERUSE HEADACHE, business.industry, MENSTRUAL MIGRAINE, Disease Management, BRIEF INTERVENTION, medicine.disease, TENSION-TYPE, Family medicine, Practice Guidelines as Topic, Neurology (clinical), Brief intervention, business, 030217 neurology & neurosurgery, PHARMACOLOGICAL-TREATMENT, Patient education, migraine, diagnosis, management
Abstract: Migraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up. In this Consensus Statement, which is endorsed by the European Headache Federation and the European Academy of Neurology, an expert panel provides recommendations for the diagnosis and management of migraine to support clinical decision-making by general practitioners, neurologists and headache specialists.
Published: 2021
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17. Structured headache services as the solution to the ill-health burden of headache. 3. Modelling effectiveness and cost-effectiveness of implementation in Europe: findings and conclusions

Author: Elena Ruiz de la Torre, Matilde Leonardi, Dimos D. Mitsikostas, Michela Tinelli, Koen Paemeleire, Alberto Raggi, and Timothy J. Steiner
Subjects: Quality management, Cost estimate, Cost effectiveness, IMPACT, Cost-Benefit Analysis, Psychological intervention, Healthy Life Years, Tension-type-headache (TTH), Medicine and Health Sciences, Medicine, health care economics and organizations, Headache, General Medicine, European Brain Council Value of Treatment Headache Working Group, the European Headache Federation, the European Migraine and Headache Alliance and Lifting The Burden: the Global Campaign against Headache, PREVALENCE, Europe, Health, Life Sciences & Biomedicine, Research Article, DISORDERS, Headache Disorders, Clinical Neurology, Humans, Quality improvement, RUSSIA, Migraine, Healthy-life-years, 0604 Genetics, Actuarial science, Health economics, Science & Technology, Neurology & Neurosurgery, business.industry, Tension-Type Headache, Neurosciences, Healthy-life-years (HLYs), 1103 Clinical Sciences, economics, Medication-overuse-headache (MOH), medicine.disease, Anesthesiology and Pain Medicine, Global campaign against headache, Economic evaluation, Structured headache services, RA Public aspects of medicine, Cost-effectiveness, Neurology (clinical), Neurosciences & Neurology, business, (HLYs)
Abstract: BackgroundThere have been several calls for estimations of costs and consequences of headache interventions to inform European public-health policies. In a previous paper, in the absence of universally accepted methodology, we developed headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Here we apply this methodology and present the findings.MethodsData sources were published evidence and expert opinions, including those from an earlier economic evaluation framework using the WHO-CHOICE model. We used three headache-type-specific analytical models, for migraine, tension-type-headache (TTH) and medication-overuse-headache (MOH). We considered three European Region case studies, from Luxembourg, Russia and Spain to include a range of health-care systems, comparing current (suboptimal) care versus target care (structured services implemented, with provider-training and consumer-education). We made annual and 5-year cost estimates from health-care provider and societal perspectives (2020 figures, euros). We expressed effectiveness as healthy life years (HLYs) gained, and cost-effectiveness as incremental cost-effectiveness-ratios (ICERs; cost to be invested/HLY gained). We applied WHO thresholds for cost-effectiveness.ResultsThe models demonstrated increased effectiveness, and cost-effectiveness (migraine) or cost saving (TTH, MOH) from the provider perspective over one and 5 years and consistently across the health-care systems and settings. From the societal perspective, we found structured headache services would be economically successful, not only delivering increased effectiveness but also cost saving across headache types and over time. The predicted magnitude of cost saving correlated positively with country wage levels. Lost productivity had a major impact on these estimates, but sensitivity analyses showed the intervention remained cost-effective across all models when we assumed that remedying disability would recover only 20% of lost productivity.ConclusionsThis is the first study to propose a health-care solution for headache, in the form of structured headache services, and evaluate it economically in multiple settings. Despite numerous challenges, we demonstrated that economic evaluation of headache services, in terms of outcomes and costs, is feasible as well as necessary. Furthermore, it is strongly supportive of the proposed intervention, while its framework is general enough to be easily adapted and implemented across Europe.
Published: 2021

18. Editorial. Valuing headache's solution

Author: Timothy J. Steiner and Michela Tinelli
Subjects: medicine.medical_specialty, Neurology, Global Campaign against Headache, business.industry, Pain medicine, Headache, Economic analysis, General Medicine, Health policy, Anesthesiology and Pain Medicine, Family medicine, Structured headache services, Commentary, RA Public aspects of medicine, RC Internal medicine, Humans, Medicine, Neurology (clinical), business, Value of treatment
Published: 2021

19. Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and description

Author: Zaza Katsarava, Jon H. Eliasson, Akbar A. Herekar, Mohammed Al Jumah, Yared Zenebe Zewde, Girish Baburao Kulkarni, Koen Paemeleire, Susan W. Broner, Mehila Zebenigus, Mattias Linde, Rigmor Jensen, Girish N Rao, Deanna Saylor, Raquel Gil-Gouveia, Shengyuan Yu, Timothy J. Steiner, Najib Kissani, Otgonbayar Luvsannorov, Youssoufa Maiga, Guiovanna Quispe, V. V. Osipova, Ajay Risal, Ali M. Al Khathaami, Larus S. Gudmundsson, Jasna Zidverc-Trajkovic, Jes Olesen, Matilde Leonardi, Teymur Musayev, Michela Tinelli, Ivan Milanov, Mark Braschinsky, Latifa Adarmouch, Derya Uluduz, Elena R. Lebedeva, Elena Ruiz de la Torre, Mansoureh Togha, Messoud Ashina, Nfwama Kawatu, Lars Jacob Stovner, Mario Fernando Prieto Peres, Dimos D. Mitsikostas, and Juan B. Gómez-Galván
Subjects: medicine.medical_specialty, Headache Disorders, Pain medicine, 03 medical and health sciences, 0302 clinical medicine, Argument, Medicine, Humans, 030212 general & internal medicine, Health policy, Public health, Horizontal integration, Primary Health Care, Global Campaign against Headache, business.industry, Health-technology assessment, Principal (computer security), Headache, General Medicine, medicine.disease, Primary care, Needs assessment, Consensus Article, Anesthesiology and Pain Medicine, Migraine, Barriers to care, Service organization and delivery, Structured headache services, RA Public aspects of medicine, RC Internal medicine, Neurology (clinical), Medical emergency, business, Delivery of Health Care, 030217 neurology & neurosurgery
Abstract: In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the “patient journey”) with perplexing obstacles.High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary.The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded.It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.
Published: 2021

20. The relationship between headache-attributed disability and lost productivity: 1. A review of the literature

Author: Timothy J. Steiner, Rigmor Hølland Jensen, and Simple Futarmal Kothari
Subjects: media_common.quotation_subject, Context (language use), Efficiency, 03 medical and health sciences, Lost productivity, 0302 clinical medicine, Empirical research, Reading (process), Headache disorders, Selection (linguistics), Relevance (law), Medicine, Humans, 030212 general & internal medicine, Meaning (existential), Productivity, media_common, Disability, Global Campaign against Headache, business.industry, Systematic literature review, Headache, General Medicine, Anesthesiology and Pain Medicine, Systematic review, Neurology (clinical), business, 030217 neurology & neurosurgery, Clinical psychology, Research Article
Abstract: BackgroundHeadache disorders are disabling and have a significant impact on productivity. The relationship between these two consequences is of considerable economic and political interest. We enquired into it through a systematic search of the English-language literature.MethodsWe followed PRISMA guidelines in specifying search terms and syntax and in article selection. We used the term “disability” in the search, accepting any meaning that authors attached to it, but this proved problematic. Accordingly, we adopted the definition used in the Global Burden of Disease study. In article selection, we included only those that purported to measure disability as so defined and lost productivity. We reviewed the full texts of those selected. We included further articles identified from review of the bibliographies of selected articles.ResultsThe literature search found 598 studies, of which 21 warranted further review. Their bibliographies identified another four of possible relevance. On full-text reading of these 25, all were rejected. Ten applied incompatible definitions of disability and/or lost productivity. Two did not measure both. Four reported lost productivity but not disability. Eight studies reported and measured both but did not assess the association between them or provide the means of doing so. One was purely methodological.ConclusionsThe literature is silent on the relationship between headache-attributed disability and lost productivity. In view of its health economic and political importance, empirical studies are required to remedy this. A prerequisite is to clarify what is meant by “disability” in this context.
Published: 2021
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21. Burden of Neurological Disorders Across the US From 1990-2017: A Global Burden of Disease Study

Author: Veeresh Kumar N. Shivamurthy, Simona Giampaoli, Rupak Desai, Mahya Beheshti, Theo Vos, Timothy J. Steiner, E. Ray Dorsey, Maziar Moradi-Lakeh, Giancarlo Logroscino, Gregory A. Roth, Arianna Maever L. Amit, Shane D. Morrison, Michael K. Hole, Joseph R. Zunt, Takayoshi Ikeda, Lars Jacob Stovner, Mohsen Naghavi, Emma Nichols, Daniel Kim, Azadeh Shafieesabet, George A. Mensah, Ali H. Mokdad, Ted R. Miller, Warren D. Lo, Michael H. Criqui, Khaled Khatab, Walter J. Koroshetz, Fares Alahdab, Amir Radfar, Prachi Chavan, Ettore Beghi, Sara Sheikhbahaei, Giorgia Giussani, Samath D Dharmaratne, Jordan Weiss, Till Bärnighausen, Aziz Sheikh, Jae Il Shin, Vijay Krishnamoorthy, Catherine O. Johnson, Christopher M Odell, Mitchell T. Wallin, Jaimie D. Adelson, Valery L. Feigin, Xuefeng Liu, Islam Y. Elgendy, Christopher J L Murray, Jagdish Khubchandani, Irina Filip, Bo Norrving, Salahuddin Mohammed, Rita Krishnamurthi, Elisabetta Pupillo, Arielle Wilder Eagan, Nima Hafezi-Nejad, Rizwan Kalani, Chenkai Wu, and Jasvinder A. Singh
Subjects: medicine.medical_specialty, Pediatrics, Neurology, Population, Disease, Global Health, Global Burden of Disease, 03 medical and health sciences, Epilepsy, 0302 clinical medicine, Cost of Illness, medicine, Dementia, Humans, Online First, 030212 general & internal medicine, education, Stroke, Original Investigation, education.field_of_study, business.industry, Incidence (epidemiology), Research, Disability-Adjusted Life Years, medicine.disease, United States, Featured, Migraine, Neurology (clinical), Nervous System Diseases, business, 030217 neurology & neurosurgery, Comments
Abstract: Key Points Question What is the current burden of neurological disorders in the US by states, and what are the temporal trends (from 1990 to 2017)? Findings Systematic analysis of the Global Burden of Disease study shows that, in 2017, the 3 most burdensome neurological disorders in the US were stroke, Alzheimer disease and other dementias, and migraine. The burden of individual neurological disorders varied moderately to widely by states (a 1.2-fold to 7.5-fold difference), and the absolute numbers of incident, prevalent, and fatal cases and disability-adjusted life-years of neurological disorders (except for traumatic brain injury incidence; spinal cord injury prevalence; meningitis prevalence, deaths, and disability-adjusted life-years; and encephalitis disability-adjusted life-years) across all US states increased from 1990 to 2017. Meaning A large and increasing number of people have various neurological disorders in the US, with significant variation in the burden of and trends in neurological disorders across the US states, and the reasons for these geographic variations need to be explored further., This analysis of the Global Burden of Disease 2017 study presents burden estimates of major neurological disorders in the US states by age and sex from 1990 to 2017., Importance Accurate and up-to-date estimates on incidence, prevalence, mortality, and disability-adjusted life-years (burden) of neurological disorders are the backbone of evidence-based health care planning and resource allocation for these disorders. It appears that no such estimates have been reported at the state level for the US. Objective To present burden estimates of major neurological disorders in the US states by age and sex from 1990 to 2017. Design, Setting, and Participants This is a systematic analysis of the Global Burden of Disease (GBD) 2017 study. Data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of major neurological disorders were derived from the GBD 2017 study of the 48 contiguous US states, Alaska, and Hawaii. Fourteen major neurological disorders were analyzed: stroke, Alzheimer disease and other dementias, Parkinson disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, traumatic brain injury, spinal cord injuries, brain and other nervous system cancers, meningitis, encephalitis, and tetanus. Exposures Any of the 14 listed neurological diseases. Main Outcome and Measure Absolute numbers in detail by age and sex and age-standardized rates (with 95% uncertainty intervals) were calculated. Results The 3 most burdensome neurological disorders in the US in terms of absolute number of DALYs were stroke (3.58 [95% uncertainty interval [UI], 3.25-3.92] million DALYs), Alzheimer disease and other dementias (2.55 [95% UI, 2.43-2.68] million DALYs), and migraine (2.40 [95% UI, 1.53-3.44] million DALYs). The burden of almost all neurological disorders (in terms of absolute number of incident, prevalent, and fatal cases, as well as DALYs) increased from 1990 to 2017, largely because of the aging of the population. Exceptions for this trend included traumatic brain injury incidence (−29.1% [95% UI, −32.4% to −25.8%]); spinal cord injury prevalence (−38.5% [95% UI, −43.1% to −34.0%]); meningitis prevalence (−44.8% [95% UI, −47.3% to −42.3%]), deaths (−64.4% [95% UI, −67.7% to −50.3%]), and DALYs (−66.9% [95% UI, −70.1% to −55.9%]); and encephalitis DALYs (−25.8% [95% UI, −30.7% to −5.8%]). The different metrics of age-standardized rates varied between the US states from a 1.2-fold difference for tension-type headache to 7.5-fold for tetanus; southeastern states and Arkansas had a relatively higher burden for stroke, while northern states had a relatively higher burden of multiple sclerosis and eastern states had higher rates of Parkinson disease, idiopathic epilepsy, migraine and tension-type headache, and meningitis, encephalitis, and tetanus. Conclusions and Relevance There is a large and increasing burden of noncommunicable neurological disorders in the US, with up to a 5-fold variation in the burden of and trends in particular neurological disorders across the US states. The information reported in this article can be used by health care professionals and policy makers at the national and state levels to advance their health care planning and resource allocation to prevent and reduce the burden of neurological disorders.
Published: 2020

22. Migraine: epidemiology and systems of care

Author: Dawn C. Buse, Simona Sacco, Timothy J. Steiner, Thien Phu Do, Messoud Ashina, Samaira Younis, Sait Ashina, Abouch V. Krymchantowski, Aynur Özge, Shengyuan Yu, K. Ravishankar, Zaza Katsarava, Elena R. Lebedeva, Patricia Pozo-Rosich, and Richard B. Lipton
Subjects: medicine.medical_specialty, Referral, Migraine Disorders, Medizin, MEDLINE, Developing country, 030204 cardiovascular system & hematology, Global Health, 03 medical and health sciences, 0302 clinical medicine, Nursing, Formal education, Epidemiology, Global health, Prevalence, Medicine, Humans, Disabled Persons, 030212 general & internal medicine, Developing Countries, Referral and Consultation, Health policy, Primary Health Care, business.industry, Health Policy, General Medicine, Continuity of Patient Care, medicine.disease, Migraine, business
Abstract: Migraine is a neurovascular disorder that affects over 1 billion people worldwide. Its widespread prevalence, and associated disability, have a range of negative and substantial effects not only on those immediately affected but also on their families, colleagues, employers, and society. To reduce this global burden, concerted efforts are needed to implement and improve migraine care that is supported by informed health-care policies. In this Series paper, we summarise the data on migraine epidemiology, including estimates of its very considerable burden on the global economy. First, we present the challenges that continue to obstruct provision of adequate care worldwide. Second, we outline the advantages of integrated and coordinated systems of care, in which primary and specialist care complement and support each other; the use of comprehensive referral and linkage protocols should enable continuity of care between these systems levels. Finally, we describe challenges in low and middle-income countries, including countries with poor public health education, inadequate access to medication, and insufficient formal education and training of health-care professionals resulting in misdiagnosis, mismanagement, and wastage of resources.
Published: 2020

23. Health-care utilization for headache disorders in Nepal: a population-based door-to-door survey

Author: Ajay Risal, Timothy J. Steiner, Kedar Manandhar, and Mattias Linde
Subjects: Male, Rural Population, IMPACT, lcsh:Medicine, 0302 clinical medicine, Surveys and Questionnaires, Health care, EPIDEMIOLOGY, 030212 general & internal medicine, education.field_of_study, Health Policy, General Medicine, Middle Aged, PREVALENCE, MIGRAINE, Health-care utilization, Population Surveillance, Female, Cluster sampling, Public Health, Life Sciences & Biomedicine, Research Article, Adult, medicine.medical_specialty, EUROPE, Adolescent, Pain medicine, Population, Clinical Neurology, Young Adult, 03 medical and health sciences, Nepal, Headache disorders, medicine, Humans, education, Health policy, Aged, Population-based study, 0604 Genetics, Science & Technology, Neurology & Neurosurgery, business.industry, lcsh:R, Neurosciences, Quality of care, 1103 Clinical Sciences, Patient Acceptance of Health Care, medicine.disease, Global campaign against headache, Cross-Sectional Studies, Anesthesiology and Pain Medicine, Migraine, Family medicine, Structured interview, Structured headache services, PATTERNS, Neurosciences & Neurology, Neurology (clinical), Medical consultation, business, 030217 neurology & neurosurgery
Abstract: Background Headache disorders are an important global public-health problem, but under-diagnosed, undertreated and under-prioritized. Deficiencies in health care for headache, present everywhere, are likely to be greater in poorly-resourced countries. This study reports on health-care utilization for headache in Nepal, a low-income country with high headache burden. Methods We took data from a cross-sectional, nationwide population-based door-to-door survey, with multistage cluster random sampling. Face-to-face structured interviews included enquiry into consultations with professional health-care providers (HCPs), and investigations and treatments for headache. Analysis included associations with sociodemographic variables and indices of symptom severity. Results Of 2100 participants, 1794 reported headache during the preceding year (mean age 36.1 ± 12.6 years; male/female ratio 1:1.6). Of these, 58.4% (95% CI: 56.1–60.7%) had consulted at least once in the year with HCPs at any level, most commonly (25.0%) paramedical; 15.0% had consulted pharmacists, 10.8% general physicians and 7.6% specialists (of any type). Participants with probable medication-overuse headache consulted most (87.0%), followed by those with migraine (67.2%) and those with tension-type headache (48.6%; p
Published: 2018
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24. The Global Burden of Headache

Author: Deanna Saylor and Timothy J. Steiner
Subjects: medicine.medical_specialty, Population, Psychological intervention, Global Health, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Economic cost, Environmental health, Intervention (counseling), Epidemiology, medicine, Humans, 030212 general & internal medicine, education, education.field_of_study, business.industry, Headache, medicine.disease, Neurology, Migraine, Scale (social sciences), Neurology (clinical), business, Delivery of Health Care, 030217 neurology & neurosurgery
Abstract: At the turn of the century, most of the world's population lived in regions where the prevalence of headache was unknown and its impact poorly understood. Lifting The Burden (LTB), a nonprofit organization in official relations with the World Health Organization, established the Global Campaign against Headache, with the ultimate purpose of reducing the burden of headache worldwide. First, the scope and scale of this burden had to be known. LTB embarked upon a program of population-based studies in countries in all world regions in order to achieve its aim. Its studies have demonstrated a high prevalence of headache disorders, including migraine, tension-type headache, and medication-overuse headache, and their associations with impaired quality of life, substantial lost productivity, and high economic costs in every country surveyed. Informed by these, the Global Burden of Disease study ranks headache disorders as the second leading cause of years lived with disability worldwide; migraine alone is third among people aged 15 to 49 years. With interventions urgently needed to reduce these burdens throughout the world, we review the epidemiological studies conducted by LTB, examine proposed interventions to improve provision of headache care including a three-tier system of structured headache services, and consider the challenges still remaining in providing effective, efficient, and equitable headache care especially in low-income countries.
Published: 2018
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25. Undifferentiated headache: broadening the approach to headache in children and adolescents, with supporting evidence from a nationwide school-based cross-sectional survey in Turkey

Author: Ugur Uygunoglu, Yeliz Bahar Özdemir, Derya Uluduz, Tanja Auer, Timothy J. Steiner, Selen Ilhan Alp, Tuna Stefan Aslan, Christian Wöber, Caner Feyzi Demir, Ferhat Balgetir, Ahmet Tufekci, Fidan Surgun, Taskin Duman, Çiçek Wöber-Bingöl, Gülser Karadaban Emir, Aksel Siva, MÜ, RTEÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, and Tüfekçi, Ahmet
Subjects: Male, Pediatrics, Neurology, Turkey, Cross-sectional study, lcsh:Medicine, Diseases, Adolescents, 0302 clinical medicine, CLINICAL CHARACTERISTICS, Quality of life, Surveys and Questionnaires, Epidemiology, Headache yesterday, Prevalence, Longitudinal Studies, 030212 general & internal medicine, Child, Children, Schools, Injuries, Global Campaign against Headache, SCHOOLCHILDREN, Headache, General Medicine, DISEASES, Female, Headaches, medicine.symptom, Burden of headache, Life Sciences & Biomedicine, Research Article, medicine.medical_specialty, Adolescent, Clinical Neurology, Schoolchildren, 03 medical and health sciences, SYSTEMATIC ANALYSIS, medicine, Humans, Migraine, Population-based study, 0604 Genetics, Science & Technology, Neurology & Neurosurgery, Disability, business.industry, DISABILITY, Tension-Type Headache, lcsh:R, Neurosciences, 1103 Clinical Sciences, Global Burden, GLOBAL BURDEN, medicine.disease, Tension-type headache, Cross-Sectional Studies, Anesthesiology and Pain Medicine, Nationwide, INJURIES, School based, Neurosciences & Neurology, Neurology (clinical), business, Clinical Characteristics, Systematic Analysis, 030217 neurology & neurosurgery, Undifferentiated headache
Abstract: Background Headache is a leading disabler in adults worldwide. In children and adolescents, the same may be true but the evidence is much poorer. It is notable that published epidemiological studies of these age groups have largely ignored headaches not fulfilling any specific set of ICHD criteria, although such headaches appear to be common. A new approach to these is needed: here we introduce, and investigate, a diagnostic category termed “undifferentiated headache” (UdH), defined in young people as recurrent mild-intensity headache of
Published: 2018
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26. Structured education to improve primary‐care management of headache: how long do the benefits last? A follow‐up observational study

Author: Zaza Katsarava, Sulev Haldre, Mart Kals, B. Saar, M. Niibek, Timothy J. Steiner, Mark Braschinsky, and M. Arge
Subjects: Adult, Estonia, Male, myalgia, medicine.medical_specialty, Referral, Migraine Disorders, Medizin, Primary care, Structured education, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Continuing medical education, General Practitioners, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Baseline (configuration management), Referral and Consultation, Aged, Primary Health Care, business.industry, Age Factors, Headache, Disease Management, Middle Aged, medicine.disease, Quality Improvement, Neurology, Migraine, Physical therapy, Education, Medical, Continuing, Female, Observational study, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: BACKGROUND AND PURPOSE Our earlier study showed that structured education of general practitioners (GPs) improved their practice in headache management. Here the duration of this effect was assessed. METHODS In a follow-up observational study in southern Estonia, subjects were the same six GPs as previously, managing patients presenting with headache as the main complaint. Data reflecting their practice were collected prospectively during a 1-year period commencing 2 years after the educational intervention. The primary outcome measure was referral rate (RR) to neurological services. Comparisons were made with baseline and post-intervention data from the earlier study. RESULTS In 366 patients consulting during the follow-up period, the RR was 19.9%, lower than at baseline (39.5%; P
Published: 2017
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27. Migraine Nurses in Primary Care

Author: Boudewijn J. Kollen, Timothy J. Steiner, Jan S.P. van den Berg, Petra J.L. Veenstra, and Life Course Epidemiology (LCE)
Subjects: Male, Pediatrics, Time Factors, Total cost, IMPACT, Cost-Benefit Analysis, primary care nurse, Nurses, DISEASE, burden, Indirect costs, 0302 clinical medicine, Cost of Illness, cost analysis, Absenteeism, Medicine, migraine, 030212 general & internal medicine, Referral and Consultation, health care economics and organizations, Netherlands, EUROLIGHT PROJECT, Cost–benefit analysis, PRODUCTIVITY, Health Care Costs, Neurology, Female, management, Cohort study, Adult, HEADACHE DISORDERS, medicine.medical_specialty, EUROPE, Migraine Disorders, UNITED-STATES, Primary care, 03 medical and health sciences, Sex Factors, Humans, Neurologists, Productivity, Primary Health Care, Salaries and Fringe Benefits, business.industry, medicine.disease, Migraine, disability, Emergency medicine, Neurology (clinical), business, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: Objective. We examined the costs and benefits of introducing migraine nurses into primary care.Background. Migraine is one of the most costly neurological diseases.Methods. We analyzed data from our earlier nonrandomized cohort study comparing an intervention group of 141 patients, whose care was supported by nurses trained in migraine management, and a control group of 94 patients receiving usual care. Estimates of per-person direct costs were based on nurses' salaries and referrals to neurologists. Indirect costs were estimated as lost productivity, including numbers of days of absenteeism or with Results. After 9 months the direct costs were (sic)281.11 in the control group against (sic)332.23 in the intervention group (mean difference -51.12; 95% CI: -113.20-15.56; P=.134); the indirect costs were (sic)1985.51 in the control group against (sic)1631.75 in the intervention group (mean difference 353.75; 95% CI: -355.53-1029.82; P=.334); and total costs were (sic)2266.62 in the control group, against (sic)1963.99 in the intervention group (mean difference 302.64; 95% CI: -433.46-1001.27; P=.438). When costs attributable to lost household productivity were included, total costs increased to (sic)6076.62 in the control group and (sic)5048.15 in the intervention group (mean difference 1028.47; 95% CI: -590.26-2603.67; P=.219).Conclusion. Migraine nurses in primary care seemed in this study to increase practice costs but decrease total societal costs. However, it was a nonrandomized study, and the differences did not reach significance. For policy-makers concerned with headache-service organization and delivery, the important messages are that we found no evidence that nurses increased overall costs, and investment in a definitive study would therefore be worthwhile.
Published: 2017
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28. Headache burden in a HIV population of sub-Saharan Africa: scope and implications from a pilot study

Author: Maureen Kamponda, Luca Giani, Maria Cristina Marazzi, Timothy J. Steiner, Giovanni Guidotti, Tayyar Şaşmaz, Victor Tamba Tolno, Monica Mwazangati, Massimo Leone, and Derya Uluduz
Subjects: medicine.medical_specialty, education.field_of_study, Sub saharan, Scope (project management), business.industry, Population, Headache, Human immunodeficiency virus (HIV), HIV Infections, Pilot Projects, Dermatology, General Medicine, medicine.disease_cause, Psychiatry and Mental health, Family medicine, medicine, Humans, Neurology (clinical), Neurosurgery, education, business, Africa South of the Sahara, Neuroradiology
Published: 2020
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29. The prevalence of primary headache disorders in Saudi Arabia: A cross-sectional population-based study

Author: Mohamed Hussain, Ali M. Al Khathaami, Mohammed Al Jumah, Suleman Kojan, Timothy J. Steiner, and Hallie Thomas
Subjects: Male, Headache Disorders, Primary, Epidemiology, lcsh:Medicine, DISEASE, Surveys and Questionnaires, National health policy, Prevalence, Headache Disorders, Secondary, Medicine, education.field_of_study, Global Campaign against Headache, Headache, General Medicine, Middle Aged, Medication-overuse headache, Female, Life Sciences & Biomedicine, Research Article, Adult, medicine.medical_specialty, Adolescent, Migraine Disorders, Population, Clinical Neurology, Saudi Arabia, Eastern Mediterranean Region, Young Adult, Age Distribution, SYSTEMATIC ANALYSIS, Humans, education, Migraine, Aged, 0604 Genetics, Science & Technology, Neurology & Neurosurgery, business.industry, DISABILITY, lcsh:R, Tension-Type Headache, Neurosciences, Mean age, 1103 Clinical Sciences, GLOBAL BURDEN, medicine.disease, Population based study, Eastern mediterranean, Anesthesiology and Pain Medicine, Cross-Sectional Studies, INJURIES, Neurology (clinical), Neurosciences & Neurology, business, Demography, Primary Headache Disorders
Abstract: Background The large geographical gaps in our knowledge of the prevalence and burden of headache disorders include most of Eastern Mediterranean Region (EMR). Following a nationwide population-based study in Pakistan, we present here a similar study from Kingdom of Saudi Arabia (KSA). Both were conducted as projects within the Global Campaign against Headache The two purposes of this study were to inform national health policy and contribute to global knowledge of headache disorders. Methods We surveyed Arabic-speaking adults aged 18–65 years in all 13 regions of KSA. While previous Global Campaign studies have engaged participants by calling at randomly selected households, the culture of KSA made this unacceptable. Participants were, instead, contacted by cell-phone (since cell-phone coverage exceeded 100% in KSA), using random-digit dialling. Trained interviewers used a culturally adapted version of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, with diagnostic enquiry based on ICHD-II. We estimated 1-year prevalences of the headache disorders of public-health importance (migraine, tension-type headache [TTH] and probable medication-overuse headache [pMOH]) and examined their associations with demographic variables. Results A total of 2316 participants (mean age of 32.2 ± 10.7 years; 62.3% male; 37.7% female) were included (participation proportion 86.5%). Gender and age distributions imperfectly matched those of the national population, requiring adjustments for these to prevalence estimates. Observed 1-year prevalence of all headache was 77.2%, reducing to 65.8% when adjusted. For headache types, adjusted 1-year prevalences were migraine 25.0%, TTH 34.1%, pMOH 2.0% and other headache on ≥15 days/month 2.3%. Adjusted 1-day prevalence of any headache was 11.5%. Migraine and pMOH were associated with female gender (ORs: 1.7 and 4.7; p 45 years (OR: 0.4; p = 0.0143) while pMOH was most prevalent in those aged 46–55 years (OR: 2.7; p = 0.0415). TTH reportedly became more common with increasing level of education. Conclusion Prevalences of migraine and TTH in KSA are considerably higher than global averages (which may be underestimated), and not very different from those in Pakistan. There is more pMOH in KSA than in Pakistan, reflecting, probably, its higher-income status and greater urbanisation (facilitating access to medication).
Published: 2020

30. 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

Author: Sorin Hostiuc, Shaun Wen Huey Lee, Jorge R. Ledesma, Carsten Flohr, Masoumeh Sadeghi, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Mehdi Bohluli, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Seyyed Meysam Mousavi, Bernhard T. Baune, Ehsan Ahmadpour, Dinh-Toi Chu, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Mohammad Taghi Khodayari, Gianna Gayle Herrera Amul, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Michael K. Hole, Azeem Majeed, Iman Halvaei, Saqib Ali, Arianna Maever L. Amit, Tomas Y. Yeheyis, John S. Ji, Martin McKee, Jamileh Shadid, Leonardo Roever, Peng Jia, Ettore Beghi, Pablo M. Lavados, Young Eun Kim, Vahid Alipour, Sowmya J. Rao, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nicole K. DeCleene, Ebrahim Babaee, Saman Esmaeilnejad, Boris Bikbov, William M. Gardner, Lydia M. Haile, Luca Ronfani, Azalea M. Thomson, Irena Ilic, Ruth W. Kimokoti, Yingxi Zhao, Guoqing Hu, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Nathaniel J. Henry, Brijesh Sathian, Daniel Kim, Peter Memiah, Mohammad Hadi Abbasi, Andrea Farioli, Zahra Kamiab, Bolajoko O. Olusanya, Matthew C. Doxey, Tommi Vasankari, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Shanshan Li, Tanvir M. Huda, Dillon O Sylte, Rosario Cárdenas, Agegnehu Bante, Helen Ippolito, Alyssa Acebedo, Jeffrey D. Stanaway, Anwar Faraj, João Pedro Silva, Amin Mousavi Khaneghah, Pushpendra Kumar, Sangram Kishor Patel, Josephine W. Ngunjiri, Holly E. Erskine, Eugene Sobngwi, Filippo Ariani, Shane D. Morrison, Mohammad Aghaali, Meghan D. Mooney, Vera Marisa Costa, Palash Chandra Banik, Rupak Desai, Ken Takahashi, Maigeng Zhou, Morteza Oladnabi, Bogdan Oancea, Daniela Ribeiro, Mohammad Farahmand, Irmina Maria Michalek, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Emilie R Maddison, Syed Mohamed Aljunid, Damian G. Hoy, Hosni Salem, V. Prakash, Shuhei Nomura, Inga Dora Sigfusdottir, Anders Larsson, Sharareh Eskandarieh, Abdollah Mohammadian-Hafshejani, Somayeh Bohlouli, Joana Morgado-da-Costa, Siamak Sabour, Theo Vos, Han Yong Wunrow, Khaled Khatab, Alireza Zangeneh, Ann Kristin Knudsen, Marissa B Reitsma, Hannah J. Henrikson, Randah R. Hamadeh, Tuomo J. Meretoja, Ireneous N. Soyiri, Giuseppe Grosso, Ziyad Al-Aly, Taraneh Yousefinezhadi, Joseph L Ward, Roba Khundkar, Ricardo Santiago Gomez, Reza Malekzadeh, John J. McGrath, Sandra B. Munro, Shahin Soltani, Amy E. Peden, Rufus Akinyemi, Marcel Ausloos, Naohiro Yonemoto, Bogdan Wojtyniak, Ahmad Ghashghaee, Guilherme Borges, Sadia Bibi, Farhad Islami, Hamed Mirzaei, Mohammad Ali Sahraian, M. Ashworth Dirac, Hosna Janjani, Kairat Davletov, Hermann Brenner, Yuichiro Yano, Elissa M. Abrams, Ana Vukovic, Bartosz Miazgowski, Jobert Richie Nansseu, Jennifer O Lam, Mona Pathak, Leeberk Raja Inbaraj, Thirunavukkarasu Sathish, Asadollah Gholamian, Carlos A Castañeda-Orjuela, Babak Eshrati, Edgar Denova-Gutiérrez, Atte Meretoja, Lorenzo Monasta, Ronan A. Lyons, Neda Kianipour, Desalegn Getnet Demsie, Yasir Waheed, Desta Debalkie Atnafu, Davide Sattin, Kevin S Ikuta, Ghobad Moradi, Srinivas Goli, Krittika Bhattacharyya, Mika Kivimäki, Christopher Troeger, Jordi Alonso, Alireza Ahmadi, Navid Manafi, Caroline Stein, Songhomitra Panda-Jonas, Jason Nguyen, Moses K. Muriithi, Aziz Rezapour, Ismael R. Campos-Nonato, Adrian Pana, H. Dean Hosgood, Noore Alam, James L. Fisher, Mariam Molokhia, Susan F. Rumisha, Ernoiz Antriyandarti, Ayman Grada, Emma Nichols, Babak Asghari, André Luiz Sena Guimarães, Ferrán Catalá-López, Aletta E. Schutte, Fiona B. Bennitt, Maciej Banach, Antonio Biondi, Donal Bisanzio, Josip Car, Ronny Westerman, Shafiu Mohammed, Biniyam Sahiledengle Geberemariyam, Kenji Shibuya, Meghdad Pirsaheb, Milena Santric-Milicevic, Karen M. Tabb, Paula Moraga, Soheil Hassanipour, Hasan Yusefzadeh, Avina Vongpradith, Dara K. Mohammad, Ralph Maddison, Babak Moazen, Getachew Mullu Kassa, Rahman Shiri, Fernando Neves Hugo, Hmwe H Kyu, Zachary V Dingels, Florian Fischer, Valentin Yurievich Skryabin, Rafael Tabarés-Seisdedos, Massimo Cirillo, Nikita Otstavnov, Robert C. Reiner, Van C. Lansingh, Rodrigo Sarmiento-Suarez, Ashkan Afshin, Benjamin A Stark, Mohsen Abbasi-Kangevari, Natalie C. Galles, Behnam Heidari, Eun-Kee Park, Mohammad Ali Jahani, Suzanne Polinder, Mahalaqua Nazli Khatib, Farhad Jadidi-Niaragh, Amir Radfar, Mowafa Househ, Derrick A Bennett, Gaorui Guo, Hesam Ghiasvand, Taweewat Wiangkham, Tamás Joó, Cristiana Abbafati, Kathryn Mei Ming Lau, Anita K. Nandi, Miklós Szócska, Manasi Kumar, Eduardo A. Undurraga, Oladimeji M. Adebayo, Simon Yadgir, Victor Aboyans, Justin J. Lang, Catherine O. Johnson, Soewarta Kosen, Carla Sofia e.Sá Farinha, Marcos Roberto Tovani-Palone, Kamarul Imran Musa, Farshad Pourmalek, Kiomars Sharafi, Heather Orpana, Samuel B. Albertson, Mahdi Afshari, Nicholas J K Breitborde, Nelson J. Alvis-Zakzuk, Adrian Oţoiu, Iván Landires, Robert G. Weintraub, Kidanemaryam Berhe, André Faro, Sophia Emmons-Bell, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Naderi, Yordanos Gizachew Yeshitila, Mehdi Hosseinzadeh, Arash Etemadi, Oleguer Plana-Ripoll, Theodore Patrick Younker, Joemer C. Maravilla, Alireza Ansari-Moghaddam, Borhan Mansouri, Narayanaswamy Venketasubramanian, Seyed Mohammad Kazem Aghamir, Linda Morales, Amanda Deen, Noushin Mohammadifard, Obinna Onwujekwe, Ai Koyanagi, Michele Nguyen, Chieh Han, Kiana Ramezanzadeh, Mika Shigematsu, Mohammed Shannawaz, Khurshid Alam, Javad Nazari, Bryan L. Sykes, Rajat Das Gupta, Stephen S Lim, Lingkan Barua, Zubair Kabir, Michael Brauer, Afarin Rahimi-Movaghar, Deepa Jahagirdar, Kaja Abbas, Gholamreza Bazmandegan, Mark A. Stokes, Rajaa Al-Raddadi, Kanyin L. Ong, Kate Causey, Ahmed Omar Bali, Matilde Leonardi, Jeffrey V. Lazarus, Wondimeneh Shibabaw Shiferaw, André Karch, Blair R. Bumgarner, Nelson Alvis-Guzman, Jennifer H MacLachlan, Saeed Amini, Parvaiz A Koul, Blessing J. Akombi, Ro Ting Lin, Dabere Nigatu, Alaa Badawi, Flavia M. Cicuttini, Deanna Anderlini, Claudio Alberto Dávila-Cervantes, Rupert R A Bourne, Tanuj Kanchan, Catherine P. Benziger, Tahiya Alam, M. Mofizul Islam, Muktar Omer Omer, Leila Zaki, Mehdi Mirzaei-Alavijeh, Inbal Salz, Katharine J Looker, Shiwei Liu, Fatemeh Amiri, Christopher R. Cederroth, Mitra Abbasifard, Hamidreza Pazoki Toroudi, Gbenga A. Kayode, Antonio Luiz Pinho Ribeiro, Krishna Kumar Aryal, Mu'awiyyah Babale Sufiyan, Mohamed M. Gad, Assefa Desalew, Lidia Morawska, Davood Anvari, Mohammad Reza Salahshoor, Hadi Pourjafar, Abdu A. Adamu, Maryam Adabi, Zulfiqar A. Bhutta, Jessica A. Cruz, Foad Abd-Allah, Amir Hasanzadeh, Jordan Weiss, Maryam Ghadimi, Seyed-Mohammad Fereshtehnejad, Serge Resnikoff, Joanna L Whisnant, Kelly Compton, Priya Parmar, Sanjay Basu, Leila R Kalankesh, Nickolas Reinig, Ana Maria Mantilla Herrera, Fatemeh Rajati, Damian Santomauro, Mojisola Oluwasanu, Sheikh Mohammed Shariful Islam, David M. Pereira, Joht Singh Chandan, Deepak Kumar Pasupula, Aristidis Tsatsakis, Hoa Thi Do, Whitney L. Teagle, Hans W. Hoek, James Leigh, Morteza Arab-Zozani, Yasser Vasseghian, Stephanie R M Zimsen, Charlie Ashbaugh, Fariba Dorostkar, Abdelrahman Ibrahim Abushouk, Mikk Jürisson, Golnaz Heidari, Kala M. Mehta, Saeed Shahabi, Sarah Wulf Hanson, Nizal Sarrafzadegan, Dharmesh Kumar Lal, Hai Quang Pham, Aleksandr Y. Aravkin, Joshua A. Salomon, David C. Schwebel, Milena Ilic, Kareha M Agesa, Jost B. Jonas, Dian Kusuma, Benjamin B. Massenburg, Santosh Varughese, Yousef Mohammad, Beatriz Paulina Ayala Quintanilla, Mihaela Hostiuc, Richard G. Cowden, Morteza Shamsizadeh, Thomas Pilgrim, Alessandra C. Goulart, Leila Doshmangir, Gabriele Nagel, Saravanan Muthupandian, Zahra Sadat Dibaji Forooshani, Maryam Mirzaei, Zabihollah Yousefi, Shadrach Wilson, Iman El Sayed, Juanita A. Haagsma, Segun Emmanuel Ibitoye, Eirini Skiadaresi, Reza Shirkoohi, Tim Driscoll, Morteza Jafarinia, Maha El Tantawi, Telma Zahirian Moghadam, Katarzyna Kissimova-Skarbek, Abdilahi Yousuf Yousuf, Dickson A. Amugsi, Awoke Misganaw, Maseer Khan, Norito Kawakami, Jingkai Wei, Jai K Das, Vishnu Renjith, Tessa M. Pilz, Sameer Vali Gopalani, Roghiyeh Faridnia, Islam Y. Elgendy, Prateek Rastogi, Lauren B. Wilner, Josep Maria Haro, Zahiruddin Quazi Syed, Ben Lacey, Ketema Bizuwork Gebremedhin, Sam Rolfe, Iffat Elbarazi, Yannick Béjot, Raimundas Lunevicius, Sezer Kisa, Harish Chander Gugnani, Basema Saddik, Manu Raj Mathur, Mansour Ghafourifard, Riaz Uddin, Anna Poznańska, Faris Lami, Niguse Meles Alema, Michael T. Chung, Arya Aminorroaya, Arash Sarveazad, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, João M. Furtado, Hamid Ahmadieh, Sara Conti, Yunquan Zhang, Manthan D Janodia, Aislyn U. Orji, S. Mohammad Sajadi, Jalal Arabloo, Gabrielle B. Britton, Colm McAlinden, Francisco Rogerlândio Martins-Melo, Simona Cătălina Ştefan, Ester Cerin, Nuno Taveira, Lars Jacob Stovner, Amir Taherkhani, Masoud Foroutan, Tomasz Miazgowski, Amir Manafi, Yeshambel T. Nigatu, Barthelemy Kuate Defo, Mithila Faruque, Alan D. Lopez, Man Mohan Mehndiratta, Graeme J. Hankey, Mojgan Gitimoghaddam, Chantal Huynh, G Anil Kumar, Martin Amogre Ayanore, Abbas Sheikhtaheri, Turki Alanzi, Simon Øverland, David Laith Rawaf, Brian J. Hall, Edward J Mills, Ali Kabir, Ravi Prakash Jha, Akbar Barzegar, Simin Mouodi, Alize J. Ferrari, Chirag P. Doshi, Saleh Salehi Zahabi, Mohsen Naghavi, Mohammad Hassan Emamian, Amir Jalali, Chukwudi A Nnaji, Kebadnew Mulatu Mihretie, Maarten J. Postma, David Edvardsson, Chhabi Lal Ranabhat, Catherine M. Antony, Hannah Han, Ken Lee Chin, Getinet Ayano, Kewal Krishan, Maryam Zamanian, Farshad Farzadfar, Ali A. Asadi-Pooya, Daniel Diaz, Oliver J. Brady, Mohsen Bayati, Christopher M Odell, Jalil Jaafari, Walter Mendoza, Susanna Dunachie, Raffaele Palladino, Raaj Kishore Biswas, Alessandra Lugo, Reshmi Bhageerathy, Paulo A. Lotufo, Maia Kereselidze, Salman Rawaf, Olayinka Stephen Ilesanmi, Mousa Yaminfirooz, Neeraj Bedi, Mahesh P A, Harvey Whiteford, Gina Agarwal, Pallab K. Maulik, Ranjitha S Shetty, Adhanom Gebreegziabher Baraki, Prasanna Mithra, Binyam Minuye Birihane, Mohammad Ali Mansournia, Tomislav Mestrovic, Razique Anwer, Marcello Tonelli, Hanne Christensen, Juan Jesus Carrero, Ali H. Mokdad, Alberto Ortiz, Samad Azari, Ted R. Miller, Rebecca Ivers, Stephen R. Robinson, Saeid Safiri, Masood Ali Shaikh, Rajesh Sagar, Kelly Cercy, Mehran Asadi-Aliabadi, João Vasco Santos, Maziar Moradi-Lakeh, Sarah Lewington, Dimas Ria Angga Pribadi, Savita Lasrado, Abdul Moiz Hafiz, Amir Almasi-Hashiani, Burcu Kucuk Bicer, Praveen Hoogar, Fatemeh Heydarpour, Hala Rashad Elhabashy, Peng Zheng, Senthilkumar Balakrishnan, Paul H. Lee, Cameron J. Kneib, Srinivasa Rao Bolla, Harrison Chase Gottlich, Andrew M. Briggs, Alibek Mereke, Om P Kurmi, Kavumpurathu Raman Thankappan, Nikolay Ivanovich Briko, Shahram Saeidi, Anbissa Muleta Senbeta, Assefa Ayalew Ayalew Ayalew Gebreslassie, Aminu K. Bello, Tomi Akinyemiju, Ambrish Singh, Anamika Pandey, Matthew Cunningham, Endalkachew Worku Mengesha, Christine Linehan, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Stanislav S. Otstavnov, Andre M. N. Renzaho, Dinesh Bhandari, Masoud Moghadaszadeh, Atkilt Esaiyas Etisso, Valery L. Feigin, Christopher J L Murray, James D. Harvey, Daniel Cury Ribeiro, Girikumar Kumaresh, Javad Yoosefi Lebni, Elisabetta Pupillo, Shaimaa I. El-Jaafary, Marlena S Bannick, Caitlyn Steiner, Agus Sudaryanto, Eduardo Bernabé, Fereshteh Mehri, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Shaun Roberts, Rajeev Gupta, Jamal A. Yearwood, Nima Rezaei, Muhammad Shahdaat Bin Sayeed, David M. Pigott, Hadi Hassankhani, Samuel M. Ostroff, Gerhard Sulo, Keyghobad Ghadiri, Pankaj Bhardwaj, Suzanne Lyn Barker-Collo, Fiona J Charlson, Norberto Perico, Jonathan M. Kocarnik, Sergio I. Prada, Mohammad Sadegh Rezai, Mustafa Z. Younis, Neeraj Bhala, Mahmoud Yousefifard, Hue Thi Mai, Marwa Rashad Salem, Reza Pourmirza Kalhori, Carl Abelardo T. Antonio, Stefan Lorkowski, Farzad Jalilian, Nicholas J Kassebaum, Haley Lescinsky, Gholamreza Roshandel, Reza Heidari-Soureshjani, Kirsten E. Wiens, Ionut Negoi, Bhaskaran Unnikrishnan, Daniel J. Weiss, Sare Safi, Hamid Reza Tohidinik, Fablina Sharara, François Alla, Mohammad Rabiee, Sivan Yegnanarayana Iyer Saraswathy, Jack T Fox, Amirhossein Sahebkar, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Firooz Esmaeilzadeh, Brittney S. Sheena, Kyle E. Simpson, Muluken Bekele Sorrie, Vivekanand Jha, Morteza Abdullatif Khafaie, Seyed Mohammad Riahi, Nader Jahanmehr, Yuming Guo, George C. Patton, Rashid Abdi Guled, Tim C.D. Lucas, Alberto Raggi, Peter W. Gething, Mohaimenul Islam, Abdallah M. Samy, Cuong Tat Nguyen, Kaleab Alemayehu Zewdie, Ahamarshan Jayaraman Nagarajan, Roman Topor-Madry, C. E. G. Brayne, Phoebe Anne Rhinehart, Isabela M. 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L., Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Public Health, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, GBD 2019 Diseases and Injuries Collaborator, Violante FS, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, and UT-I-ITC-ACQUAL
Subjects: Male, Life expectancy, Disability-Adjusted Life Year, Diseases, Disease, communicable disease, systematic analysis, Global Burden of Disease, 0302 clinical medicine, 80 and over, Medicine, 10. No inequality, Child, 11 Medical and Health Sciences, injuries, Aged, 80 and over, education.field_of_study, Sjúkdómar, DEMENTIA, FALLS, General Medicine, Forvarnir, 3. Good health, Child, Preschool, Human, GBD, Population health, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Humans, Global Burden of Disease Study, education, Aged, Spatial Analysis, Global burden, Disability, Prevention, DISABILITY, Infant, Spatial Analysi, Mortality rate, Global Burden of Disease, Diseases, Injuries, Systematic analysis, PREVENTION, Years of potential life lost, Risk factors, Disease study, ITC-ISI-JOURNAL-ARTICLE, RISK-FACTORS, Clinical Medicine, RA, Demography, Fötlun, Dánartíðni, Áhættuþættir, 030204 cardiovascular system & hematology, Risk Factors, Cause of Death, Global health, 030212 general & internal medicine, 1. No poverty, Disability-Adjusted Life Years, Public Health, Global Health, Social Medicine and Epidemiology, Middle Aged, 3142 Public health care science, environmental and occupational health, Adolescent, Adult, Age Distribution, Female, Infant, Newborn, Young Adult, Lýðheilsa, CLINICAL-TRIALS, Population, Settore MED/01 - Statistica Medica, diseases, ITC-HYBRID, Heilbrigðisvísindi, General & Internal Medicine, Mortality, Preschool, Disease burden, business.industry, Risk Factor, Klinisk medicin, Newborn, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Áverkar, Systematic analysis, NA, business
Abstract: Publisher's version (útgefin grein), Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd., Research reported in this publication was supported by the Bill & Melinda Gates Foundation; the University of Melbourne; Queensland Department of Health, Australia; the National Health and Medical Research Council, Australia; Public Health England; the Norwegian Institute of Public Health; St Jude Children's Research Hospital; the Cardiovascular Medical Research and Education Fund; the National Institute on Ageing of the National Institutes of Health (award P30AG047845); and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated, the National Health Service (NHS), the National Institute for Health Research (NIHR), the UK Department of Health and Social Care, or Public Health England; the United States Agency for International Development (USAID), the US Government, or MEASURE Evaluation; or the European Centre for Disease Prevention and Control (ECDC). This research used data from the Chile National Health Survey 2003, 2009-10, and 2016-17. The authors are grateful to the Ministry of Health, the survey copyright owner, for allowing them to have the database. All results of the study are those of the authors and in no way committed to the Ministry. The Costa Rican Longevity and Healthy Aging Study project is a longitudinal study by the University of Costa Rica's Centro Centroamericano de Poblacion and Instituto de Investigaciones en Salud, in collaboration with the University of California at Berkeley. The original pre-1945 cohort was funded by the Wellcome Trust (grant 072406), and the 1945-55 Retirement Cohort was funded by the US National Institute on Aging (grant R01AG031716). The principal investigators are Luis Rosero-Bixby and William H Dow and co-principal investigators are Xinia Fernandez and Gilbert Brenes. The accuracy of the authors' statistical analysis and the findings they report are not the responsibility of ECDC. ECDC is not responsible for conclusions or opinions drawn from the data provided. ECDC is not responsible for the correctness of the data and for data management, data merging and data collation after provision of the data. ECDC shall not be held liable for improper or incorrect use of the data. The Health Behaviour in School-Aged Children (HBSC) study is an international study carried out in collaboration with WHO/EURO. The international coordinator of the 1997-98, 2001-02, 2005-06, and 2009-10 surveys was Candace Currie and the databank manager for the 1997-98 survey was Bente Wold, whereas for the following surveys Oddrun Samdal was the databank manager. A list of principal investigators in each country can be found on the HBSC website. Data used in this paper come from the 2009-10 Ghana Socioeconomic Panel Study Survey, which is a nationally representative survey of more than 5000 households in Ghana. The survey is a joint effort undertaken by the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana and the Economic Growth Centre (EGC) at Yale University. It was funded by EGC. ISSER and the EGC are not responsible for the estimations reported by the analysts. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with license number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. Data for this research was provided by MEASURE Evaluation, funded by USAID. The authors thank the Russia Longitudinal Monitoring Survey, conducted by the National Research University Higher School of Economics and ZAO Demoscope together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology, Russia Academy of Sciences for making data available. This paper uses data from the Bhutan 2014 STEPS survey, implemented by the Ministry of Health with the support of WHO; the Kuwait 2006 and 2014 STEPS surveys, implemented by the Ministry of Health with the support of WHO; the Libya 2009 STEPS survey, implemented by the Secretariat of Health and Environment with the support of WHO; the Malawi 2009 STEPS survey, implemented by Ministry of Health with the support of WHO; and the Moldova 2013 STEPS survey, implemented by the Ministry of Health, the National Bureau of Statistics, and the National Center of Public Health with the support of WHO. This paper uses data from Survey of Health, Ageing and Retirement in Europe (SHARE) Waves 1 (DOI:10.6103/SHARE. w1.700), 2 (10.6103/SHARE.w2.700), 3 (10.6103/SHARE.w3.700), 4 (10.6103/SHARE.w4.700), 5 (10.6103/SHARE.w5.700), 6 (10.6103/SHARE.w6.700), and 7 (10.6103/SHARE.w7.700); see Borsch-Supan and colleagues (2013) for methodological details. The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N degrees 211909, SHARE-LEAP: GA N degrees 227822, SHARE M4: GA N degrees 261982) and Horizon 2020 (SHARE-DEV3: GA N degrees 676536, SERISS: GA N degrees 654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and from various national funding sources is gratefully acknowledged. This study has been realised using the data collected by the Swiss Household Panel, which is based at the Swiss Centre of Expertise in the Social Sciences. The project is financed by the Swiss National Science Foundation. The United States Aging, Demographics, and Memory Study is a supplement to the Health and Retirement Study (HRS), which is sponsored by the National Institute of Aging (grant number NIA U01AG009740). It was conducted jointly by Duke University and the University of Michigan. The HRS is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. This paper uses data from Add Health, a program project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website. No direct support was received from grant P01-HD31921 for this analysis. The data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government. Collection of data for the Mozambique National Survey on the Causes of Death 2007-08 was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00. This manuscript is based on data collected and shared by the International Vaccine Institute (IVI) from an original study IVI conducted. L G Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (Brazil; finance code 001) and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, a Brazilian funding agency). I N Ackerman was supported by a Victorian Health and Medical Research Fellowship awarded by the Victorian Government. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. A Agrawal acknowledges the Wellcome Trust DBT India Alliance Senior Fellowship. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. M Ausloos, C Herteliu, and A Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. A Badawi is supported by the Public Health Agency of Canada. D A Bennett was supported by the NIHR Oxford Biomedical Research Centre. R Bourne acknowledges the Brien Holden Vision Institute, University of Heidelberg, Sightsavers, Fred Hollows Foundation, and Thea Foundation. G B Britton and I Moreno Velasquez were supported by the Sistema Nacional de Investigacion, SNI-SENACYT, Panama. R Buchbinder was supported by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship. J J Carrero was supported by the Swedish Research Council (2019-01059). F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. A R Chang was supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant K23 DK106515. V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundacao para a Ciencia e Tecnologia, IP, under the Norma Transitaria DL57/2016/CP1334/CT0006. A Douiri acknowledges support and funding from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, and support from the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. B B Duncan acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. H E Erskine is the recipient of an Australian NHMRC Early Career Fellowship grant (APP1137969). A J Ferrari was supported by a NHMRC Early Career Fellowship grant (APP1121516). H E Erskine and A J Ferrari are employed by and A M Mantilla-Herrera and D F Santomauro affiliated with the Queensland Centre for Mental Health Research, which receives core funding from the Queensland Department of Health. M L Ferreira holds an NHMRC Research Fellowship. C Flohr was supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust. M Freitas acknowledges financial support from the EU (European Regional Development Fund [FEDER] funds through COMPETE POCI-01-0145-FEDER-029248) and National Funds (Fundacao para a Ciencia e Tecnologia) through project PTDC/NAN-MAT/29248/2017. A L S Guimaraes acknowledges support from CNPq. C Herteliu was partially supported by a grant co-funded by FEDER through Operational Competitiveness Program (project ID P_40_382). P Hoogar acknowledges Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education and Centre for Holistic Development and Research, Kalaghatagi. F N Hugo acknowledges the Visiting Professorship, PRINT Program, CAPES Foundation, Brazil. B-F Hwang was supported by China Medical University (CMU107-Z-04), Taichung, Taiwan. S M S Islam was funded by a National Heart Foundation Senior Research Fellowship and supported by Deakin University. R Q Ivers was supported by a research fellowship from the National Health and Medical Research Council of Australia. M Jakovljevic acknowledges the Serbian part of this GBD-related contribution was co-funded through Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. P Jeemon was supported by a Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust-Department of Biotechnology, India Alliance (2015-20). O John is a recipient of UIPA scholarship from University of New South Wales, Sydney. S V Katikireddi acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13, MC_UU_12017/15), and the Scottish Government Chief Scientist Office (SPHSU13, SPHSU15). C Kieling is a CNPq researcher and a UK Academy of Medical Sciences Newton Advanced Fellow. Y J Kim was supported by Research Management Office, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/00010). K Krishan is supported by UGC Centre of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar was supported by K43 TW 010716 FIC/NIMH. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. J V Lazarus was supported by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III [ISCIII]/ESF, the EU [CP18/00074]). K J Looker thanks the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England, for research support. S Lorkowski was funded by the German Federal Ministry of Education and Research (nutriCARD, grant agreement number 01EA1808A). R A Lyons is supported by Health Data Research UK (HDR-9006), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, NIHR (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. J J McGrath is supported by the Danish National Research Foundation (Niels Bohr Professorship), and the Queensland Health Department (via West Moreton HHS). P T N Memiah acknowledges support from CODESRIA. U O Mueller gratefully acknowledges funding by the German National Cohort Study BMBF grant number 01ER1801D. S Nomura acknowledges the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). A Ortiz was supported by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. S B Patten was supported by the Cuthbertson & Fischer Chair in Pediatric Mental Health at the University of Calgary. G C Patton was supported by an aNHMRC Senior Principal Research Fellowship. M R Phillips was supported in part by the National Natural Science Foundation of China (NSFC, number 81371502 and 81761128031). A Raggi, D Sattin, and S Schiavolin were supported by grants from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4-Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). P Rathi and B Unnikrishnan acknowledge Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. A L P Ribeiro was supported by Brazilian National Research Council, CNPq, and the Minas Gerais State Research Agency, FAPEMIG. D C Ribeiro was supported by The Sir Charles Hercus Health Research Fellowship (#18/111) Health Research Council of New Zealand. D Ribeiro acknowledges financial support from the EU (FEDER funds through the Operational Competitiveness Program; POCI-01-0145-FEDER-029253). P S Sachdev acknowledges funding from the NHMRC of Australia Program Grant. A M Samy was supported by a fellowship from the Egyptian Fulbright Mission Program. M M Santric-Milicevic acknowledges the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). R Sarmiento-Suarez received institutional support from Applied and Environmental Sciences University (Bogota, Colombia) and ISCIII (Madrid, Spain). A E Schutte received support from the South African National Research Foundation SARChI Initiative (GUN 86895) and Medical Research Council. S T S Skou is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council under the EU's Horizon 2020 research and innovation program (grant agreement number 801790). J B Soriano is funded by Centro de Investigacion en Red de Enfermedades Respiratorias, ISCIII. R Tabares-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. N Taveira was partially supported by the European & Developing Countries Clinical Trials Partnership, the EU (LIFE project, reference RIA2016MC-1615). S Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral programme (reference number CD15/00019 from ISCIII-FEDER). S B Zaman received a scholarship from the Australian Government research training programme in support of his academic career., "Peer Reviewed"
Published: 2020
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31. The prevalence of headache disorders in children and adolescents in Mongolia: a nationwide schools-based study

Author: Timothy J. Steiner, Derya Uluduz, Otgonbayar Luvsannorov, Tsengunmaa Anisbayar, Khaliunaa Batmagnai, Khulan Tumurbaatar, Tayyar Şaşmaz, Sarantuya Enkhbaatar, Otgonzaya Baatar, Munkhzul Davaasuren, Elif Tuğçe Solmaz, and İÜC, Cerrahpaşa Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü
Subjects: Male, Epidemiology, lcsh:Medicine, DISEASE, Global Burden of Disease, 0302 clinical medicine, Surveys and Questionnaires, Headache Disorders, Secondary, Prevalence, Schools-based study, 030212 general & internal medicine, Child, Schools, Health Policy, Headache, General Medicine, Medication-overuse headache, Child and adolescent headache, Reporting bias, Lower prevalence, Female, Life Sciences & Biomedicine, Research Article, Adult, medicine.medical_specialty, Adolescent, Headache Disorders, Migraine Disorders, Clinical Neurology, Lifetime prevalence, 03 medical and health sciences, SYSTEMATIC ANALYSIS, medicine, Humans, CAMPAIGN, Migraine, 0604 Genetics, Science & Technology, Neurology & Neurosurgery, business.industry, DISABILITY, lcsh:R, Neurosciences, 1103 Clinical Sciences, Mongolia, GLOBAL BURDEN, medicine.disease, Tension-type headache, Cross-Sectional Studies, Global campaign against headache, Anesthesiology and Pain Medicine, INJURIES, Neurosciences & Neurology, Neurology (clinical), Rural area, business, 030217 neurology & neurosurgery, Undifferentiated headache, Demography
Abstract: Background The Global Campaign against Headache collects data from children (7–11 years) and adolescents (12–17 years) both to inform health and education policies and to contribute to the Global Burden of Disease (GBD) study. This survey in Mongolia was part of this global enquiry. Methods Following the generic protocol for the global enquiry, this was a schools-based cross-sectional survey. Self-completed structured questionnaires were administered, within classes, in seven schools in four districts of the Capital city and three rural areas of Mongolia, selected to represent the country’s diversities. Headache diagnostic questions were based on ICHD-3 criteria but for the inclusion of undifferentiated headache (UdH). Results Of 4515 potential participants, 4266 completed the questionnaire (children 2241 [52.5%], adolescents 2025 [47.5%]; males 2107 [49.4%], females 2159 [50.6%]). Children were therefore slightly over-represented, although overall mean age was 11.3 ± 3.3 years (range: 6–17; median 11). The non-participation proportion was 4.5%. Observed lifetime prevalence of headache was 81.0%. Gender- and age-adjusted 1-year prevalence was 59.4% (migraine: 27.3%; tension-type headache [TTH]: 16.1%; UdH: 6.6%; all headache on ≥15 days/month: 4.2%; probable medication-overuse headache: 0.7%). All headache types except UdH were more prevalent among females than males, and all were more prevalent among adolescents than children, although UdH represented a higher proportion of all headache in children (13.0%) than in adolescents (10.0%). Headache yesterday was reported by 15.9% of the sample, 26.0% of those with headache. Conclusions At least in adolescents, headache in Mongolia is no less common than in adults. The clear difference from similar studies in other countries was a lower prevalence of UdH, perhaps a consequence of reporting bias in a non-troublesome headache (mild and short-lasting by definition). This study informs policy in Mongolia and, with no similar study yet from elsewhere in Western Pacific Region, makes an important contribution to the global enquiry. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Published: 2020

32. Primary headache disorders among the adult population of Mongolia: prevalences and associations from a population-based survey

Author: Otgonbayar Luvsannorov, Selenge Enkhtuya, Byambasuren Tsenddorj, Timothy J. Steiner, Hallie Thomas, Delgermaa Purev, and Dorjkhand Baldorj
Subjects: Male, Rural Population, Headache Disorders, Primary, Urban Population, Adult population, lcsh:Medicine, Pilot Projects, Associations, DISEASE, Random Allocation, 0302 clinical medicine, Surveys and Questionnaires, Prevalence, 030212 general & internal medicine, education.field_of_study, Global Campaign against Headache, Headache, General Medicine, Middle Aged, Medication-overuse headache, Population Surveillance, Cluster sampling, Female, Life Sciences & Biomedicine, Research Article, Adult, Adolescent, Tension type headache, Population, Clinical Neurology, 03 medical and health sciences, Young Adult, medicine, SYSTEMATIC ANALYSIS, Humans, CAMPAIGN, education, Population based survey, RUSSIA, Migraine, Population-based study, Aged, 0604 Genetics, Science & Technology, Neurology & Neurosurgery, business.industry, DISABILITY, lcsh:R, Neurosciences, 1103 Clinical Sciences, Mongolia, GLOBAL BURDEN, medicine.disease, Obesity, LIFE, Anesthesiology and Pain Medicine, Cross-Sectional Studies, INJURIES, Neurology (clinical), Neurosciences & Neurology, business, 030217 neurology & neurosurgery, Demography, Primary Headache Disorders
Abstract: Background In the ongoing Global Campaign endeavour to improve knowledge and awareness of headache prevalence worldwide, Mongolia is a country of interest. It sits between Russia and China, in which prevalence is, respectively, much higher and much lower than the estimated global mean. We conducted a population-based study in Mongolia both to add to knowledge and to inform local health policy. Methods Using standardized methodology with cluster random sampling, we selected Mongolian adults (aged 18–65 years) from five regions reflecting the country’s diversities. They were interviewed by trained researchers, cold-calling at their homes, using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) structured questionnaire following pilot-testing. ICHD-3 beta diagnostic criteria were applied. Results N = 2043 (mean age 38.0 [±13.4] years, 40% urban-dwelling and 60% rural), with a non-participation proportion of 1.7%. Males were somewhat underrepresented, for which corrections were made. The crude 1-year prevalence of any headache was 66.1% (95% CI: 64.0–68.2%), with a strong female preponderance (OR: 2.2; p p = 0.0008). Unclassified cases were only 35 (1.7%). Any headache yesterday was reported by 410 (20.1%; for females, OR = 2.4; p p = 0.0326), while pMOH again showed the reverse (OR: 2.4; p p = 0.0214). Conclusion Headache disorders are common in Mongolia, with, most notably, a very high prevalence of headache on ≥15 days/month corroborated by the high prevalence of headache yesterday. The picture is very like that in Russia, and dissimilar to China. There are messages for national health policy.
Published: 2019

33. Aids to management of headache disorders in primary care (2nd edition):on behalf of the European Headache Federation and Lifting The Burden: the Global Campaign against Headache

Author: V. V. Osipova, Paolo Martelletti, EA MacGregor, Jes Olesen, Koen Paemeleire, Mattias Linde, Zaza Katsarava, RH Jensen, Michele Peters, and Timothy J. Steiner
Subjects: Translation, Medizin, Outcome measures, Headache Disorders/diagnosis, 0302 clinical medicine, Diagnosis, Medicine and Health Sciences, Medicine, Headache calendar, 030212 general & internal medicine, European Headache Federation, Persistent idiopathic facial pain, Red flags, Global Campaign against Headache, Follow-up, burden of disease, classification, cluster headache, diagnosis, european headache federation, follow-up, global campaign against headache, guidelines, headache calendar, headache diary, headache disorders, instruments, management, medication-overuse headache, migraine, outcome measures, patient information leaflets, persistent idiopathic facial pain, primary care, red flags, tension-type headache, translation, trigeminal neuralgia, humans, primary health care, world health organization, Burden of disease, General Medicine, Classification, Primary care, Medication-overuse headache, Management, Consensus Article, Patient information leaflets, General partnership, Headache diary, Life Sciences & Biomedicine, Trigeminal neuralgia, medicine.medical_specialty, Cluster headache, Headache Disorders, CULTURAL-ADAPTATION, Pain medicine, Clinical Neurology, ORGANIZATION, Guidelines, World Health Organization, VALIDATION, World health, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), Headache disorders, Humans, Migraine, 0604 Genetics, Science & Technology, Neurology & Neurosurgery, Primary Health Care, business.industry, Neurosciences, 1103 Clinical Sciences, INSTRUMENTS, medicine.disease, Tension-type headache, Anesthesiology and Pain Medicine, Family medicine, Neurosciences & Neurology, Neurology (clinical), Instruments, business, 030217 neurology & neurosurgery
Abstract: The Aids to Management are a product of the Global Campaign against Headache, a worldwide programme of action conducted in official relations with the World Health Organization. Developed in partnership with the European Headache Federation, they update the first edition published 11 years ago. The common headache disorders (migraine, tension-type headache and medication-overuse headache) are major causes of ill health. They should be managed in primary care, firstly because their management is generally not difficult, and secondly because they are so common. These Aids to Management, with the European principles of management of headache disorders in primary care as the core of their content, combine educational materials with practical management aids. They are supplemented by translation protocols, to ensure that translations are unchanged in meaning from the English-language originals. The Aids to Management may be individually downloaded and, as is the case for all products of the Global Campaign against Headache, are available without restriction for non-commercial use. © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)
Published: 2019
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34. Familial occurrence of headache disorders: A population-based study in mainland China

Author: Jiachun Feng, Timothy J. Steiner, Shengyuan Yu, Gang Zhao, Yannan Fang, Xiaosu Yang, Ruozhuo Liu, Xiutang Cao, Mianwang He, and Xiangyang Qiao
Subjects: Adult, Male, China, medicine.medical_specialty, Pediatrics, Headache Disorders, Primary, Multivariate analysis, Adolescent, Migraine Disorders, Population, Disease cluster, Logistic regression, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, Prevalence, Humans, Medicine, Family, Genetic Predisposition to Disease, 030212 general & internal medicine, First-degree relatives, education, Aged, education.field_of_study, business.industry, Public health, Tension-Type Headache, General Medicine, Middle Aged, medicine.disease, Health Surveys, Cross-Sectional Studies, Migraine, Female, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: Background Headache disorders are highly prevalent worldwide, and familial occurrence and heredity are contributory factors attracting the interest of epidemiological researchers. Our purpose, in a large sample drawn nationwide from the Chinese general population, was to evaluate the frequency of similar headache in first-degree relatives (FDRs) of those with different headache types. Methods This was a questionnaire-based nationwide cross-sectional door-to-door survey using cluster random-sampling, selecting one adult (18–65 years) per household. Headache was diagnosed by ICHD-II criteria. Participants with headache were asked whether or not any FDRs had similar headache to their own. Chi-squared test and multivariate logistic regression analysis were used to assess the strength and significance of associations. Results Of 5041 survey participants (participation rate 94.1%), 1060 (21.0%) were diagnosed with headache (migraine 469 [9.3%], tension-type headache [TTH] 543 [10.8%], headache on ≥15 days/month 48 [0.95%]). From these, 31 were excluded because of missing data about FDRs, leaving 1029 for analysis (male 350 [mean age: 46.7 ± 11.4 years]; female 679 [mean age 46.3 ± 11.2 years]). Similar headache in one or more FDRs was reported by 22.2% (95% CI: 19.6–24.7%) overall, by 25.1% (21.1–29.1%) of those with migraine, by 19.1% (15.7–22.4%) with TTH and by 29.2% (16.3–42.0%) with headache on ≥15 days/month. The differences was significant between migraine and TTH (OR = 1.4, p = 0.023), but were not significant between headache on ≥15 days/month and TTH (OR = 1.7, p = 0.093), migraine and headache on ≥15 days/month (OR = 1.2,p = 0.534). In multivariate analysis: for migraine versus TTH,AOR = 1.2 (p = 0.015); for headache on ≥15 days/month versus TTH, AOR 2.3 (p = 0.018). Conclusion Headache was highly prevalent in China and common among FDRs of those with any type of headache (headache on ≥15 days/month > migraine > TTH). Against the background of the general-population prevalence of each disorder, familial occurrence was a very highly influential factor in headache on ≥15 days/month. There are important implications in this for public health and education.
Published: 2016
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35. Life expectancy and disease burden in the Nordic countries: results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Author: Mette Christophersen Tollånes, Anne Elise Eggen, Aliasghar Ahmad Kiadaliri, Rasmus Havmoeller, Tone Bjørge, Lars Johansson, Inga Dora Sigfusdottir, Jens Christoffer Skogen, Mohsen Naghavi, Vegard Skirbekk, Kim Moesgaard Iburg, John J. McGrath, Truc Trung Nguyen, Knud Juel, Teferi Mekonnen, Atte Meretoja, Mika Gissler, Theo Vos, Gerhard Sulo, Tuomo J. Meretoja, Oleguer Plana-Ripoll, Emilie Agardh, Tea Lallukka, Rannveig Sigurvinsdottir, Thomas Truelsen, Subas Neupane, Ann Kristin Knudsen, Timothy J. Steiner, Christian Lycke Ellingsen, Stein Emil Vollset, Rahman Shiri, Kishor Hadkhale, Tommi Vasankari, Max Petzold, Juan J Carrero, Peter Allebeck, Simon Øverland, Elisabete Weiderpass, Christopher R. Cederroth, Ziad El-Khatib, Seyed-Mohammad Fereshtehnejad, Sezer Kisa, Peter Benedikt Juliusson, Adnan Kisa, Johan Ärnlöv, Søren Thorgaard Skou, Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, Department of Public Health, University Management, University of Helsinki, Institute for Molecular Medicine Finland, Clinicum, Staff Services, HUS Comprehensive Cancer Center, HUS Neurocenter, Department of Neurosciences, and Neurologian yksikkö
Subjects: Male, Heilsufar, Life expectancy, Health Status, Áhættuþættir, Diseases, Global Health, 01 natural sciences, Global Burden of Disease, 0302 clinical medicine, Cause of Death, Delivery of Health Care/economics, Health care, Global health, Medicine, 030212 general & internal medicine, Konur, Life Expectancy/trends, Public health, education.field_of_study, Life expectancies, Sjúkdómar, VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801, lcsh:Public aspects of medicine, Áfengisneysla, Smoking, DEATH, Norðurlandabúar, Men, 3142 Public health care science, environmental and occupational health, Health policy, 3. Good health, Global burden of disease, Nordic countries, Disease burdens, language, Female, Lýðheilsa, TERRITORIES, Alcohol use, Reykingar, Lífshættir, medicine.medical_specialty, Cost Control, Waiting Lists, Population, Norwegian, Scandinavian and Nordic Countries, Article, 03 medical and health sciences, AGE, Life Expectancy, SMOKING PREVALENCE, SYSTEMATIC ANALYSIS, Heilbrigðisstefna, Humans, Women, Cross-cultural comparison, 0101 mathematics, Risk factor, education, Disease burden, Global Burden of Disease/trends, Heilsugæsla, business.industry, MORTALITY, 010102 general mathematics, Klinisk medicin, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Metabolic diseases, Efnaskiptasjúkdómar, language.human_language, Scandinavian and Nordic Countries/epidemiology, Þvermenningarlegur samanburður, Risk factors, Karlar, Life style, Clinical Medicine, VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801, business, Delivery of Health Care, Demography
Abstract: Publisher's version (útgefin grein), Background The Nordic countries have commonalities in gender equality, economy, welfare, and health care, but differ in culture and lifestyle, which might create country-wise health differences. This study compared life expectancy, disease burden, and risk factors in the Nordic region.Methods Life expectancy in years and age-standardised rates of overall, cause-specific, and risk factor-specific estimates of disability-adjusted life-years (DALYs) were analysed in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Data were extracted for Denmark, Finland, Iceland, Norway, and Sweden (ie, the Nordic countries), and Greenland, an autonomous area of Denmark. Estimates were compared with global, high-income region, and Nordic regional estimates, including Greenland.Findings All Nordic countries exceeded the global life expectancy; in 2017, the highest life expectancy was in Iceland among females (85·9 years [95% uncertainty interval [UI] 85·5–86·4] vs 75·6 years [75·3–75·9] globally) and Sweden among males (80·8 years [80·2–81·4] vs 70·5 years [70·1–70·8] globally). Females (82·7 years [81·9–83·4]) and males (78·8 years [78·1–79·5]) in Denmark and males in Finland (78·6 years [77·8–79·2]) had lower life expectancy than in the other Nordic countries. The lowest life expectancy in the Nordic region was in Greenland (females 77·2 years [76·2–78·0], males 70·8 years [70·3–71·4]). Overall disease burden was lower in the Nordic countries than globally, with the lowest age-standardised DALY rates among Swedish males (18 555·7 DALYs [95% UI 15 968·6–21 426·8] per 100 000 population vs 35 834·3 DALYs [33 218·2–38 740·7] globally) and Icelandic females (16 074·1 DALYs [13 216·4–19 240·8] vs 29 934·6 DALYs [26 981·9–33 211·2] globally). Greenland had substantially higher DALY rates (26 666·6 DALYs [23 478·4–30 218·8] among females, 33 101·3 DALYs [30 182·3–36 218·6] among males) than the Nordic countries. Country variation was primarily due to differences in causes that largely contributed to DALYs through mortality, such as ischaemic heart disease. These causes dominated male disease burden, whereas non-fatal causes such as low back pain were important for female disease burden. Smoking and metabolic risk factors were high-ranking risk factors across all countries. DALYs attributable to alcohol use and smoking were particularly high among the Danes, as was alcohol use among Finnish males.Interpretation Risk factor differences might drive differences in life expectancy and disease burden that merit attention also in high-income settings such as the Nordic countries. Special attention should be given to the high disease burden in Greenland., This study was funded by the Bill & Melinda Gates Foundation. The authors wish to thank Jonas Minet Kinge (Norwegian Institute of Public Health, Oslo, Norway) for valuable input regarding socioeconomic differences in life expectancy in the Nordic countries. CRC has received research funding from Svenska Läkaresällskapet (SLS-779681), Tysta Skolan, Hörselforskningsfonden (#503), the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 72204655 and the GENDERNET Co-Plus Fund (GNP-182). JJC acknowledges grant support from the Swedish Research Council (grant number 2019-01059). JMcG is supported by the Danish National Research Foundation (Niels Bohr Professorship), and is employed by The Queensland Centre for Mental Health Research which receives core funding from the Queensland Health. STS is currently funded by a grant from Region Zealand and a grant from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (grant agreement No 801790). OP-R has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 837180. TL is supported by the Academy of Finland (Grant #319200). Where authors are identified as personnel of the International Agency for Research on Cancer/WHO, the authors alone are responsible for the views expressed in this Article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/WHO., "Peer Reviewed"
Published: 2019
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36. The burden of headache disorders in the Eastern Mediterranean Region, 1990-2016: Findings from the Global Burden of Disease study 2016

Author: Lars Jacob Stovner, Timothy J. Steiner, Reza Majdzadeh, Mohsen Naghavi, Seyed-Mohammad Fereshtehnejad, Kia Vosoughi, Theo Vos, Valery L. Feigin, Ali H. Mokdad, Farshad Farzadfar, Christopher J L Murray, Sadaf G. Sepanlou, Mohammad Ali Sahraian, Maziar Moradi-Lakeh, Pouria Heydarpour, Arash Tehrani-Banihashemi, and Reza Malekzadeh
Subjects: Male, lcsh:Medicine, SCHOOL-CHILDREN, Global Health, Global burden of disease study (GBD), Global Burden of Disease, 0302 clinical medicine, Prevalence, EPIDEMIOLOGY, Medicine, 030212 general & internal medicine, Female to male, Mediterranean Region, Incidence (epidemiology), Disability-adjusted life years (DALYs), General Medicine, Middle Aged, Female, Quality-Adjusted Life Years, Life Sciences & Biomedicine, Research Article, Burden of disease, Adult, Headache Disorders, Uncertainty interval, Clinical Neurology, UNITED-STATES, Burden, MECHANISMS, 03 medical and health sciences, Primary headache, Years lived with disability (YLDs), EPISODIC MIGRAINE, Humans, Disabled Persons, Migraine, 0604 Genetics, Science & Technology, Neurology & Neurosurgery, business.industry, DISABILITY, lcsh:R, Neurosciences, POPULATION-BASED SAMPLE, 1103 Clinical Sciences, Bayes Theorem, medicine.disease, Eastern Mediterranean region (EMR), Tension-type headache, Eastern mediterranean, Anesthesiology and Pain Medicine, MEDICATION OVERUSE HEADACHE, Neurosciences & Neurology, Neurology (clinical), business, 030217 neurology & neurosurgery, Demography, Primary Headache Disorders
Abstract: Objectives Using the findings of the Global Burden of Disease Study (GBD), we report the burden of primary headache disorders in the Eastern Mediterranean Region (EMR) from 1990 to 2016. Methods We modelled headache disorders using DisMod-MR 2.1 Bayesian meta-regression tool to ensure consistency between prevalence, incidence, and remission. Years lived with disability (YLDs) were calculated by multiplying prevalence and disability weight (DW) of migraine and tension-type headache (TTH). We assumed primary headache disorders as non-fatal, so their YLD is equal to disability-adjusted life years (DALYs). Results Migraine and TTH were the second and twentieth leading causes of YLDs in EMR. Between 1990 and 2016, the absolute YLD numbers of migraine and TTH increased from 2.3 million (95% uncertainty interval (UI): 1.5–3.2) to 4.7 million (95%UI: 3–6.5) and from 383 thousand (95%UI: 240–562) to 816 thousand (95%UI: 516–1221), respectively. During the same period, age-standardised YLD rates of migraine and TTH in EMR increased by 0.7% and 2.5%, respectively, in comparison to a small decrease in the global rates (0.2% decrease in migraine and TTH). The bulk of burden due to headache occurred in the 30–49 year age group, with a peak at ages 35–44 years. The age-standardised YLD rates of both headache disorders were higher in women with female to male ratio of 1.69 for migraine and 1.38 for TTH. All countries of the EMR except for Somalia and Djibouti had higher age-standardised YLD rates for migraine and TTH in compare to the global rates. Libya and Saudi Arabia had the highest increase in age-standardised YLD rates of migraine and TTH, respectively. Conclusion The findings of this study show that primary headache disorders are a major and a growing cause of disability in EMR. Since 1990, burden of primary headache disorders has constantly been higher in EMR compared to rest of the world, which indicates that health systems in EMR must focus further on developing and implementing preventive and management strategies to control headache. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Published: 2019

37. Headache service quality : the role of specialized headache centres within structured headache services, and suggested standards and criteria as centres of excellence

Author: Timothy J. Steiner, Dimos-Dimitrios Mitsikostas, H. Gobel, Zaza Katsarava, Christian Lampl, Koen Paemeleire, Rigmor Jensen, Raquel Gil-Gouveia, Mark Braschinsky, and Mattias Linde
Subjects: Medizin, lcsh:Medicine, 0302 clinical medicine, Health care, Medicine and Health Sciences, PROGRAM, 030212 general & internal medicine, Specialized headache centres, European Headache Federation, GLOBAL CAMPAIGN, media_common, Global Campaign against Headache, Brief Report, Headache, General Medicine, PREVALENCE, Service quality, MIGRAINE, Health service organization, Medical emergency, HEALTH, BURDEN, Life Sciences & Biomedicine, European Headache Federation and Lifting The Burden: the Global Campaign against Headache, Standards, Headache Disorders, DISORDERS, media_common.quotation_subject, Pain medicine, Clinical Neurology, Context (language use), Primary care, ORGANIZATION, 03 medical and health sciences, Excellence, medicine, Humans, Quality (business), Quality of Health Care, 0604 Genetics, Science & Technology, Neurology & Neurosurgery, Primary Health Care, business.industry, DISABILITY, lcsh:R, Neurosciences, 1103 Clinical Sciences, CARE, medicine.disease, Anesthesiology and Pain Medicine, Migraine, Structured headache services, Pain Clinics, Neurology (clinical), Neurosciences & Neurology, business, Delivery of Health Care, 030217 neurology & neurosurgery
Abstract: In joint initiatives, the European Headache Federation and Lifting The Burden have described a model of structured headache services (with their basis in primary care), defined service quality in this context, and developed practical methods for its evaluation. Here, in a continuation of the service quality evaluation programme, we set out ten suggested role- and performance-defining standards for specialized headache centres operating as an integral component of these services. Verifiable criteria for evaluation accompany each standard. The purposes are five-fold: (i) to inspire and promote, or stimulate the establishment of, specialized headache centres as centres of excellence; (ii) to define the role of such centres within optimally structured and organized national headache services; (iii) to set out criteria by which such centres may be recognized as exemplary in their fulfilment of this role; (iv) to provide the basis for, and to initiate and motivate, collaboration and networking between such centres both nationally and internationally; (v) ultimately to improve the delivery and quality of health care for headache. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Published: 2019
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38. Migraine : a major debilitating chronic non-communicable disease in Brazil, evidence from two national surveys

Author: Pedro Augusto Sampaio Rocha-Filho, Zaza Katsarava, Mario Fernando Prieto Peres, Luiz Paulo Queiroz, Elder Machado Sarmento, and Timothy J. Steiner
Subjects: Male, Headache Disorders, Primary, Epidemiology, Medizin, lcsh:Medicine, GUIDELINES, 0302 clinical medicine, TENSION-TYPE HEADACHE, Surveys and Questionnaires, Health care, 030212 general & internal medicine, education.field_of_study, Public health, Headache epidemiology, General Medicine, Middle Aged, PREVALENCE, Female, Life Sciences & Biomedicine, Brazil, Research Article, Adult, medicine.medical_specialty, Adolescent, Health surveys, DISORDERS, Migraine Disorders, Population, Clinical Neurology, 03 medical and health sciences, Young Adult, PROBABLE MIGRAINE, Environmental health, medicine, SYSTEMATIC ANALYSIS, Humans, Disabled Persons, Non-communicable diseases, VALIDITY, education, Noncommunicable Diseases, Migraine, Science & Technology, Neurology & Neurosurgery, business.industry, DISABILITY, lcsh:R, Neurosciences, Non-communicable disease, GLOBAL BURDEN, medicine.disease, PREVENTION, Anesthesiology and Pain Medicine, Cross-Sectional Studies, Global campaign against headache, Neurology (clinical), Neurosciences & Neurology, business, 030217 neurology & neurosurgery
Abstract: Background Even though migraine and other primary headache disorders are common and debilitating, major health surveys in Brazil have not included them. We repair this omission by combining data on non-communicable diseases (NCDs) in the Brazilian National Health Survey (PNS) 2013 with epidemiological data on migraine prevalence and severity in Brazil. The purpose is to rank migraine and its impact on public healthh among NCDs in order to support public-health policy toward better care for migraine in Brazil. Methods Data from PNS, a cross-sectional population-based study, were merged with estimates made by the Brazilian Headache Epidemiology Study (BHES) of migraine prevalence (numbers of people affected and of candidates for migraine preventative therapy) and migraine-attributed disability. Results Migraine ranked second in prevalence among the NCDs, and as the highest cause of disability among adults in Brazil. Probable migraine accounted for substantial additional disability. An estimated total of 5.5 million people in Brazil (or 9.5 million with probable migraine included) were in need of preventative therapy. Conclusion On this evidence, migraine should be included in the next health surveys in Brazil. Public-health policy should recognize the burden of migraine expressed in public ill health, and promote health services offering better diagnosis and treatment. © The Author(s). 201 9Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Published: 2019

39. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013

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Gosselin, Maziar Moradi-Lakeh, Soraya Seedat, Janet L Leasher, Belinda K Lloyd, Lorenzo Monasta, Bruno F. Sunguya, Eun-Kee Park, Eduardo A. Undurraga, Mohammad A. AlMazroa, Mohammad H. Forouzanfar, Young-Ho Khang, Vasiliki Stathopoulou, Dima M. Qato, James Scott, Ileana Heredia-Pi, Luca Ronfani, Haidong Kan, Tasara T. Mazorodze, Murugesan Raju, Saeid Shahraz, Taavi Tillmann, Wang Wenzhi, Neil Pearce, Eric Y. Tenkorang, Aliya Naheed, Ferrán Catalá-López, Sudan Prasad Neupane, Emily Dansereau, Michael McKee, Derrick A Bennett, Mazeda Hossain, Paul S. F. Yip, Grant Nguyen, Norberto Perico, Miguel Angel Alegretti, Babak Eshrati, Boris Bikbov, Palwasha Anwari, Guoqing Hu, Amelia Bertozzi-Villa, Peter A. Meaney, Farshad Farzadfar, Svetlana Popova, Tara Templin, Hmwe H Kyu, Uche S. Uchendu, Kebede Deribe, Sergey Soshnikov, Nobhojit Roy, Daniel Kim, Ilana N. Ackerman, Homie Razavi, Leslie T. Cooper, Sandra Nolte, David T. 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B., Leasher, Janet L., Leigh, Jame, Leung, Ricky, Levitz, Carly E., Li, Bin, Li, Yichong, Li, Yongmei, Lim, Stephen S., Lind, Maggie, Lipshultz, Steven E., Liu, Shiwei, Liu, Yang, Lloyd, Belinda K., Lofgren, Katherine T., Logroscino, Giancarlo, Looker, Katharine J., Lortet-Tieulent, Joannie, Lotufo, Paulo A., Lozano, Rafael, Lucas, Robyn M., Lunevicius, Raimunda, Lyons, Ronan A., Ma, Stefan, Macintyre, Michael F., Mackay, Mark T., Majdan, Marek, Malekzadeh, Reza, Marcenes, Wagner, Margolis, David J., Margono, Christopher, Marzan, Melvin B., Masci, Joseph R., Mashal, Mohammad T., Matzopoulos, Richard, Mayosi, Bongani M., Mazorodze, Tasara T., Mcgill, Neil W., Mcgrath, John J., Mckee, Martin, Mclain, Abigail, Meaney, Peter A., Medina, Catalina, Mehndiratta, Man Mohan, Mekonnen, Wubegzier, Melaku, Yohannes A., Meltzer, Michele, Memish, Ziad A., Mensah, George A., Meretoja, Atte, Mhimbira, Francis A., Micha, Renata, Miller, Ted R., Mills, Edward J., Mitchell, Philip B., Mock, Charles N., Ibrahim, Norlinah Mohamed, Mohammad, Karzan A., Mokdad, Ali H., Mola, Glen L. D., Monasta, Lorenzo, Hernandez, Julio C. Montañez, Montico, Marcella, Montine, Thomas J., Mooney, Meghan D., Moore, Ami R., Moradi-Lakeh, Maziar, Moran, Andrew E., Mori, Rintaro, Moschandreas, Joanna, Moturi, Wilkister N., Moyer, Madeline L., Mozaffarian, Dariush, Msemburi, William T., Mueller, Ulrich O., Mukaigawara, Mitsuru, Mullany, Erin C., Murdoch, Michele E., Murray, Joseph, Murthy, Kinnari S., Naghavi, Mohsen, Naheed, Aliya, Naidoo, Kovin S., Naldi, Luigi, Nand, Devina, Nangia, Vinay, Narayan, K M. Venkat, Nejjari, Chakib, Neupane, Sudan P., Newton, Charles R., Ng, Marie, Ngalesoni, Frida N., Nguyen, Grant, Nisar, Muhammad I., Nolte, Sandra, Norheim, Ole F., Norman, Rosana E., Norrving, Bo, Nyakarahuka, Luke, Oh, In-Hwan, Ohkubo, Takayoshi, Ohno, Summer L., Olusanya, Bolajoko O., Opio, John Nelson, Ortblad, Katrina, Ortiz, Alberto, Pain, Amanda W., Pandian, Jeyaraj D., Panelo, Carlo Irwin A., Papachristou, Christina, Park, Eun-Kee, Park, Jae-Hyun, Patten, Scott B., Patton, George C., Paul, Vinod K., Pavlin, Boris I., Pearce, Neil, Pereira, David M., Perez-Padilla, Rogelio, Perez-Ruiz, Fernando, Perico, Norberto, Pervaiz, Aslam, Pesudovs, Konrad, Peterson, Carrie B., Petzold, Max, Phillips, Michael R., Phillips, Bryan K., Phillips, David E., Piel, Frédéric B., Plass, Dietrich, Poenaru, Dan, Polinder, Suzanne, Pope, Daniel, Popova, Svetlana, Poulton, Richie G., Pourmalek, Farshad, Prabhakaran, Dorairaj, Prasad, Noela M., Pullan, Rachel L., Qato, Dima M., Quistberg, D Alex, Rafay, Anwar, Rahimi, Kazem, Rahman, Sajjad U., Raju, Murugesan, Rana, Saleem M., Razavi, Homie, Reddy, K Srinath, Refaat, Amany, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L., Richardson, Lee, Richardus, Jan Hendrik, Roberts, D Allen, Rojas-Rueda, David, Ronfani, Luca, Roth, Gregory A., Rothenbacher, Dietrich, Rothstein, David H., Rowley, Jane T., Roy, Nobhojit, Ruhago, George M., Saeedi, Mohammad Y., Saha, Sukanta, Sahraian, Mohammad Ali, Sampson, Uchechukwu K. A., Sanabria, Juan R., Sandar, Logan, Santos, Itamar S., Satpathy, Maheswar, Sawhney, Monika, Scarborough, Peter, Schneider, Ione J., Schöttker, Ben, Schumacher, Austin E., Schwebel, David C., Scott, James G., Seedat, Soraya, Sepanlou, Sadaf G., Serina, Peter T., Servan-Mori, Edson E., Shackelford, Katya A., Shaheen, Amira, Shahraz, Saeid, Levy, Teresa Shamah, Shangguan, Siyi, She, Jun, Sheikhbahaei, Sara, Shi, Peilin, Shibuya, Kenji, Shinohara, Yukito, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Shrime, Mark G., Sigfusdottir, Inga D., Silberberg, Donald H., Simard, Edgar P., Sindi, Shireen, Singh, Abhishek, Singh, Jasvinder A., Singh, Lavanya, Skirbekk, Vegard, Slepak, Erica Leigh, Sliwa, Karen, Soneji, Samir, Søreide, Kjetil, Soshnikov, Sergey, Sposato, Luciano A., Sreeramareddy, Chandrashekhar T., Stanaway, Jeffrey D., Stathopoulou, Vasiliki, Stein, Dan J., Stein, Murray B., Steiner, Caitlyn, Steiner, Timothy J., Stevens, Antony, Stewart, Andrea, Stovner, Lars J., Stroumpoulis, Konstantino, Sunguya, Bruno F., Swaminathan, Soumya, Swaroop, Mamta, Sykes, Bryan L., Tabb, Karen M., Takahashi, Ken, Tandon, Nikhil, Tanne, David, Tanner, Marcel, Tavakkoli, Mohammad, Taylor, Hugh R., Te Ao, Braden J., Tediosi, Fabrizio, Temesgen, Awoke M., Templin, Tara, Ten Have, Margreet, Tenkorang, Eric Y., Terkawi, Abdullah S., Thomson, Blake, Thorne-Lyman, Andrew L., Thrift, Amanda G., Thurston, George D., Tillmann, Taavi, Tonelli, Marcello, Topouzis, Foti, Toyoshima, Hideaki, Traebert, Jefferson, Tran, Bach X., Trillini, Matia, Truelsen, Thoma, Tsilimbaris, Miltiadi, Tuzcu, Emin M., Uchendu, Uche S., Ukwaja, Kingsley N., Undurraga, Eduardo A., Uzun, Selen B., Van Brakel, Wim H., Van De Vijver, Steven, Van Gool, Coen H., Van Os, Jim, Vasankari, Tommi J., Venketasubramanian, N, Violante, Francesco S., Vlassov, Vasiliy V., Vollset, Stein Emil, Wagner, Gregory R., Wagner, Joseph, Waller, Stephen G., Wan, Xia, Wang, Haidong, Wang, Jianli, Wang, Linhong, Warouw, Tati S., Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Wenzhi, Wang, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A., Wilkinson, James D., Williams, Thomas N., Wolfe, Charles D., Wolock, Timothy M., Woolf, Anthony D., Wulf, Sarah, Wurtz, Brittany, Xu, Gelin, Yan, Lijing L., Yano, Yuichiro, Ye, Pengpeng, Yentür, Gökalp K., Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z., Yu, Chuanhua, Zaki, Maysaa E., Zhao, Yong, Zheng, Yingfeng, Zonies, David, Zou, Xiaonong, Salomon, Joshua A., Lopez, Alan D., Vos, Theo, Medische Sociologie, MUMC+: Hersen en Zenuw Centrum (3), MUMC+: MA Psychiatrie (3), Psychiatrie & Neuropsychologie, Barber, Ryan M, Foreman, Kyle J, Abd Allah, Foad, Abera, Semaw F, Abraham, Jerry P, Abu Raddad, Laith J, Abu Rmeileh, Niveen M, Ackerman, Ilana N, Adou, Arsène K, Adsuar, José C, Agardh, Emilie E, Albittar, Mohammed I, Alegretti, Miguel A, Alemu, Zewdie A, Alfonso Cristancho, Rafael, Almazroa, Mohammad A, Alvis Guzman, Nelson, Amare, Azmeraw T, Ameh, Emmanuel A, Anderson, Benjamin O, Antonio, Carl Abelardo T, Asghar, Rana J, Atkins, Lydia S, Avila, Marco A, Bachman, Victoria F, Bahit, Maria C, Barker Collo, Suzanne L, Barrero, Lope H, Basulaiman, Mohammed O, Bell, Michelle L, Bennett, Derrick A, Bensenor, Isabela M, Bertozzi Villa, Amelia, Beyene, Tariku J, Bhutta, Zulfiqar A, Blore, Jed D, Blosser, Christopher D, Blyth, Fiona M, Bohensky, Megan A, Bolliger, Ian W, Bornstein, Natan M, Bourne, Rupert R. 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Venkat, Neupane, Sudan P, Newton, Charles R, Ngalesoni, Frida N, Nisar, Muhammad I, Norheim, Ole F, Norman, Rosana E, Oh, In Hwan, Ohno, Summer L, Olusanya, Bolajoko O, Pain, Amanda W, Pandian, Jeyaraj D, Panelo, Carlo Irwin A, Park, Eun Kee, Park, Jae Hyun, Patten, Scott B, Patton, George C, Paul, Vinod K, Pavlin, Boris I, Pereira, David M, Perez Padilla, Rogelio, Perez Ruiz, Fernando, Peterson, Carrie B, Phillips, Michael R, Phillips, Bryan K, Phillips, David E, Piel, Frédéric B, Poulton, Richie G, Prasad, Noela M, Pullan, Rachel L, Qato, Dima M, Quistberg, D. Alex, Rahman, Sajjad U, Rana, Saleem M, Reddy, K. Srinath, Ribeiro, Antonio L, Roberts, D. Allen, Rojas Rueda, David, Roth, Gregory A, Rothstein, David H, Rowley, Jane T, Ruhago, George M, Saeedi, Mohammad Y, Sampson, Uchechukwu K. 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Te, Temesgen, Awoke M, Tenkorang, Eric Y, Terkawi, Abdullah S, Thorne Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tran, Bach X, Tuzcu, Emin M, Uchendu, Uche S, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uzun, Selen B, Van Brakel, Wim H, van Gool, Coen H, Vasankari, Tommi J, Violante, Francesco S, Vlassov, Vasiliy V, Wagner, Gregory R, Waller, Stephen G, Warouw, Tati S, Weintraub, Robert G, Whiteford, Harvey A, Wilkinson, James D, Williams, Thomas N, Wolfe, Charles D, Wolock, Timothy M, Woolf, Anthony D, Yan, Lijing L, Yentür, Gökalp K, Yoon, Seok Jun, Younis, Mustafa Z, Zaki, Maysaa E, Salomon, Joshua A, Lopez, Alan D, Computational Science and Engineering Department [Daresbury] ( STFC ), Science & Technologie Facilities Council, Neuroépidémiologie Tropicale ( NET ), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Génomique, Environnement, Immunité, Santé, Thérapeutique ( GEIST ), Université de Limoges ( UNILIM ) -Université de Limoges ( UNILIM ), Service de Chirurgie Thoracique et Vasculaire - 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Case Western Reserve University, Case Western Reserve University [Cleveland], Institut Lumière Matière [Villeurbanne] ( ILM ), Université Claude Bernard Lyon 1 ( UCBL ), World Health Organization, Nordic School of Public Health, The James Hutton Institute, Sero, Sero consulting, Evolutionary Ecology of Infectious Disease Group, Department of Zoology, Horia Hulubei National Institute for Physics and Nuclear Engineering, Dunedin School of Medicine, University of Otago, Department of Physics, Clarendon Laboratory, Center for TeleInFrastruktur ( CTIF ), Aalborg University [Denmark] ( AAU ), Physikalisches Institut [Freiburg], Albert-Ludwigs-Universität Freiburg, Savoirs, Textes, Langage (STL) - UMR 8163 ( STL ), Université de Lille-Centre National de la Recherche Scientifique ( CNRS ), Dept.of Computer Science, Indian Institute of Technology Madras ( IIT Madras ), Istituto Mario Negri Bergamo, Centro Ricerche e Trapianti Villa Camozzi, Universidade Estadual Paulista Júlio de Mesquita ( UNESP ), Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Université Grenoble Alpes - UFR Médecine ( UGA UFRM ), Université Grenoble Alpes ( UGA ), Clinical Epidemiology and Aging Research, German Cancer Research Center, Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Symantec, European Microsoft Innovation Center ( EMIC ), Microsoft Corporation [Redmond, Wash.], Laboratoire de Mécanique, Physique et Géosciences ( LMPG ), Université Le Havre Normandie ( ULH ), Normandie Université ( NU ) -Normandie Université ( NU ), Novartis institute for tropical diseases, Institut de Génétique et de Biologie Moléculaire et Cellulaire ( IGBMC ), Université de Strasbourg ( UNISTRA ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Departments of Anatomy and Cell Biology, Wayne State University School of Medicine, Departments of Ophthalmology, Departments of Applied Physics [New Haven], Yale University [New Haven], Center for Mathematical Modeling ( CMM ), Universidad de Santiago de Chile [Santiago] ( USACH ), Laboratory for Atmospheric and Space Physics [Boulder] ( LASP ), University of Colorado Boulder [Boulder], University of Occupational and Environmental Health [Kitakyushu] ( UEOH ), Department of Computer Science and Engineering [New Delhi], Indian Institute of Technology Delhi ( IIT Delhi ), Institut de Recherche sur les Phénomènes Hors Equilibre ( IRPHE ), Aix Marseille Université ( AMU ) -Ecole Centrale de Marseille ( ECM ) -Centre National de la Recherche Scientifique ( CNRS ), GlaxoSmithKline, Imperial College London-Clinical Imaging Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, Yale School of Medicine-Yale School of Medicine-Yale Stem Cell Center, Maclean Building, Benson Lane, Crowmarsh Gifford, Centre for Ecology and Hydrology, Nanoscience Institute ( NEST ), Dipartimento di Fisica, Università di Pisa, Aristotle University of Thessaloniki, Laboratory Of Immune Cell Biology ( LICB ), National Institutes of Health ( NIH ), Institute of Human Genetics, Bonn Universität [Bonn], Occupational Health Unit, Bologna University Hospital-Sant'Orsola-Malpighi Polyclinic, Royal Institute of Technology [Stockholm] ( KTH ), Institut für Informatik [München/Munich] ( LMU ), Ludwig-Maximilians-Universität München, NICTA [Eveleigh], National ICT Australia [Sydney] ( NICTA ), Manchester Academic Health Sciences Centre, Institut d'Histoire et de Philosophie des Sciences et des Techniques ( IHPST ), Université Panthéon-Sorbonne ( UP1 ) -Département d'Etudes Cognitives - ENS Paris ( DEC ), École normale supérieure - Paris ( ENS Paris ) -École normale supérieure - Paris ( ENS Paris ) -Centre National de la Recherche Scientifique ( CNRS ), Ghent University [Belgium] ( UGENT ), German Research Centre for Geosciences - Helmholtz-Centre Potsdam ( GFZ ), Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique ( LHEEA ), École Centrale de Nantes ( ECN ) -Centre National de la Recherche Scientifique ( CNRS ), Institut de Recherche en Génie Civil et Mécanique ( GeM ), Université de Nantes ( UN ) -École Centrale de Nantes ( ECN ) -Centre National de la Recherche Scientifique ( CNRS ), Neurorestoration Group, King‘s College London-Wolfson Centre for Age-related Diseases, Department of Computer Science [KAIST] ( CS ), Korea Advanced Institute of Science and Technology ( KAIST ), Laboratoire de l'Accélérateur Linéaire ( LAL ), Natl Engn Res Ctr Vegetables, Key Lab Biol & Genet Improvement Hort Crops N Chi, Beijing Acad Agr & Forestry Sci, University Hospital Puerta de Hierro, Madrid, Computational Science and Engineering Department [Daresbury] (STFC), Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Weill Cornell Medicine [Qatar], Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Centro de Estudios Avanzados en Zonas Aridas (CEAZA), Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratoire d'Ingénierie des Matériaux (LIM), Centre National de la Recherche Scientifique (CNRS), Lawrence Berkeley National Laboratory [Berkeley] (LBNL), Samsung Research &Development Institute India - Bangalore (Groupe Samsung) (SRI-B), Multimedia Research Center (MRC), University of Alberta, Division of Biostatistics (Biostat - MINNEAPOLIS), University of Minnesota [Twin Cities] (UMN), University of Minnesota System-University of Minnesota System, University of Southampton, University of Cambridge [UK] (CAM), Interactions, transferts, ruptures artistiques et culturels - EA 6301 (InTRu), Université de Tours (UT), Institut Jacques Monod (IJM (UMR_7592)), Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Stanford University, Unité de recherche Virologie et Immunologie Moléculaires (VIM (UR 0892)), Institut National de la Recherche Agronomique (INRA), National University of Singapore (NUS), Université Paris 1 Panthéon-Sorbonne - UFR Science Politique (UP1 UFR11), Université Paris 1 Panthéon-Sorbonne (UP1), National Diagnostics Centre (NDC), National University of Ireland [Galway] (NUI Galway), Arthritis Research UK Epidemiology Unit (MANCHESTER - Arthritis Research), Universidade do Porto = University of Porto, Advanced Laboratories on Embedded Systems [Roma] (ALES), Wageningen University and Research [Wageningen] (WUR), University of Oxford, Universitat Politècnica de Catalunya [Barcelona] (UPC), Institut National de Recherche et d'Analyse Physico-Chimique (INRAP), University of Connecticut (UCONN), Norwegian Institute for Air Research (NILU), Franche-Comté Électronique Mécanique, Thermique et Optique - Sciences et Technologies (UMR 6174) (FEMTO-ST), Université de Technologie de Belfort-Montbeliard (UTBM)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), University of Tehran, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Sociétés, Acteurs, Gouvernement en Europe (SAGE), Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), The George Washington University (GW), Washington State University (WSU), Laboratoire de Physique de l'ENS Lyon (Phys-ENS), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Institut de recherche en informatique de Toulouse (IRIT), Université Toulouse Capitole (UT Capitole), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Université Catholique de Louvain = Catholic University of Louvain (UCL), Div Cyclotron & Radiopharmaceut Sci (DRDO, INMAS), School of Physics and Astronomy [St Andrews], Tata Research Development and Design Center (TRDDC), MOLTECH-Anjou, Université d'Angers (UA)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Swedish Defense Research Agency (FOI), Centre de Recherche en Information Biomédicale sino-français (CRIBS), Université de Rennes (UR)-Southeast University [Jiangsu]-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratory of Image Science and Technology [Nanjing] (LIST), Laboratoire de glaciologie et géophysique de l'environnement (LGGE), Observatoire des Sciences de l'Univers de Grenoble (OSUG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), Department of Mechanical and Automation Engineering (CAD Laboratory), Università degli studi di Bari Aldo Moro = University of Bari Aldo Moro (UNIBA), Heuristique et Diagnostic des Systèmes Complexes [Compiègne] (Heudiasyc), Université de Technologie de Compiègne (UTC)-Centre National de la Recherche Scientifique (CNRS), Biotechnology and Biological Sciences Research Council (BBSRC)-Biotechnology and Biological Sciences Research Council (BBSRC), Queen Mary University of London (QMUL), Centre d'économie de la Sorbonne (CES), Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Paris School of Economics (PSE), Université Paris 1 Panthéon-Sorbonne (UP1)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École des hautes études en sciences sociales (EHESS)-École des Ponts ParisTech (ENPC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), Università della Svizzera italiana = University of Italian Switzerland (USI)-Scuola universitaria professionale della Svizzera italiana = University of Applied Sciences and Arts of Southern Switzerland [Manno] (SUPSI), Pennsylvania State University (Penn State), Penn State System-Penn State System, Jet Propulsion Laboratory (JPL), NASA-California Institute of Technology (CALTECH), Hong Kong Baptist University (HKBU), Département Optique (OPT), Université européenne de Bretagne - European University of Brittany (UEB)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT), Services répartis, Architectures, MOdélisation, Validation, Administration des Réseaux (SAMOVAR), Institut Mines-Télécom [Paris] (IMT)-Télécom SudParis (TSP), Département Réseaux et Services Multimédia Mobiles (TSP - RS2M), University of Melbourne, Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), University of Otago [Dunedin, Nouvelle-Zélande], Center for TeleInFrastruktur (CTIF), Aalborg University [Denmark] (AAU), Savoirs, Textes, Langage (STL) - UMR 8163 (STL), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Indian Institute of Technology Madras (IIT Madras), Universidade Estadual Paulista Júlio de Mesquita Filho = São Paulo State University (UNESP), Erasmus University Medical Center [Rotterdam] (Erasmus MC), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), German Cancer Research Center - Deutsches Krebsforschungszentrum [Heidelberg] (DKFZ), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), European Microsoft Innovation Center (EMIC), Laboratoire de Mécanique, Physique et Géosciences (LMPG), Université Le Havre Normandie (ULH), Normandie Université (NU)-Normandie Université (NU), Novartis Institute for Tropical Diseases (NITD), Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Center for Mathematical Modeling (CMM), Universidad de Chile = University of Chile [Santiago] (UCHILE), Laboratory for Atmospheric and Space Physics [Boulder] (LASP), University of Colorado [Boulder], University of Occupational and Environmental Health [Kitakyushu] (UEOH), Indian Institute of Technology Delhi (IIT Delhi), Institut de Recherche sur les Phénomènes Hors Equilibre (IRPHE), Aix Marseille Université (AMU)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS), Yale University [New Haven]-Yale School of Medicine [New Haven, Connecticut] (YSM), Nanoscience Institute (NEST), University of Pisa - Università di Pisa, Laboratory Of Immune Cell Biology (LICB), National Institutes of Health [Bethesda] (NIH), Rheinische Friedrich-Wilhelms-Universität Bonn, Royal Institute of Technology [Stockholm] (KTH ), Institut für Informatik [München/Munich] (LMU), Ludwig-Maximilians-Universität München (LMU), National ICT Australia [Sydney] (NICTA), Institut d'Histoire et de Philosophie des Sciences et des Techniques (IHPST), Université Paris 1 Panthéon-Sorbonne (UP1)-Département d'Etudes Cognitives - ENS Paris (DEC), École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS), Universiteit Gent = Ghent University (UGENT), German Research Centre for Geosciences - Helmholtz-Centre Potsdam (GFZ), Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique (LHEEA), École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche en Génie Civil et Mécanique (GeM), Université de Nantes - UFR des Sciences et des Techniques (UN UFR ST), Université de Nantes (UN)-Université de Nantes (UN)-École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Department of Computer Science [KAIST] (CS), Korea Advanced Institute of Science and Technology (KAIST), Kardiyoloji, Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Minnesota [Twin Cities], Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Unité de recherche Virologie et Immunologie Moléculaires (VIM), Université Panthéon-Sorbonne - UFR Science Politique (UP1 UFR11), Université Panthéon-Sorbonne (UP1), Wageningen University and Research Centre [Wageningen] (WUR), Institut National de Recherche et d'Analyse Physico-chimique (Ariana, Tunisie) (INRAP), Université de Franche-Comté (UFC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Université de Technologie de Belfort-Montbeliard (UTBM), George Washington University (GW), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université Toulouse 1 Capitole (UT1)-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées, Université Catholique de Louvain (UCL), MOLTECH-ANJOU (MOLTECH-ANJOU), Université d'Angers (UA)-Centre National de la Recherche Scientifique (CNRS), University of Helsinki, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Southeast University [Jiangsu]-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS), Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Università della Svizzera italiana (USI)-Scuola universitaria professionale della Svizzera italiana [Manno] (SUPSI), California Institute of Technology (CALTECH)-NASA, Institut Mines-Télécom [Paris] (IMT)-Télécom SudParis (TSP)-Centre National de la Recherche Scientifique (CNRS), Département Réseaux et Services Multimédia Mobiles (RS2M), Universidade Estadual Paulista Júlio de Mesquita Filho [São José do Rio Preto] (UNESP), Université Grenoble Alpes (UGA), Universidad de Santiago de Chile [Santiago] (USACH), Yale University [New Haven]-Yale University School of Medicine, Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Département d'Etudes Cognitives - ENS Paris (DEC), École normale supérieure - Paris (ENS Paris)-École normale supérieure - Paris (ENS Paris), Ghent University [Belgium] (UGENT), Université de Nantes - Faculté des Sciences et des Techniques, Grelier, Elisabeth, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Universidade do Porto, Université de Technologie de Belfort-Montbeliard (UTBM)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), École normale supérieure - Lyon (ENS Lyon)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Université Toulouse 1 Capitole (UT1), Centre National de la Recherche Scientifique (CNRS)-Institut national des sciences de l'Univers (INSU - CNRS)-Observatoire des Sciences de l'Univers de Grenoble (OSUG), Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Institut national des sciences de l'Univers (INSU - CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), Università degli studi di Bari Aldo Moro (UNIBA), École des Ponts ParisTech (ENPC)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-École des hautes études en sciences sociales (EHESS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Università della Svizzera italiana = University of Italian Switzerland (USI)-Scuola universitaria professionale della Svizzera italiana [Manno] (SUPSI), Institut Mines-Télécom [Paris] (IMT)-Télécom Bretagne-Université européenne de Bretagne - European University of Brittany (UEB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA), École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS Paris), Universiteit Gent = Ghent University [Belgium] (UGENT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-CHU Limoges-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Centre National de la Recherche Scientifique (CNRS)-Université de Technologie de Belfort-Montbeliard (UTBM), Institut de Chimie du CNRS (INC)-Université d'Angers (UA)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)-École Centrale de Nantes (ECN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS), Wolfson Centre for Age-related Diseases-King‘s College London, Cell biology, Public Health, Epidemiology, Health Technology Assessment (HTA), Erasmus MC other, Pathology, and Cardiothoracic Surgery
Subjects: Gerontology, Male, CHANGING RELATION, Nutrition and Disease, MESH : Life Expectancy, MESH : Aged, ECONOMIC-DEVELOPMENT, Poison control, MESH: Global Health, Global Health, Socioeconomic Factor, Communicable Disease, MESH : Chronic Disease, Health Transition, Voeding en Ziekte, Quality-Adjusted Life Year, SELF-RATED HEALTH, MESH : Socioeconomic Factors, Medicine, MESH : Female, MESH: Mortality, Premature, 2. Zero hunger, MESH: Aged, education.field_of_study, MESH: Middle Aged, Mortality rate, Medicine (all), GBD2013 diseases, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, Middle Aged, 3. Good health, MESH : Wounds and Injuries, Epidemiological transition, MESH: Quality-Adjusted Life Years, MESH: Communicable Diseases, NONCOMMUNICABLE DISEASES, Female, Quality-Adjusted Life Years, MESH: Life Expectancy, MESH: Health Transition, Human, MESH: Socioeconomic Factors, ACUTE MYOCARDIAL-INFARCTION, MESH : Male, MORTALITY TRENDS, Population, MESH : Health Transition, Communicable Diseases, Article, Life Expectancy, EUROPEAN-UNION, SDG 3 - Good Health and Well-being, General & Internal Medicine, SYSTEMATIC ANALYSIS, Disability-adjusted life year, Humans, Life Science, MESH : Middle Aged, Mortality, education, Premature, MESH : Mortality, Premature, VLAG, Aged, MESH: Humans, business.industry, Mortality, Premature, MESH: Chronic Disease, MESH : Communicable Diseases, Wounds and Injurie, MESH : Humans, MESH : Quality-Adjusted Life Years, Non-communicable disease, Chronic Disease, Socioeconomic Factors, Wounds and Injuries, medicine.disease, MESH: Male, LOW SOCIOECONOMIC-STATUS, Years of potential life lost, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Wounds and Injuries, Life expectancy, RISK-FACTORS, MESH : Global Health, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, Demography
Abstract: Summary Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. Funding Bill & Melinda Gates Foundation. BACKGROUND: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. METHODS: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. FINDINGS: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. INTERPRETATION: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition-in which increasing sociodemographic status brings structured change in disease burden-is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. FUNDING: Bill & Melinda Gates Foundation.
Published: 2015
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40. The Headache-Attributed Lost Time (HALT) Indices: measures of burden for clinical management and population-based research

Author: Timothy J. Steiner and Richard B. Lipton
Subjects: Research design, Time Factors, IMPACT, assessment, lcsh:Medicine, Efficiency, burden, Disability Evaluation, 0302 clinical medicine, Cost of Illness, Surveys and Questionnaires, Epidemiology, 030212 general & internal medicine, education.field_of_study, Global Campaign against Headache, TO-DOOR SURVEY, Headache, General Medicine, Research Design, instruments, HEALTH, Life Sciences & Biomedicine, management, medicine.medical_specialty, DISORDERS, Migraine Disorders, Population, Clinical Neurology, population-based studies, 03 medical and health sciences, medicine, Humans, education, Psychiatry, Science & Technology, Neurology & Neurosurgery, Recall, business.industry, lcsh:R, Methodology, Neurosciences, medicine.disease, headache disorders, Anesthesiology and Pain Medicine, Migraine, Neurosciences & Neurology, Neurology (clinical), Headache Disorders, business, 030217 neurology & neurosurgery, Lost time
Abstract: Background The burden attributable to headache disorders has multiple components: a simple measure summarising them all does not exist. The Migraine Disability Assessment (MIDAS) instrument has proved useful, estimating productive time lost in the preceding 3 months due to the disabling effect of headache. We developed adaptations of MIDAS for purposes of the Global Campaign against Headache, embracing epidemiological studies and the provision of clinical management aids. Methods We reviewed the structure, content, wording and scoring of MIDAS and made revisions, developing the Headache-Attributed Lost Time (HALT) Indices in three versions. Over 10 years, these were employed in multiple epidemiological and clinical studies in countries worldwide. Results In the original HALT-90, we made no changes to the structure and scoring of MIDAS, but used wording in questions 1–4 that we believed would be more widely understood and more easily translated into other languages. Of the two alternative versions, HALT-30 kept the same structure, question format and wording except that “3 months” was replaced by “1 month”. HALT-7/30 was a variant of HALT-30: focusing only on lost work time for population-based studies of headache-attributed burden, it enquired into lost days in the preceding month (30 days) and week (7 days). Conclusions Three versions of the HALT Indices serve different purposes as measures of headache-attributed burden, and offer different means of scoring. In studies using HALT as a population measure, there is no need to reflect the states of individuals, whereas a measure over shorter periods than 3 months is likely to be more reliable through better recall. Assessment of individual patients prior to treatment may best estimate impact if enquiry is made into the preceding 90 days, except in cases where headache is highly frequent. Follow-up in clinical management may be better served by assessments over 30 rather than 90 days. © The Author(s). 2018. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Published: 2018
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41. The headache under-response to treatment (HURT) questionnaire, an outcome measure to guide follow-up in primary care: development, psychometric evaluation and assessment of utility

Author: M. Al Jumah, Dawn C. Buse, Shengyuan Yu, L. Prilipko, K. Ravishankar, Cristina Tassorelli, Miguel J. A. Láinez, Timothy J. Steiner, M. Fontebasso, EA MacGregor, Michael L. Reed, Fabio Antonaci, A. Al Khathami, Richard B. Lipton, F Sakai, RH Jensen, Maria Lurenda Westergaard, and Francesco Saverio Mennini
Subjects: lcsh:Medicine, Global Health, Outcome measures, Headache Disorders/diagnosis, Health Services Accessibility, DISEASE, Migraine Disorders/diagnostic imaging, 0302 clinical medicine, Sickness Impact Profile, Surveys and Questionnaires, Health care, Outcome Assessment, Health Care, Prevalence, 030212 general & internal medicine, Medical diagnosis, Settore SECS-P/01 - Economia Politica, Pain Measurement, Evidence-Based Medicine, Follow-up, COST, General Medicine, Primary care, Medication-overuse headache, Management, PREVALENCE, Scale (social sciences), Respondent, Life Sciences & Biomedicine, Treatment planning, Acute treatment, medicine.medical_specialty, Psychometrics/instrumentation, Psychometrics, Cluster headache, DISORDERS, Pain medicine, Migraine Disorders, Preventative treatment, Clinical Neurology, Burden of Disease, Burden, ORGANIZATION, Assessment, 03 medical and health sciences, Outcome Assessment (Health Care), Headache disorders, medicine, SYSTEMATIC ANALYSIS, Humans, Pain Measurement/instrumentation, VALIDITY, Migraine, HURT questionnaire, Science & Technology, Treatment satisfaction, Neurology & Neurosurgery, Primary Health Care, business.industry, DISABILITY, lcsh:R, Methodology, Neurosciences, Reproducibility of Results, Treatment optimization, GLOBAL BURDEN, medicine.disease, Tension-type headache, Anesthesiology and Pain Medicine, Global campaign against headache, Family medicine, Neurology (clinical), Neurosciences & Neurology, business, Instruments, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: Background Headache disorders are both common and burdensome but, given the many people affected, provision of health care to all is challenging. Structured headache services based in primary care are the most efficient, equitable and cost-effective solution but place responsibility for managing most patients on health-care providers with limited training in headache care. The development of practical management aids for primary care is therefore a purpose of the Global Campaign against Headache. This manuscript presents an outcome measure, the Headache Under-Response to Treatment (HURT) questionnaire, describing its purpose, development, psychometric evaluation and assessment for clinical utility. The objective was a simple-to-use instrument that would both assess outcome and provide guidance to improving outcome, having utility across the range of headache disorders, across clinical settings and across countries and cultures. Methods After literature review, an expert consensus group drawn from all six world regions formulated HURT through item development and item reduction using item-response theory. Using the American Migraine Prevalence and Prevention Study’s general-population respondent panel, two mailed surveys assessed the psychometric properties of HURT, comparing it with other instruments as external validators. Reliability was assessed in patients in two culturally-contrasting clinical settings: headache specialist centres in Europe (n = 159) and primary-care centres in Saudi Arabia (n = 40). Clinical utility was assessed in similar settings (Europe n = 201; Saudi Arabia n = 342). Results The final instrument, an 8-item self-administered questionnaire, addressed headache frequency, disability, medication use and effect, patients’ perceptions of headache “control” and their understanding of their diagnoses. Psychometric evaluation revealed a two-factor model (headache frequency, disability and medication use; and medication efficacy and headache control), with scale properties apparently stable across disorders and correlating well and in the expected directions with external validators. The literature review found few instruments linking assessment to clinical advice or suggested actions: HURT appeared to fill this gap. In European specialist care, it showed utility as an outcome measure across headache disorders. In Saudi Arabian primary care, HURT (translated into Arabic) was reliable and responsive to clinical change. Conclusions With demonstrated validity and clinical utility across disorders, cultures and settings, HURT is available for clinical and research purposes. Electronic supplementary material The online version of this article (10.1186/s10194-018-0842-6) contains supplementary material, which is available to authorized users.
Published: 2018
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42. Poor medical care for people with migraine in Europe ? evidence from the Eurolight study

Author: Zaza Katsarava, Timothy J. Steiner, Maka Mania, Christian Lampl, and Johanna Herberhold
Subjects: Male, Medizin, lcsh:Medicine, Triptans, Medical care, 0302 clinical medicine, Surveys and Questionnaires, Health care, 030212 general & internal medicine, Analgesics, education.field_of_study, Headache, General Medicine, Middle Aged, Tryptamines, Health policy, PREVALENCE, Analgesics, Opioid, Europe, Impact, Female, Family Practice, PRIMARY HEADACHE DISORDERS, Life Sciences & Biomedicine, Research Article, medicine.drug, Adult, medicine.medical_specialty, Adolescent, Headache Disorders, Migraine Disorders, Pain medicine, Population, Clinical Neurology, ORGANIZATION, Eurolight project, Young Adult, 03 medical and health sciences, medicine, SYSTEMATIC ANALYSIS, MANAGEMENT, Humans, CAMPAIGN, education, Migraine, Quality of Health Care, Science & Technology, Neurology & Neurosurgery, business.industry, DISABILITY, lcsh:R, Neurosciences, RECOGNITION, Patient Acceptance of Health Care, GLOBAL BURDEN, medicine.disease, PREVENTION, Cross-Sectional Studies, Anesthesiology and Pain Medicine, Global campaign against headache, Family medicine, Pre-Exposure Prophylaxis, Neurology (clinical), Neurosciences & Neurology, business, Delivery of Health Care, 030217 neurology & neurosurgery
Abstract: Background Migraine is prevalent everywhere, and disabling. It is also neglected: consequently, it is under-diagnosed and undertreated. We analysed data from the Eurolight study on consultations and utilization of migraine-specific medications as indicators of adequacy of medical care in Europe. Methods Eurolight was a cross-sectional questionnaire-based survey in 10 European countries. Sampling was population-based in six (Germany, Italy, Lithuania, Luxembourg, Netherlands, Spain) and from consecutive patients attending general practitioners (GPs) for any reason in three (Austria, France, UK). Additional samples in Netherlands and Spain, and the only sample from Ireland, were recruited by lay headache organisations. We recorded migraine prevalence and frequency, and utilization of medical services and medications (acute and preventative). Results Among 9247 participants (mean age 43.9 ± 13.9 years, M/F ratio 1:1.4), 3466 (37.6%) were diagnosed with migraine (definite or probable). Of these, 1175 (33.8%) reported frequent migraine (> 5 days/month) and might clearly expect benefit from, and therefore had need of, preventative medication. In population-based samples, minorities of participants with migraine had seen a GP (9.5–18.0%) or specialist (3.1–15.0%), and smaller minorities received adequate treatment: triptans 3.4–11.0%, with Spain outlying at 22.4%; preventative medication (1.6–6.4% of those eligible, with Spain again outlying at 13.7%). Proportions were greater in GP-based samples (13.6–24.5% using triptans, 4.4–9.1% on preventative medication) and among those from lay organisations (46.2–68.2% and 16.0–41.7%). Participants with migraine who had consulted specialists (3.1–33.8%) were receiving the best care by these indicators; those treated by GPs (9.5–29.6%) fared less well, and those dependent on self-medication (48.0–84.2%) were, apparently, inadequately treated. Conclusion In wealthy European countries, too few people with migraine consult physicians, with proportionately too many of these seeing specialists, and migraine-specific medications are used inadequately even among those who do. These findings represent yet another call for action in Europe to improve care for people with headache. Education of both health-care providers and the public should be central to this action. © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Published: 2018

43. Lifting the burden of headache in China: managing migraine in a SMART way

Author: Shengyuan Yu and Timothy J. Steiner
Subjects: medicine.medical_specialty, Health Knowledge, Attitudes, Practice, China, Pain medicine, Migraine Disorders, Alternative medicine, Clinical Neurology, Lifting the burden, lcsh:Medicine, Continuing medical education, DIAGNOSIS, Clinical decision support system, VALIDATION, DISEASE, 03 medical and health sciences, 0302 clinical medicine, Intervention (counseling), Medicine, Humans, 030212 general & internal medicine, Disease management (health), Psychiatry, Letter to the Editor, VERSION, Migraine, Science & Technology, Neurology & Neurosurgery, DECISION-SUPPORT-SYSTEM, business.industry, Public health, lcsh:R, Neurosciences, General Medicine, medicine.disease, Headache schools, PREVALENCE, Anesthesiology and Pain Medicine, Smart, Global campaign against headache, Neurology, Education, Medical, Continuing, Neurology (clinical), Medical emergency, Neurosciences & Neurology, business, Life Sciences & Biomedicine, 030217 neurology & neurosurgery
Abstract: With support from Lifting The Burden , a UK-registered charitable organization, a nationwide survey of headache disorders in the Chinese adult population was conducted in 2008–2009. This project, which was within the Global Campaign against Headache, showed that headache disorders have a major adverse impact on public health in China. Subsequently, as essential support for implementing headache services around the country, an enactment of stage 3 (intervention) of the Global Campaign against Headache − the continuing medical education (CME) program Headache Schools − was established. ‘SMART’ (Screen, Migraine, Aura, Red flag and Treatment), a systematic and operational disease management model, was introduced with the aims of enhancing neurologists’ knowledge of migraine, standardizing their diagnostic and treatment approaches, and improving their practices and outcomes. To date, 615 neurologists have been trained and 135 headache clinics have been established. In future, as we promote SMART in CME, we can use the database of our computerized clinical decision support systems to evaluate the impact on treatment outcomes.
Published: 2017

44. The burden of headache disorders in Ethiopia: national estimates from a population-based door-to-door survey

Author: Mehila Zebenigus, Hallie Thomas, Dawit Kibru Worku, Timothy J. Steiner, and Redda Tekle-Haimanot
Subjects: Male, Rural Population, Epidemiology, Alternative medicine, lcsh:Medicine, RECOMMENDATIONS, Random Allocation, 0302 clinical medicine, Cost of Illness, Risk Factors, 030212 general & internal medicine, education.field_of_study, Sub-Saharan Africa, Health Policy, Burden of disease, Headache, General Medicine, Middle Aged, Medication-overuse headache, PREVALENCE, Scale (social sciences), DISEASES, Population Surveillance, Female, Life Sciences & Biomedicine, Research Article, Adult, medicine.medical_specialty, Headache Disorders, Population, Clinical Neurology, Pain, ORGANIZATION, 03 medical and health sciences, Young Adult, Quality of life (healthcare), medicine, SYSTEMATIC ANALYSIS, Humans, CAMPAIGN, Psychiatry, education, Health policy, Migraine, 0604 Genetics, Science & Technology, Neurology & Neurosurgery, business.industry, DISABILITY, lcsh:R, Neurosciences, 1103 Clinical Sciences, GLOBAL BURDEN, medicine.disease, Health Surveys, Tension-type headache, Anesthesiology and Pain Medicine, Global campaign against headache, Cross-Sectional Studies, PRINCIPLES, Quality of Life, INJURIES, Neurology (clinical), Neurosciences & Neurology, Ethiopia, business, 030217 neurology & neurosurgery, Demography
Abstract: Background: Headache disorders are the third-highest cause of disability worldwide, with migraine and medication-overuse headache (MOH) the major contributors. In Ethiopia we have shown these disorders to be highly prevalent: migraine 17.7%, TTH 20.6%, probable MOH (pMOH) 0.7%, any headache yesterday (HY) 6.4%. To inform local health policy, we now estimate disability and other burdens attributable to headache in this country. Methods: In a cross-sectional survey using cluster-randomized sampling, we visited households unannounced in four diverse regions (urban and rural) of Ethiopia. We interviewed one member (18–65 years old) of each household using the HARDSHIP structured questionnaire. Screening and diagnostic questions based on ICHD-II were followed by burden enquiry in multiple domains. We estimated disability using disability weights (DWs) from the Global Burden of Disease 2013 study. Results: We interviewed 2385 participants (1064 [44.7%] male, 596 [25.0%] urban; participating proportion 99.8%). Reported mean intensity of migraine was 2.6 (scale 1–3). People with migraine spent 11.7% of their time in the ictal state (DW: 0.441); they were therefore 5.2% disabled overall. Pain and disability from TTH were much lower. Mean intensity of pMOH was 2.95. People with pMOH spent 60.2% of time with headache (DW: 0.223), and were 13.4% disabled. Average proportions of per-person lost productive time were, for migraine, 4.5% from paid work, 5.3% from household work; for pMOH they were 29.2% and 16.0%. There were highly-disabled minorities, and large gender differences, males losing more paid workdays, females more household workdays. All headache types were associated with impairments in quality of life. Across the population aged 18–65 years (effectively the working population), disability from headache was 1.4%, with 1.6% of workdays lost (half from migraine). Estimates from HY, eliminating recall error, were highly compatible. Conclusions: Ethiopia is a low-income country, and cannot afford these losses – including, perhaps, 1.6% of GDP. Political action is necessary, aimed at mitigating both the economic burden and the associated ill health. WHO has recommended structured headache services with their basis in primary care as the most efficient, effective, affordable and equitable solution, potentially cost-saving. We believe they can be implemented within Ethiopia’s existing health-care infrastructure. © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Published: 2017

45. Prevalence and burden of headache disorders in Lithuania and their public-health and policy implications: a population-based study within the Eurolight Project

Author: Lars Jacob Stovner, Colette Andrée, Daiva Rastenytė, Timothy J. Steiner, Hallie Thomas, and Dalia Mickevičienė
Subjects: Male, IMPACT, lcsh:Medicine, DISEASE, Random Allocation, 0302 clinical medicine, Quality of life, Cost of Illness, Health care, Prevalence, Medicine, 030212 general & internal medicine, education.field_of_study, Public health, Health Policy, General Medicine, Middle Aged, Medication-overuse headache, Europe, Population Surveillance, Workforce, Female, Life Sciences & Biomedicine, Research Article, Adult, medicine.medical_specialty, Adolescent, Headache Disorders, Population, Clinical Neurology, QUESTIONNAIRE, Burden, 03 medical and health sciences, Lost productivity, Young Adult, SYSTEMATIC ANALYSIS, Humans, CAMPAIGN, education, Psychiatry, Health policy, Migraine, Population-based study, Aged, Health Services Needs and Demand, Science & Technology, Neurology & Neurosurgery, Disability, business.industry, NATIONAL INCIDENCE, lcsh:R, Neurosciences, Lithuania, GLOBAL BURDEN, medicine.disease, Tension-type headache, Anesthesiology and Pain Medicine, Global campaign against headache, Cross-Sectional Studies, Quality of Life, INJURIES, Neurosciences & Neurology, Neurology (clinical), business, 030217 neurology & neurosurgery, Demography
Abstract: Background The Eurolight project assessed the impact of headache disorders in ten EU countries, using the same structured questionnaire but varying sampling methods. In Lithuania, sample selection employed methods in line with consensus recommendations for population-based burden-of-headache studies. Methods The survey was cross-sectional. We identified, from the Residents’ Register Service, a sample of inhabitants of Kaunas city and surrounding Kaunas region reflecting age (in the range 18–65 years), gender and rural/urban distributions of Lithuania. Medical students called unannounced at their homes and conducted face-to-face interviews employing a structured questionnaire. Results Of 1137 people in the pre-identified sample, 573 (male 237 [41.4%], female 336 [58.6%]; mean age 40.9 ± 13.8 years) completed interviews (participation proportion: 50.4%). Gender-adjusted 1-year prevalences were: any headache 74.7%; migraine 18.8%; tension-type headache (TTH) 42.2%; all headache on ≥15 days/month 8.6%; probable medication-overuse headache (pMOH) 3.2%. Migraine (OR: 3.6) and pMOH (OR: 2.9) were associated with female gender. All headache types except TTH were associated with significantly diminished quality of life. Migraine caused a mean 4.5% loss in paid worktime per affected male and 3.5% per affected female. Lost per-person times due to TTH were much less, but to pMOH and other headache on ≥15 days/month much higher. Among the entire workforce, lost productivity to migraine was estimated at 0.7%, to TTH 0.3% and to pMOH or other headache on ≥15 days/month 0.5%. The total of 1.5% may translate directly into lost GDP. Alternative calculations based on headache yesterday (with little recall error) produced, for all headache, a corroborating 1.7%. Similar losses from household work would also drain the nation’s economy. Our findings were comparable to those from earlier studies using similar methods in Russia and Georgia. Conclusions The multiple burdens from headache in Lithuania indicate substantial ill-health and unmet need for health care. The heavy burdens on individuals are matched by heavy economic burden. Of particular concern is the high prevalence of headache on ≥15 days/month, seen also in Russia and Georgia. Health policy in Lithuania must heed WHO’s advice that effective treatment of headache, clearly desirable for its health benefits, is also expected to be cost-saving. © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Published: 2017

46. Quality indicators in headache care: an implementation study in six Italian specialist-care centres

Author: Silvia Benemei, Simona Guerzoni, Lanfranco Pellesi, Matteo Paolucci, Carla Lupi, Andrea Negro, Timothy J. Steiner, Valentina Favoni, M. Ulivi, E. Mampreso, S. Cevoli, Pellesi, L., Benemei, S., Favoni, V., Lupi, C., Mampreso, E., Negro, A., Paolucci, M., Steiner, T.J., Ulivi, M., Cevoli, S., and Guerzoni, S.
Subjects: Male, Quality management, Headache Disorder, Tertiary Care Center, lcsh:Medicine, Tertiary Care Centers, 0302 clinical medicine, Surveys and Questionnaires, Surveys and Questionnaire, Medicine, Service quality evaluation, 030212 general & internal medicine, Medical diagnosis, Referral and Consultation, media_common, Academic Medical Centers, Global Campaign against Headache, Medical record, quality indicators, General Medicine, Benchmarking, health care, Academic Medical Center, Italy, Female, BURDEN, Life Sciences & Biomedicine, Human, Research Article, Adult, medicine.medical_specialty, Referral, DISORDERS, Headache Disorders, media_common.quotation_subject, Health Personnel, Clinical Neurology, 03 medical and health sciences, Quality of life (healthcare), Headache care, Humans, Quality (business), Quality Indicators, Health Care, Protocol (science), 0604 Genetics, Science & Technology, Neurology & Neurosurgery, business.industry, lcsh:R, Neurosciences, 1103 Clinical Sciences, HURT, Anesthesiology and Pain Medicine, Family medicine, benchmarking, global campaign against headache, headache care, headache disorders, service quality evaluation, academic medical centers, adult, female, health personnel, humans, italy, male, quality indicators, health care, referral and consultation, surveys and questionnaires, tertiary care centers, neurology (clinical), anesthesiology and pain medicine, Physical therapy, Neurology (clinical), Neurosciences & Neurology, business, 030217 neurology & neurosurgery
Abstract: Background: Headache disorders are highly prevalent, and have a substantial and negative impact on health worldwide. They are largely treatable, but differences in structure, objectives, organization and delivery affect the quality of headache care. In order to recognize and remedy deficiencies in care, the Global Campaign against Headache, in collaboration with the European Headache Federation, recently developed a set of quality indicators for headache services. These require further assessment to demonstrate fitness for purpose. This is their first implementation to evaluate quality in headache care as a multicentre national study. Methods: Between September and December 2016, we applied the quality indicators in six Italian specialist headache centres (Bologna, Firenze, Modena, Padova, Roma Campus Bio-Medico and Roma Sapienza). We used five previously developed assessment instruments, translated into Italian according to Lifting The Burden’s translation protocol for hybrid documents. We took data from 360 consecutive patients (60 per centre) by questionnaire and from their medical records, and by different questionnaires from their health-care providers (HCPs), including physicians, nurses, psychologists and nursing assistants. Results: The findings, comparable between centres, confirmed the feasibility and practicability of using the quality indicators in Italian specialist headache centres. The questionnaires were easily understood by HCPs and patients, and were not unduly time-consuming. Diagnoses were almost all (> 97%) according to ICHD criteria, and routinely (100%) reviewed during follow-up. Diagnostic diaries were regularly used by 96% of physicians. Referral pathways from primary to specialist care existed in five of the six clinics, as did urgent referral pathways. Instruments to assess disability and quality of life were not used regularly, a deficiency that needs to be addressed. Conclusion: This Italy-wide survey confirmed in six specialist centres that the headache service quality indicators are fit for purpose. By establishing majority practice, identifying commonalities and detecting deficits as a guide to quality improvement, the quality indicators may be used to set benchmarks for quality assessment. The next step is extend use and evaluation of the indicators into non-specialist care. © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Published: 2017

47. Medication-overuse headache in China: Clinical profile, and an evaluation of the ICHD-3 beta diagnostic criteria

Author: Mingjie Zhang, Xiaoyan Chen, Wei Dai, Meiyan Pan, Hai Di, Shengyuan Yu, Zhao Dong, Lei Hou, Ruozhuo Liu, Timothy J. Steiner, and Mianwang He
Subjects: Adult, Male, China, Pediatrics, medicine.medical_specialty, business.industry, General Medicine, Middle Aged, Demographic data, International Classification of Diseases, Headache Disorders, Secondary, medicine, Humans, Female, Neurology (clinical), Headaches, medicine.symptom, business, Medication overuse, Aged
Abstract: Background Although medication-overuse headache (MOH) is common in China, its clinical profile is not yet fully established. Meanwhile, ICHD-3 beta has been published, but its diagnostic criteria require further validation. Methods We retrospectively classified the clinical features of 240 consecutive patients with MOH (55 males, 185 females), whose demographic data, headache features, overused medications (type, quantity, frequency and duration of use), headache-attributed burden, and outcomes were reviewed. We then applied the criteria of the several versions of ICHD (II, IIR and 3-beta) to these patients. Results Compared with those with other headaches, patients with MOH were more likely to be less well educated (64.6% vs 42.0% for secondary school or lower, p Conclusions MOH in China is associated with lower educational level and annual income. MOH has rarely been diagnosed and correctly treated in China. ICHD-3 beta appears to be more appropriate for the diagnosis of MOH than previous versions.
Published: 2014
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48. Value of treatment of headache patients and need to improve headache patients’ journey

Author: Licia Grazzi, Alberto Raggi, Timothy J. Steiner, E. Ruiz De La Torre, Michela Tinelli, Koen Paemeleire, Dimos-Dimitrios Mitsikostas, Matilde Leonardi, and D. D’Amico
Subjects: medicine.medical_specialty, Neurology, Headache epidemiology, business.industry, Headache, MEDLINE, Dermatology, General Medicine, R Medicine (General), Pain management, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Physical therapy, Humans, Pain Management, Medicine, 030212 general & internal medicine, Neurology (clinical), Neurosurgery, business, Value (mathematics), 030217 neurology & neurosurgery, Neuroradiology
Published: 2018
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49. Headache-attributed burden and its impact on productivity and quality of life in Russia: structured healthcare for headache is urgently needed

Author: Ilya Ayzenberg, V. V. Osipova, M Chernysh, A. Sborowski, G. R. Tabeeva, Timothy J. Steiner, and Zaza Katsarava
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Population, Medizin, Community Health Planning, Russia, Young Adult, Indirect costs, Cost of Illness, Willingness to pay, Quality of life, Surveys and Questionnaires, Health care, medicine, Humans, education, Productivity, Aged, education.field_of_study, business.industry, Headache, Health Services, Middle Aged, medicine.disease, Neurology, Migraine, Quality of Life, Physical therapy, Female, Neurology (clinical), Rural area, business
Abstract: Background and purpose The study evaluated headache-attributed burden and its impact on productivity and quality of life (QoL) in Russia. Its purpose was to support recommendations for change. Methods A countrywide population-based random sample of 2725 biologically unrelated adults (aged 18–65 years) in 35 cities and nine rural areas of Russia were interviewed in a door-to-door survey. The structured questionnaire enquired into symptom burden, functional disability, lost productive time and QoL (applying the WHOQoL-8 question set), as well as willingness to pay (WTP) for adequate headache treatment, if it were available. Results Mean lost paid-work days due to headache in the previous 3 months were 1.9 ± 4.2, and mean lost household work days were 3.4 ± 5.7. The estimated annual indirect cost of primary headache disorders was USD 22.8 billion, accounting for 1.75% of gross domestic product. QoL was reduced by all types of primary headaches. According to WHOQoL-8, it was significantly lower in those with headache on ≥15 days/month than in those with episodic headache (24.7 ± 4.6 vs. 28.1 ± 5.0; P
Published: 2014
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50. Validation of ICHD-3 beta diagnostic criteria for 13.7 Tolosa-Hunt syndrome: Analysis of 77 cases of painful ophthalmoplegia

Author: Rongfei Wang, Shengyuan Yu, Wei Zhang, Xiaolin Wang, Zhibing Zhou, Timothy J. Steiner, Ruozhuo Liu, Xingwen Zhang, and Zhao Dong
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Cranial nerve palsy, Methylprednisolone, Dexamethasone, Diagnosis, Differential, International Classification of Diseases, Tolosa-Hunt Syndrome, Humans, Medicine, Painful ophthalmoplegia, Aged, Retrospective Studies, Ophthalmoplegia, business.industry, Cranial nerves, General Medicine, Middle Aged, Image Enhancement, medicine.disease, Magnetic Resonance Imaging, Surgery, Abnormal MRI findings, Treatment Outcome, Steroid therapy, Median time, Prednisone, Female, International Classification of Headache Disorders, Neurology (clinical), business, Tolosa–Hunt syndrome
Abstract: Background Three editions of International Classification of Headache Disorders (ICHD) diagnostic criteria for Tolosa-Hunt syndrome (THS) have been published in 1998, 2004 and 2013; in ICHD-3 beta, there have been considerable changes. The validity of these new diagnostic criteria remains to be established. Methods We retrospectively identified 77 patients with non-traumatic painful ophthalmoplegia (PO) admitted between 2003 and 2013. We reviewed patients’ age at onset and gender, time courses between onset of pain and development of cranial nerve palsy, the cranial nerves involved, imaging findings, therapeutic efficacy of steroid treatment and recurrence of attacks. Results THS was the most frequent type of PO (46/77). In THS patients, the third cranial nerve was most commonly involved (76.3%). The median time interval between pain and cranial nerve palsy was two days, although in five patients (10.9%) the interval ranged from 16 to 30 days. Definitely abnormal MRI findings were found in 24 patients (52.2%). Conclusions It is essential to rule out other causes of PO in diagnosing THS, with MRI playing a crucial role in differential diagnosis. It may be helpful to understand and master the entity of THS for researchers and clinicians to adjust the gradation and ranking of the diagnostic criteria.
Published: 2014
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