275 results on '"Timothy J. Steiner"'
Search Results
102. 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 more...
- Published
- 2014
- Full Text
- View/download PDF
103. 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. more...
- Published
- 2014
- Full Text
- View/download PDF
104. The International Classification of Headache Disorders, 3rd edition (beta version)
- Author
-
Marica Wilkinson, Joanna M Zakrzewska, P. Goadsby, Richard Ohrbach, Mark Obermann, Jes Olesen, T. Takeshima, A. May, A. Tugrul, Jean Schoenen, E. Cittadini, Zaza Katsarava, Marcel Arnold, K. Hirata, Giuseppe Nappi, C. Fernandez de las Peñas, J. Pereira-Monteiro, Aynur Özge, Lidia Savi, Bruce S. Schoenberg, Ambra Michelotti, V Pfaffenrath, A. Purdy, N. J. Wiendels, Anne Ducros, A. I. Scher, Maurice Vincent, C. Boes, Christian Lampl, Y. S. Li, Aneesh B. Singhal, S. De Siqueira, Robert S. Kunkel, L. Newman, Çiçek Wöber-Bingöl, J. W. Park, David W. Dodick, Elizabeth Leroux, S. Graff-Radford, W. Schievink, Andrew D. Hershey, C. Bordini, Gisela M. Terwindt, Jong Ling Fuh, Marcelo E. Bigal, Claudia Sommer, E. A. Macgregor, Kenneth A. Holroyd, M. Leone, Andrew I. Cohen, B. Mokri, Stephen D. Silberstein, Marie-Germaine Bousser, V. Aggarwal, S. Kirby, J. I. Escobar, K. Michael A. Welch, William B. Young, Cristina Tassorelli, R. Stark, Peter J. Goadsby, Roger Cady, A. Woda, Rigmor Jensen, Stefan Evers, Todd J. Schwedt, José M. Ferro, Andrew Charles, Michael Bjørn Russell, S. J. Huang, Martin Dichgans, T. Rozen, A. E. Lake, J. Gladstone, R. Lipton, Paul Pionchon, André Bes, E. Marchioni, M. T. Goicochea, E. Waldenlind, Hans-Christoph Diener, Vincenzo Guidetti, F. Taylor, D. Obelieniene, Fumihiko Sakai, J. A. Pareja, Henrik Winther Schytz, Donald R. Nixdorf, J.M. Láinez, J. González Menacho, Elizabeth Loder, V. V. Osipova, Peer Tfelt-Hansen, J. Pareja, D. Soyka, S. Ashina, Françoise Radat, Hayrunnisa Bolay, Julio Pascual, Federico Mainardi, Miguel J. A. Láinez, Dominik A Ettlin, Gretchen E. Tietjen, Ishaq Abu-Arafeh, A. V. Krymchantowski, Richard B. Lipton, R. Benoliel, S. Jääskeläinen, Shuu Jiun Wang, Morris Levin, Deborah I. Friedman, Hartmut Göbel, Tara Renton, Michel Lantéri-Minet, Timothy J. Steiner, James W. Lance, Frank Clifford Rose, Mario Fernando Prieto Peres, L. Bonamico, Volker Limmroth, S. Y. Yu, J. Lance, Dimos-Dimitrios Mitsikostas, Peter Svensson, E. Houdart, Peter S. Sandor, Jean-Paul Goulet, M. Serrano-Dueñas, Michael First, J. R. Berger, Lars Bendtsen, K. Ravishankar, Olesen, J., Bes, A., Kunkel, R., Lance, J. W., Nappi, Giuseppe, Pfaffenrath, V., Rose, F. C., Schoenberg, B. S., Soyka, D., Tfelt-Hansen, P., Welch, K. M. A., Wilkinson, M., Bousser, M. -G., Diener, H. -C., Dodick, D., First, M., Goadsby, P. J., Gobel, H., Lainez, M. J. A., Lipton, R. B., Sakai, F., Schoenen, J., Silberstein, S. D., Steiner, T. J., Bendtsen, L., Ducros, A., Evers, S., Hershey, A., Katsarava, Z., Levin, M., Pascual, J., Russell, M. B., Schwedt, T., Tassorelli, C., Terwindt, G. M., Vincent, M., Wang, S. -J., Charles, A., Lipton, R., Bolay, H., Lanteri-Minet, M., Macgregor, E. A., Takeshima, T., Schytz, H. W., Ashina, S., Goicochea, M. T., Hirata, K., Holroyd, K., Lampl, C., Mitsikostas, D. D., Goadsby, P., Boes, C., Bordini, C., Cittadini, E., Cohen, A., Leone, M., May, A., Newman, L., Pareja, J., Park, J. -W., Rozen, T., Waldenlind, E., Fuh, J. -L., Ozge, A., Pareja, J. A., Peres, M., Young, W., Yu, S. -Y., Abu-Arafeh, I., Gladstone, J., Huang, S. -J., Jensen, R., Lainez, J. M. A., Obelieniene, D., Sandor, P., Scher, A. I., Arnold, M., Dichgans, M., Houdart, E., Ferro, J., Leroux, E., Li, Y. -S., Singhal, A., Tietjen, G., Friedman, D., Kirby, S., Mokri, B., Purdy, A., Ravishankar, K., Schievink, W., Stark, R., Taylor, F., Krymchantowski, A. V., Tugrul, A., Wiendels, N. J., Marchioni, E., Osipova, V., Savi, L., Berger, J. R., Bigal, M., Gonzalez Menacho, J., Mainardi, F., Pereira-Monteiro, J., Serrano-Duenas, M., Cady, R., Fernandez de las Penas, C., Guidetti, V., Lance, J., Svensson, P., Loder, E., Lake, A. E., Radat, F., Escobar, J. I., Benoliel, R., Sommer, C., Woda, A., Zakrzewska, J., Aggarwal, V., Bonamico, L., Ettlin, D., Graff-Radford, S., Goulet, J. -P., Jaaskelainen, S., Limmroth, V., Michelotti, A., Nixdorf, D., Obermann, M., Ohrbach, R., Pionchon, P., Renton, T., De Siqueira, S., and Wober-Bingol, C. more...
- Subjects
medicine.medical_specialty ,Headache Disorders ,business.industry ,Headache Disorder ,Cluster headache ,Medizin ,Hemicrania continua ,General Medicine ,medicine.disease ,Hypnic headache ,ta3112 ,New daily persistent headache ,International Classification of Diseases ,Cervicogenic headache ,medicine ,Humans ,International Classification of Headache Disorders ,Paroxysmal Hemicrania ,Neurology (clinical) ,Psychiatry ,business ,Human ,Post-Traumatic Headache - Published
- 2013
- Full Text
- View/download PDF
105. Headache yesterday in China: A new approach to estimating the burden of headache, applied in a general-population survey in China
- Author
-
Shengyuan Yu, Gang Zhao, Yannan Fang, Xiangyang Qiao, Ruozhuo Liu, Xiaosu Yang, Xiutang Cao, Mianwang He, Timothy J. Steiner, and Jiachun Feng
- Subjects
Adult ,Male ,Moderate to severe ,China ,medicine.medical_specialty ,Adolescent ,Population ,Young Adult ,Cost of Illness ,Recall bias ,Prevalence ,medicine ,Humans ,General population survey ,education ,Aged ,education.field_of_study ,business.industry ,Data Collection ,Headache ,General Medicine ,Middle Aged ,Yesterday ,Physical therapy ,Female ,Neurology (clinical) ,business ,Demography - Abstract
Background In order to minimize recall bias in burden estimation, questions about headache yesterday were included in a population-based survey initiated by Lifting The Burden: The Global Campaign against Headache. Methods Throughout China, nonrelated respondents aged 18–65 years were randomly sampled from the general population by a door-to-door survey. A validated structured questionnaire included inquiry into occurrence and burden of headache on the preceding day (“headache yesterday”). Results The participation rate was 94.1%. Of 5041 participants, 286 (5.7%) (male 3.6%, female 7.9%) reported headache yesterday. Age-weighted prevalence of headache yesterday was 4.8% (male 3.0%, female 6.6%). Headache yesterday lasted all day in 36.8%, Conclusions Of the adult Chinese population, 1.8% have headache at any one time that is of moderate to severe intensity in 1.4%, and 1.3% lose the equivalent of a whole day to headache-attributed disability every day. In China this means 12.3 million people. more...
- Published
- 2013
- Full Text
- View/download PDF
106. Migraine associated with altitude: results from a population-based study in Nepal
- Author
-
Mattias Linde, Timothy J. Steiner, Lars Edvinsson, Ajay Risal, and Kedar Manandhar
- Subjects
Male ,Pediatrics ,Pilot Projects ,0302 clinical medicine ,Surveys and Questionnaires ,Epidemiology ,risk factors ,migraine ,030212 general & internal medicine ,BRAIN ,education.field_of_study ,Global Campaign against Headache ,Altitude ,Effects of high altitude on humans ,Middle Aged ,Neurology ,MAJOR DISORDERS ,Female ,Original Article ,epidemiology ,medicine.symptom ,BURDEN ,Life Sciences & Biomedicine ,headache ,HEADACHE DISORDERS ,Adult ,medicine.medical_specialty ,Adolescent ,Migraine Disorders ,Population ,prevalence ,Clinical Neurology ,03 medical and health sciences ,Young Adult ,Nepal ,medicine ,Humans ,education ,Aged ,Science & Technology ,Neurology & Neurosurgery ,business.industry ,hypoxia ,Neurosciences ,1103 Clinical Sciences ,Odds ratio ,Original Articles ,Hypoxia (medical) ,medicine.disease ,Population based study ,Cross-Sectional Studies ,Migraine ,Neurosciences & Neurology ,Neurology (clinical) ,1109 Neurosciences ,business ,METHODOLOGY ,030217 neurology & neurosurgery ,Demography - Abstract
Background and purpose A 1988 pilot study in Peru suggested an association between migraine and chronic exposure to high altitude. This study provides epidemiological evidence corroborating this. Methods In a cross-sectional nationwide population-based study, a representative sample of Nepali-speaking adults were recruited through stratified multistage cluster sampling. They were visited at home by trained interviewers using a culturally adapted questionnaire. The altitude of dwelling of each participant was recorded. Results Of 2100 participants, over half [1100 (52.4%)] were resident above 1000 m and almost one quarter [470 (22.4%)] at ≥2000 m. Age- and gender-standardized migraine prevalence increased from 27.9% to 45.5% with altitude between 0 and 2499 m and thereafter decreased to 37.9% at ≥2500 m. The likelihood of having migraine was greater (odds ratio, 1.5–2.2; P ≤ 0.007) at all higher altitudes compared with more...
- Published
- 2017
107. Primary headache disorders in the adult general population of Pakistan - a cross sectional nationwide prevalence survey
- Author
-
Umer L. Uqaili, SZ Alvi, AA Herekar, Uzma Javed, Rafiq Khanani, Arif D. Herekar, MA Shahab, Ali Ahmad, Timothy J. Steiner, Jahanzeb A. Effendi, and B Ahmed
- Subjects
Male ,Pediatrics ,Multivariate analysis ,Headache Disorders, Primary ,Cross-sectional study ,Epidemiology ,0302 clinical medicine ,Prevalence ,Headache Disorders, Secondary ,Pakistan ,SOCIOECONOMIC-STATUS ,030212 general & internal medicine ,Young adult ,GLOBAL CAMPAIGN ,education.field_of_study ,Population-based survey ,General Medicine ,Middle Aged ,Medication-overuse headache ,OBESITY ,Female ,BURDEN ,Life Sciences & Biomedicine ,Research Article ,Adult ,medicine.medical_specialty ,Adolescent ,Migraine Disorders ,Population ,Clinical Neurology ,Eastern Mediterranean Region ,03 medical and health sciences ,Young Adult ,Headache disorders ,medicine ,Humans ,education ,Migraine ,Aged ,0604 Genetics ,Science & Technology ,Neurology & Neurosurgery ,business.industry ,Tension-Type Headache ,Neurosciences ,1103 Clinical Sciences ,medicine.disease ,Anesthesiology and Pain Medicine ,Global campaign against headache ,Cross-Sectional Studies ,Neurology (clinical) ,Neurosciences & Neurology ,Headache Disorders ,business ,METHODOLOGY ,030217 neurology & neurosurgery - Abstract
Background The large geographical gaps in our knowledge of the prevalence and burden of headache disorders include almost all of Eastern Mediterranean Region (EMR). We report a nationwide population-based study in Pakistan, an EMR country with the sixth largest population in the world, conducted as a project within the Global Campaign against Headache. Methods We surveyed six locations from the four provinces of Pakistan: Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan. We randomly selected and visited rural and urban households in each. One adult member (18–65 years) of each household, also randomly selected, was interviewed by a trained non-medical interviewer from the same location using a previously-validated structured questionnaire translated into Urdu, the national language. We estimated 1-year prevalences of the headache disorders of public-health importance and examined their associations with demographic variables using multivariate analysis. Results There were 4223 participants (mean age 34.4 ± 11.0 years; male 1957 [46.3%], female 2266 [53.7%]; urban 1443 [34.2%], rural 2780 [65.8%]). Participation proportion was 89.5%. Headache in the previous year was reported by 3233 (76.6% [95% CI: 75.3–77.8%]). The age- and gender-adjusted 1-year prevalence of migraine was 22.5% [21.2–23.8%] (male 18.0% [16.8–19.2%], female 26.9% [25.6–28.2%]), of tension-type headache (TTH) 44.6% [43.1–46.1%] (male 51.2% [49.7–52.7%], female 37.9% [36.4–39.4%]), of probable medication-overuse headache 0.7% [0.5–1.0%] (male 0.7% [0.5–1.0%], female 0.8% [0.5–1.1%]) and of other headache on ≥15 days/month 7.4% [6.6–8.2%] (male 4.4% [3.8–5.0%], female 10.4% [9.5–11.3%]). Migraine was more prevalent in females by a factor of 3:2 although this association barely survived (P = 0.039) after correcting for other factors. TTH was more prevalent in males by about 4:3 (P = 0.026). All headache and migraine were age-related, peaking in the age group 40–49 years; TTH peaked a decade earlier. Higher education (P = 0.004) and income (P = 0.001) were negatively associated with prevalence of migraine. Conclusion With three quarters of its population affected, headache disorders must be on the public-health agenda of Pakistan. Worldwide, these disorders are the third leading cause of disability; information from specific enquiry into the burden attributable to headache disorders in this country is needed to inform health policy and priority-setting, and will be reported soon. Keywords © 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. more...
- Published
- 2017
108. Headache service quality: evaluation of quality indicators in 14 specialist-care centres
- Author
-
Ozan Eren, N. V. Latysheva, Mark Braschinsky, Sara Schramm, Mattias Linde, Christian Lampl, Zaza Katsarava, Maka Mania, Andrea Negro, Timothy J. Steiner, Rigmor Jensen, Jasna Zidverc-Trajkovic, Ana Podgorac, Raquel Gil Gouveia, Kirill Skorobogatykh, Knut Hagen, Elena Filatova, Paolo Martelletti, Andreas Straube, Annelien De Pue, Aleksandra Radojicic, V. V. Osipova, Koen Paemeleire, Julia Azimova, Giorgadze Gvantsa, Ugur Uygunoglu, Derya Uluduz, Aksel Siva, and Valerio De Angelis more...
- Subjects
Male ,Medizin ,Tertiary Care Centers ,0302 clinical medicine ,Outcome Assessment, Health Care ,Medicine and Health Sciences ,Medicine ,Service quality evaluation ,pain ,030212 general & internal medicine ,Prospective Studies ,Referral and Consultation ,media_common ,Medical record ,Headache ,General Medicine ,3. Good health ,PREVALENCE ,Europe ,Patient Satisfaction ,Female ,Specialization ,Research Article ,Adult ,medicine.medical_specialty ,hospital organization ,EUROPE ,Referral ,DISORDERS ,media_common.quotation_subject ,Pain medicine ,Health Personnel ,QUESTIONNAIRE ,Clinical Neurology ,03 medical and health sciences ,Patient satisfaction ,Headache care ,Headache disorders ,MANAGEMENT ,Humans ,Quality (business) ,survey ,Psychiatry ,Secondary Care Centers ,headache ,quality service ,Quality Indicators, Health Care ,Service quality ,Neurology & Neurosurgery ,business.industry ,DISABILITY ,Equity (finance) ,GLOBAL BURDEN ,HURT ,Anesthesiology and Pain Medicine ,Global campaign against headache ,Family medicine ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background The study was a collaboration between Lifting The Burden (LTB) and the European Headache Federation (EHF). Its aim was to evaluate the implementation of quality indicators for headache care Europe-wide in specialist headache centres (level-3 according to the EHF/LTB standard). Methods Employing previously-developed instruments in 14 such centres, we made enquiries, in each, of health-care providers (doctors, nurses, psychologists, physiotherapists) and 50 patients, and analysed the medical records of 50 other patients. Enquiries were in 9 domains: diagnostic accuracy, individualized management, referral pathways, patient’s education and reassurance, convenience and comfort, patient’s satisfaction, equity and efficiency of the headache care, outcome assessment and safety. Results Our study showed that highly experienced headache centres treated their patients in general very well. The centres were content with their work and their patients were content with their treatment. Including disability and quality-of-life evaluations in clinical assessments, and protocols regarding safety, proved problematic: better standards for these are needed. Some centres had problems with follow-up: many specialised centres operated in one-touch systems, without possibility of controlling long-term management or the success of treatments dependent on this. Conclusions This first Europe-wide quality study showed that the quality indicators were workable in specialist care. They demonstrated common trends, producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1 and 2). © The Author(s). 2016 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/) more...
- Published
- 2016
- Full Text
- View/download PDF
109. GBD 2015: migraine is the third cause of disability in under 50s
- Author
-
Theo Vos, Lars Jacob Stovner, and Timothy J. Steiner
- Subjects
Burden of disease ,medicine.medical_specialty ,Neurology ,Pain medicine ,Clinical Neurology ,Alternative medicine ,03 medical and health sciences ,0302 clinical medicine ,parasitic diseases ,Headache disorders ,medicine ,030212 general & internal medicine ,Psychiatry ,Migraine ,Public health ,Neurology & Neurosurgery ,Disability ,Global Campaign against Headache ,business.industry ,General Medicine ,medicine.disease ,Medication-overuse headache ,humanities ,Tension-type headache ,Anesthesiology and Pain Medicine ,Editorial ,Neurology (clinical) ,Headache Disorders ,business ,Global Burden of Disease study ,030217 neurology & neurosurgery - Published
- 2016
110. Headache yesterday in Karnataka state, India: prevalence, impact and cost
- Author
-
Girish Baburao Kulkarni, Gopalkrishna Gururaj, Girish N Rao, Lars Jacob Stovner, and Timothy J. Steiner
- Subjects
Male ,Rural Population ,Activities of daily living ,Headache Disorders, Primary ,Population level ,Urban Population ,Cross-sectional study ,Adult population ,0302 clinical medicine ,Cost of Illness ,Surveys and Questionnaires ,Activities of Daily Living ,Headache yesterday ,Headache Disorders, Secondary ,Prevalence ,030212 general & internal medicine ,GLOBAL CAMPAIGN ,education.field_of_study ,Global Campaign against Headache ,TO-DOOR SURVEY ,General Medicine ,Yesterday ,Medication-overuse headache ,Health policy ,Female ,Life Sciences & Biomedicine ,Research Article ,Adult ,COUNTRIES ,medicine.medical_specialty ,Cost ,DISORDERS ,Population ,Clinical Neurology ,QUESTIONNAIRE ,India ,Burden ,03 medical and health sciences ,medicine ,SYSTEMATIC ANALYSIS ,Humans ,Psychiatry ,education ,Migraine ,Science & Technology ,Neurology & Neurosurgery ,business.industry ,DISABILITY ,Neurosciences ,medicine.disease ,Health Surveys ,Tension-type headache ,Anesthesiology and Pain Medicine ,Cross-Sectional Studies ,Neurology (clinical) ,Neurosciences & Neurology ,Rural area ,business ,METHODOLOGY ,030217 neurology & neurosurgery ,Demography ,POPULATION SURVEYS - Abstract
Background The Global Campaign against Headache has pioneered evaluation of the prevalence and impact of headache on the preceding day (“headache yesterday”) as a new approach to the estimation of headache-attributed burden, avoiding recall error. We report its application in Karnataka State, southern India. Methods In a door-to-door survey, biologically unrelated adults (aged 18–65 years) were randomly sampled from urban and rural areas in and around Bengaluru and interviewed by trained researchers using a validated, structured questionnaire. Enquiry into headache applied ICHD-II diagnostic criteria and included questions about headache on the day preceding the interview (headache yesterday [HY]). Results There were 2329 participants (participation proportion 92.6 %; males 1141 [49.0 %], females 1188 [51.0 %]; mean age 38.0 [±12.7] years; 1103 [47.4 %] from rural areas, 1226 [52.6 %] urban). HY was reported by 138 participants (males 33 [2.9 %], females 105 [8.8 %]): the 1-day prevalence of headache was 5.9 %. Mean duration of HY was 7.0 ± 8.5 h, so that 1.7 % of the population (5.9 % * 7.0/24), on average, had headache at any moment in time yesterday. Mean intensity on a scale of 1–3 was 2.0 [±0.8]. Lost productivity due to HY was reported by 83.3 % of participants with HY: 37.7 % able to do less than half of what they had planned and 13.0 % able to do nothing. Productivity loss at population level (being the productivity loss within the entire adult population, every single day, attributable to headache) was 3.0 %. Conclusions This method of enquiry, free from recall error, confirmed a very high level of headache-attributed burden in Karnataka: previous estimates based on 3-month recall may even have been too low. Until another study is done in the country, these are the best data for all India. They demonstrate need for action nationwide to mitigate this burden, and correct action will ultimately almost certainly be cost-saving. © 2016 The Author(s). 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/) more...
- Published
- 2016
111. Anxiety and depression in Nepal: prevalence, comorbidity and associations
- Author
-
Kedar Manandhar, Are Holen, Mattias Linde, Timothy J. Steiner, and Ajay Risal
- Subjects
Adult ,Male ,medicine.medical_specialty ,Substance-Related Disorders ,Cross-sectional study ,Comorbidity ,Anxiety ,South Asia ,Hospital Anxiety and Depression Scale ,Developing countries ,03 medical and health sciences ,0302 clinical medicine ,Nepal ,Quality of life ,Surveys and Questionnaires ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,Psychiatry ,Neuroticism ,Depressive Disorder ,Public health ,Depression ,business.industry ,Urbanization ,1103 Clinical Sciences ,Widowhood ,Middle Aged ,medicine.disease ,Anxiety Disorders ,Health policy ,Psychiatry and Mental health ,Cross-Sectional Studies ,Quality of Life ,Female ,Mental health ,medicine.symptom ,business ,Psychosocial ,030217 neurology & neurosurgery ,Research Article ,Demography - Abstract
Background Anxiety and depression are two important contributors to the global burden of disease. In many developing countries, including Nepal, their prevalences are yet to be assessed. Methods A nationwide cross-sectional study was conducted among a representative sample of Nepalese adults aged 18–65 years (N = 2100), selected by multistage random cluster sampling and interviewed at home during unannounced visits. The validated questionnaires included the Hospital Anxiety and Depression Scale (HADS), to detect cases of anxiety (HADS-A), depression (HADS-D) and comorbid anxiety and depression (HADS-cAD), the Eysenck Personality Questionnaire Revised Short Form-Neuroticism (EPQRS-N), and the World Health Organization Quality of Life 8-question scale (WHOQOL-8). Logistic regression analyses were used to explore associations of caseness with four groups of variables: demographic, domicile, substance use, and behavioural and health. Results Age- and gender-adjusted point prevalences of HADS-A, HADS-D and HADS-cAD were 16.1, 4.2 and 5.9 % respectively. In a multivariate model, HADS-A was positively associated with urban residence (AOR = 1.82; p more...
- Published
- 2016
- Full Text
- View/download PDF
112. Neurological Disorders
- Author
-
Kiran T. Thakur, Emiliano Albanese, Panteleimon Giannakopoulos, Nathalie Jette, Mattias Linde, Martin J. Prince, Timothy J. Steiner, and Tarun Dua
- Subjects
03 medical and health sciences ,0302 clinical medicine ,030212 general & internal medicine ,030217 neurology & neurosurgery - Published
- 2016
- Full Text
- View/download PDF
113. Headache, depression and anxiety: associations in the Eurolight project
- Author
-
Lars Jacob Stovner, Hallie Thomas, Zaza Katsarava, Elena Ruiz de la Torre, Michel Lanteri-Minet, Christian Lampl, Colette Andrée, Daiva Rastenyte, Timothy J. Steiner, Jose Miguel Lainez, and Cristina Tassorelli more...
- Subjects
Male ,Neurology ,Cross-sectional study ,Medizin ,Comorbidity ,Anxiety ,Associations ,0302 clinical medicine ,Risk Factors ,Surveys and Questionnaires ,Odds Ratio ,Prevalence ,030212 general & internal medicine ,Depression (differential diagnoses) ,education.field_of_study ,Public health ,Global Campaign against Headache ,Depression ,Age Factors ,Headache ,General Medicine ,Middle Aged ,Medication-overuse headache ,Europe ,Female ,medicine.symptom ,Research Article ,Adult ,medicine.medical_specialty ,Population ,Clinical Neurology ,Eurolight project ,03 medical and health sciences ,Sex Factors ,Internal medicine ,medicine ,Humans ,Psychiatry ,education ,Migraine ,Aged ,Neurology & Neurosurgery ,business.industry ,Odds ratio ,medicine.disease ,Tension-type headache ,Anesthesiology and Pain Medicine ,Cross-Sectional Studies ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background: Headache disorders and psychiatric disorders are both common, while evidence, mostly pertaining to migraine, suggests they are comorbid more often than might be expected by chance. There are good reasons for establishing whether they are: symptoms of comorbid illnesses may summate synergistically; comorbidities hinder management, negatively influencing outcomes; high-level comorbidity indicates that, where one disease occurs, the other should be looked for. The Eurolight project gathered population-based data on these disorders from 6624 participants. Methods: Eurolight was a cross-sectional survey sampling from the adult populations (18–65 years) of 10 EU countries. We used data from six. The questionnaire included headache-diagnostic questions based on ICHD-II, the Headache-Attributed Lost Time (HALT) questionnaire, and HADS for depression and anxiety. We estimated odds ratios (ORs) to show associations between migraine, tension-type headache (TTH) or probable medication-overuse headache (pMOH) and depression or anxiety. Results: pMOH was most strongly associated with both psychiatric disorders: for depression, ORs (vs no headache) were 5.5 [2.2–13.5] (p more...
- Published
- 2016
114. The Headache Under-Response to Treatment (HURT) Questionnaire: Assessment of utility in headache specialist care
- Author
-
Dawn C. Buse, Richard B. Lipton, Rigmor Jensen, Cristina Tassorelli, E. Anne MacGregor, Fabio Antonaci, Maria Lurenda Westergaard, and Timothy J. Steiner
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Young Adult ,Initial visit ,Surveys and Questionnaires ,Intervention (counseling) ,Internal consistency ,medicine ,Humans ,Aged ,Specialist care ,Aged, 80 and over ,Analgesics ,business.industry ,Headache ,Outcome measures ,Reproducibility of Results ,Effective management ,General Medicine ,Middle Aged ,medicine.disease ,Response to treatment ,Treatment Outcome ,Migraine ,Physical therapy ,Female ,Neurology (clinical) ,business ,Specialization - Abstract
The HURT Questionnaire consists of eight questions which the patient answers as a measure of effectiveness of intervention against headache. This first assessment of clinical utility was conducted in headache specialist centres in three countries in order to demonstrate that HURT was responsive to change induced by effective management. We administered HURT on three occasions to 159 consecutive patients seeking non-urgent care from centres in Denmark and the United Kingdom: the first before the initial visit to the centres; the second at the initial visit; and the third when the specialist judged that the best possible outcome had been achieved in each patient. Questionnaires were also answered by 42 patients at initial and final visits to a centre in Italy. Internal consistency reliability was very good ( α = 0.85) while test-retest reliability was fair to low ( κ = 0.38–0.62 and rs = 0.49–0.76), possibly because headache was unstable prior to start of management. There were significant changes in responses post-intervention compared with baseline ( p more...
- Published
- 2012
- Full Text
- View/download PDF
115. Body mass index and migraine: a survey of the Chinese adult population
- Author
-
Gang Zhao, Yannan Fang, Ruozhuo Liu, Shengyuan Yu, Xiaosu Yang, Xiangyang Qiao, Jiachun Feng, Timothy J. Steiner, Xiutang Cao, and Mianwang He
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Original ,Cross-sectional study ,Migraine Disorders ,Population ,Clinical Neurology ,Body Mass Index ,Cohort Studies ,Young Adult ,Asian People ,Internal medicine ,Prevalence ,Odds Ratio ,medicine ,Humans ,Obesity ,education ,Migraine ,Aged ,education.field_of_study ,business.industry ,Headache ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,Obesity, Morbid ,Cross-Sectional Studies ,Anesthesiology and Pain Medicine ,Cohort ,Physical therapy ,Female ,Neurology (clinical) ,business ,Body mass index ,Cohort study - Abstract
The objective of this study is to evaluate the association between body mass index (BMI) and migraine in general population Chinese cohort. This was a crosssectional secondary analysis from a general population Chinese cohort of men and women of reproductive and post-reproductive age ranging between 18 and 65 years. Migraine was defined utilizing ICHD criteria. Body mass indices were calculated using measured height and weight and categorized based on the World Health Organizations criteria. The 1-year period prevalence of migraine was 9.3 %. No association was identified between migraine and those with a BMI\30.0. Compared to those with normal BMI (18.5–23.0), those with BMI C 30 (morbid obesity) had a greater prevalence of migraine (8.6 vs. 13.8 %, p = 0.000). Multivariate-adjusted odds ratio demonstrated that those with morbid obesity had a greater than twofold increased odds of migraine [OR 2.10 (1.39–3.12)] as compared to those with a BMI between 18.5 and 23.0. No association was found between obesity and migraine severity, frequency, or disability. Morbid obesity was associated with twofold increased odds of migraine in this Chinese men and women cohort of predominantly reproductive age. The Author(s) 2012. This article is published with Creative Commons Attribution License more...
- Published
- 2012
- Full Text
- View/download PDF
116. Why HURT? A Review of Clinical Instruments for Headache Management
- Author
-
Richard B. Lipton, Rigmor Jensen, Timothy J. Steiner, C. Mark Sollars, Dawn C. Buse, and Mohammed Al Jumah
- Subjects
Male ,medicine.medical_specialty ,Headache Disorders, Primary ,Psychometrics ,Pain medicine ,Alternative medicine ,MEDLINE ,Health Services Accessibility ,World health ,Acquired immunodeficiency syndrome (AIDS) ,Surveys and Questionnaires ,medicine ,Humans ,Pain Measurement ,Evidence-Based Medicine ,Primary Health Care ,business.industry ,Headache ,General Medicine ,Evidence-based medicine ,medicine.disease ,Anesthesiology and Pain Medicine ,Migraine ,Physical therapy ,Female ,Neurology (clinical) ,Medical emergency ,business - Abstract
The Global Campaign against Headache, directed by the non-governmental organization Lifting The Burden (LTB) in official relations with the World Health Organization (WHO), aspires to reduce the global burden of headache. Ultimately this calls for improvements in headache management, largely in primary care, where most people with headache receive medical care. In support, LTB is developing a range of headache management aids for primary care. Presently, no single instrument covers the range of assessment and decision-making necessary for successful headache management, and few make the important link between assessment and clinical advice. Expressly to fill this gap, LTB has developed a new instrument: the Headache Under-Response to Treatment (HURT) Questionnaire, an eight-item, self-administered questionnaire addressing headache frequency, disability, medication use and effect, perceptions of headache "control" and knowledge of diagnosis. This instrument is intended not only to evaluate current headache outcomes and assess the need for and response to treatment, but also to provide guidance on appropriate actions towards treatment optimization. The first draft of the HURT was created by an expert consensus group, meeting at WHO headquarters in Geneva, Switzerland. The final version came about through multiple refinements following psychometric testing. Assessment of clinical utility is ongoing in multiple countries. more...
- Published
- 2012
- Full Text
- View/download PDF
117. Risk factors for medication-overuse headache: An 11-year follow-up study. The Nord-Trøndelag Health Studies
- Author
-
Mattias Linde, Knut Hagen, John-Anker Zwart, Timothy J. Steiner, and Lars Jacob Stovner
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Multivariate analysis ,Population ,Hospital Anxiety and Depression Scale ,Risk Factors ,Epidemiology ,Headache Disorders, Secondary ,Prevalence ,medicine ,Humans ,Longitudinal Studies ,education ,Aged ,Analgesics ,education.field_of_study ,Norway ,business.industry ,Incidence ,Incidence (epidemiology) ,Odds ratio ,Middle Aged ,Confidence interval ,Anesthesiology and Pain Medicine ,Neurology ,Female ,Neurology (clinical) ,business ,Follow-Up Studies ,Cohort study - Abstract
Medication-overuse headache (MOH) is relatively common, but its incidence has not been calculated and there are no prospective population-based studies that have evaluated risk factors for developing MOH. The aim of this study was to estimate incidences of and identify risk factors for developing chronic daily headache (CDH) and MOH. This longitudinal population-based cohort study used data from the Nord-Trøndelag Health Surveys performed in 1995-1997 and 2006-2008. Among the 51,383 participants at baseline, 41,766 were eligible approximately 11 years later. There were 26,197 participants (responder rate 63%), among whom 25,596 did not report CDH at baseline in 1995-1997. Of these, 201 (0.8%) had MOH and 246 (1.0%) had CDH without medication overuse (CDHwoO) 11 years later. The incidence of MOH was 0.72 per 1000 person-years (95% confidence interval 0.62-0.81). In the multivariate analyses, a 5-fold risk for developing MOH was found among individuals who at baseline reported regular use of tranquilizers [odds ratio 5.2 (3.0-9.0)] or who had a combination of chronic musculoskeletal complaints, gastrointestinal complaints, and Hospital Anxiety and Depression Scale score ≥ 11 [odds ratio 4.7 (2.4-9.0)]. Smoking and physical inactivity more than doubled the risk of MOH. In contrast, these factors did not increase the risk of CDHwoO. In this large population-based 11-year follow-up study, several risk factors for MOH did not increase the risk for CDHwoO, suggesting these are pathogenetically distinct. If the noted associations are causal, more focus on comorbid condition, physical activity, and use of tobacco and tranquilizers may limit the development of MOH. more...
- Published
- 2012
- Full Text
- View/download PDF
118. The Prevalence and Burden of Primary Headaches in China: A Population-Based Door-to-Door Survey
- Author
-
Timothy J. Steiner, Shengyuan Yu, Ruozhuo Liu, Xiutang Cao, Yannan Fang, Jiachun Feng, Gang Zhao, Xiaosu Yang, Xiangyang Qiao, and Mianwang He
- Subjects
Adult ,Male ,China ,medicine.medical_specialty ,Headache Disorders, Primary ,Activities of daily living ,Adolescent ,Population ,Young Adult ,Indirect costs ,Cost of Illness ,Quality of life ,Surveys and Questionnaires ,Prevalence ,medicine ,Humans ,Psychiatry ,education ,Aged ,education.field_of_study ,Health economics ,business.industry ,Middle Aged ,medicine.disease ,Confidence interval ,Neurology ,Migraine ,Population Surveillance ,Female ,Neurology (clinical) ,Headaches ,medicine.symptom ,business ,Demography - Abstract
Objectives.— In the absence of reliable data on the prevalence and burden of primary headache disorders in the mainland of China, a population-based survey was initiated by Lifting The Burden: the Global Campaign against Headache. Methods.— Throughout all regions of China, 5041 non-related adult respondents aged 18-65 years were randomly sampled from the general population according to the expanded programme on immunization method established by World Health Organization. They were visited by door-to-door calling and surveyed using the structured questionnaire developed by Lifting The Burden, translated into Chinese and adapted to Chinese culture after a pilot study. Results.— The responder rate was 94.1%. The estimated 1-year prevalence of primary headache disorders was 23.8% (95% confidence interval 22.6-25.0%), of migraine 9.3% (95% confidence interval 8.5-10.1%), of tension-type headache (TTH) 10.8% (9.9-11.6%), and of chronic daily headache (CDH) 1.0% (0.7-1.2%). Of respondents with migraine, TTH, and CDH, moderate or severe impact and therefore high need for effective medical care were reported by 38.0%, 23.1%, and 47.9%, respectively. The World Health Organization quality of life-8 questionnaire showed that all 3 types of headache reduced life quality. The total estimated annual cost of primary headache disorders, including migraine, TTH, and CDH was CNY 672.7 billion, accounting for 2.24% of gross domestic product (GDP) (direct cost: CNY 108.8 billion, 0.36% of GDP; indirect cost: CNY 563.9 billion, 1.88% of GDP). Conclusion.— The prevalence of primary headaches is high in China and not dissimilar from the world average. These headaches cause disability, impair work, study and daily activities, decrease life quality, and bring about a heavy and hitherto unrecognized socioeconomic burden. more...
- Published
- 2011
- Full Text
- View/download PDF
119. The cost of headache disorders in Europe: the Eurolight project
- Author
-
Anders Gustavsson, Jose Miguel Lainez, E. Ruiz de la Torre, Mattias Linde, Christian Lampl, Michel Lanteri-Minet, Timothy J. Steiner, Daiva Rastenyte, Cristina Tassorelli, Lars Jacob Stovner, Zaza Katsarava, C. Andrée, and Jessica Barre more...
- Subjects
Estimation ,Pediatrics ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Cross-sectional study ,Population ,medicine.disease ,Indirect costs ,Neurology ,Migraine ,Health care ,Absenteeism ,Medicine ,Neurology (clinical) ,Headaches ,medicine.symptom ,business ,education ,health care economics and organizations ,Demography - Abstract
Background and purpose: Headache disorders are very common, but their monetary costs in Europe are unknown. We performed the first comprehensive estimation of how economic resources are lost to headache in Europe. Methods: From November 2008 to August 2009, a cross-sectional survey was conducted in eight countries representing 55% of the adult EU population. Participation rates varied between 11% and 59%. In total, 8412 questionnaires contributed to this analysis. Using bottom-up methodology, we estimated direct (medications, outpatient health care, hospitalization and investigations) and indirect (work absenteeism and reduced productivity at work) annual per-person costs. Prevalence data, simultaneously collected and, for migraine, also derived from a systematic review, were used to impute national costs. Results: Mean per-person annual costs were €1222 for migraine (95% CI 1055–1389; indirect costs 93%), €303 for tension-type headache (TTH, 95% CI 230–376; indirect costs 92%), €3561 for medication-overuse headache (MOH, 95% CI 2487–4635; indirect costs 92%), and €253 for other headaches (95% CI 99–407; indirect costs 82%). In the EU, the total annual cost of headache amongst adults aged 18–65 years was calculated, according to our prevalence estimates, at €173 billion, apportioned to migraine (€111 billion; 64%), TTH (€21 billion; 12%), MOH (€37 billion; 21%) and other headaches (€3 billion; 2%). Using the 15% systematic review prevalence of migraine, calculated costs were somewhat lower (migraine €50 billion, all headache €112 billion annually). Conclusions: Headache disorders are prominent health-related drivers of immense economic losses for the EU. This has immediate implications for healthcare policy. Health care for headache can be both improved and cost saving. more...
- Published
- 2011
- Full Text
- View/download PDF
120. The burden of headache in China: validation of diagnostic questionnaire for a population-based survey
- Author
-
Shengyuan Yu, Jiachun Feng, Timothy J. Steiner, Xiangyang Qiao, Yannan Fang, Ruozhuo Liu, Xiaosu Yang, Gang Zhao, and Xiutang Cao
- Subjects
Adult ,Male ,China ,medicine.medical_specialty ,Samfunnsmedisin, sosialmedisin: 801 [VDP] ,Adolescent ,Original ,Epidemiology ,Headache Disorders ,Population ,Clinical Neurology ,MEDLINE ,Diagnosis, Differential ,Interviews as Topic ,Community medicine, social medicine: 801 [VDP] ,Young Adult ,Asian People ,Cost of Illness ,Surveys and Questionnaires ,medicine ,Humans ,Young adult ,Medical diagnosis ,education ,Migraine ,Aged ,education.field_of_study ,Questionnaire ,business.industry ,Gold standard ,Headache ,General Medicine ,Middle Aged ,medicine.disease ,Health Surveys ,Tension-type headache ,Test (assessment) ,Anesthesiology and Pain Medicine ,Physical therapy ,Female ,Neurology (clinical) ,Burden of headache ,business - Abstract
The objective of this study was to test the validity, in the Chinese population, of the Lifting The Burden diagnostic questionnaire for the purpose of a population-based survey of the burden of headache in China. From all regions of China, a population-based sample of 417 respondents had completed the structured questionnaire in a door-to-door survey conducted by neurologists from local hospitals calling unannounced. They were contacted for re-interview by telephone by headache specialists who were unaware of the questionnaire diagnoses. A screening question ascertained whether headache had occurred in the last year. If they had, the specialists applied their expertise and ICHD-II diagnostic criteria to make independent diagnoses which, as the gold standard, were later compared with the questionnaire diagnoses. There were 18 refusals; 399 interviews were conducted in 202 women and 197 men aged 18–65 years (mean age 44.4 ± 12.6 years). In comparison to the specialists’ diagnoses, the sensitivity, specificity, positive predictive value, negative predictive value and Cohen’s kappa (95% CI) of the questionnaire for the diagnosis of migraine were 0.83, 0.99, 0.83, 0.99 and 0.82 (0.71–0.93), respectively; for the diagnosis of tension-type headache (TTH), they were 0.51, 0.99, 0.86, 0.92 and 0.59 (0.46–0.72), respectively. In conclusion, the questionnaire was accurate and reliable in diagnosing migraine (agreement level excellent), less so, but adequate, for TTH (sensitivity relatively low, false negative rate relatively high and agreement level fair to good). The non-specific features of TTH do not lend themselves well to diagnosis by questionnaire. Open Access This article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. more...
- Published
- 2011
- Full Text
- View/download PDF
121. What efficacy measures are clinically relevant and should be used in Cochrane reviews of acute migraine trials? An alternative viewpoint
- Author
-
Timothy J. Steiner
- Subjects
Clinical Trials as Topic ,medicine.medical_specialty ,Acute migraine ,business.industry ,Migraine Disorders ,Alternative medicine ,General Medicine ,Functional recovery ,medicine.disease ,Surgery ,Review Literature as Topic ,Systematic review ,Migraine ,Drug development ,Outcome Assessment, Health Care ,Health care ,medicine ,Humans ,Neurology (clinical) ,Intensive care medicine ,business - Abstract
I briefly review the purposes of efficacy measures, which go far beyond supporting new drug development. I use vignettes to illustrate the importance of functional recovery during the migraine attack, and argue that headache relief provides this. Sustained headache relief (SHR) is therefore a very worthwhile outcome when the alternative is a day of debilitating pain. As a measure, SHR may not be ideal for new drug development but it is informative to individuals, health care providers and politicians, and serves cost-effectiveness analysis better than any other. Cochrane are absolutely right to use it in systematic reviews along with the IHS-recommended measures. more...
- Published
- 2014
- Full Text
- View/download PDF
122. The burden of headache in Russia: validation of the diagnostic questionnaire in a population-based sample
- Author
-
M Chernysh, G. R. Tabeeva, R Mathalikov, Timothy J. Steiner, Ilya Ayzenberg, Zaza Katsarava, and V. V. Osipova
- Subjects
education.field_of_study ,medicine.medical_specialty ,Pediatrics ,business.industry ,Population ,Prevalence ,Population based sample ,medicine.disease ,Neurology ,Migraine ,Epidemiology ,medicine ,Neurology (clinical) ,Headaches ,medicine.symptom ,Rural area ,Young adult ,education ,business - Abstract
Background: We report validation of the Russian-language version of the Lifting The Burden headache screening and diagnostic questionnaire in a population-based sample of 501 individuals in four cities (Smolensk, Tchelyabinsk, Nishny Novgorod and Tver) and three rural areas (Tula, Tver and Gornyi) of Russia. Methods: The structured questionnaire, based on ICHD-II criteria, was applied face to face by trained non-medical interviewers calling at randomly selected households. Response rates were about 73% in cities and 80% in rural areas. Results: Of those responding, 301 reported headache in the previous year; of the total sample, 143 people with and 47 without headache according to the questionnaire were re-interviewed by telephone by one of the two neurologists unaware of the questionnaire diagnoses. Migraine (MIG), either definite (dMIG) or probable (pMIG), was diagnosed by the questionnaire in 72 cases, and tension-type headache (TTH), either definite (dTTH) or probable (pTTH), in 66 cases; the five others with headache were unclassifiable by questionnaire. Physicians diagnosed dMIG or pMIG in 65 cases, dTTH or pTTH in 89 cases and no headache in 31 cases; in five cases, headache was unclassifiable. The questionnaire had sensitivities and specificities of 77% and 82% for MIG (κ = 0.58) and of 64% and 91% for TTH (κ = 0.56). Conclusions: We concluded that the questionnaire can be utilized in a population-based countrywide survey of the burden attributable to primary headache disorders in Russia. more...
- Published
- 2010
- Full Text
- View/download PDF
123. Development and validation of the EUROLIGHT questionnaire to evaluate the burden of primary headache disorders in Europe
- Author
-
Lars Jacob Stovner, Michel Vaillant, Jose Miguel Lainez, Jessica Barre, Peter S. Sandor, Colette Andrée, Zaza Katsarava, Timothy J. Steiner, Christian Lampl, Marie Lise Lair, Michel Lanteri-Minet, and Cristina Tassorelli more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,Headache Disorders ,Medizin ,MEDLINE ,Comorbidity ,German ,Cost of Illness ,Quality of life ,Surveys and Questionnaires ,Internal consistency ,Humans ,Medicine ,Psychiatry ,Reliability (statistics) ,Language ,business.industry ,Reproducibility of Results ,General Medicine ,Middle Aged ,medicine.disease ,language.human_language ,Europe ,language ,Female ,Neurology (clinical) ,Headaches ,medicine.symptom ,business ,Primary Headache Disorders - Abstract
We developed a 103-item self-reporting questionnaire to assess the burden of primary headache disorders on those affected by them, including headache characteristics, associated disability, co-morbidities, disease-management and quality of life. We validated the questionnaire in five languages with 426 participants (131 in UK, 60 in Italy, 107 in Spain, 83 in Germany/Austria, and 45 in France). After a linguistic and a face-content validation, we tested the questionnaire for comprehensibility, internal consistency and test–retest reliability at an interval of one month. In the different countries, response rates were between 73% and 100%. Test–retest reliability varied between –0.27 to 1.0 depending of the nature of the expected agreement. The internal consistency was between 0.69 and 0.91. The EUROLIGHT questionnaire is suitable for evaluating the burden of primary headache disorders, and can be used in English, German, French, Italian and Spanish. more...
- Published
- 2010
- Full Text
- View/download PDF
124. Primary headache disorders in the Republic of Georgia: Prevalence and risk factors
- Author
-
Lars Jacob Stovner, Mamuka Djibuti, M. Janelidze, RH Jensen, M. Kukava, E. Mirvelashvili, A. Dzagnidze, Z Katsarava, and Timothy J. Steiner
- Subjects
Adult ,Male ,medicine.medical_specialty ,Headache Disorders, Primary ,Population ,Prevalence ,Georgia (Republic) ,Chronic Migraine ,Risk Factors ,Epidemiology ,Confidence Intervals ,Odds Ratio ,medicine ,Humans ,Risk factor ,Psychiatry ,education ,education.field_of_study ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Health Surveys ,Logistic Models ,Migraine ,Female ,Neurology (clinical) ,Headaches ,medicine.symptom ,business ,Follow-Up Studies ,Demography - Abstract
Objective: To estimate the 1-year prevalences of migraine and tension-type headache (TTH), and identify their principal risk factors, in the general population of the Republic of Georgia. Methods: In a community-based door-to-door survey, 4 medical residents interviewed all biologically unrelated adult members (≥16 years) of 500 adjacent households in Tbilisi, the capital city, and 300 in rural Kakheti in eastern Georgia, using a previously validated questionnaire based on International Headache Society diagnostic criteria. Results: The target population included 1,145 respondents, 690 (60%) women, mean age 45.4 ± 12.0 years. The 1-year prevalences were as follows: migraine 6.5% (95% confidence interval 5.0–7.9), probable migraine 9.2% (7.5–10.8), all migraine 15.6% (13.5%–17.7%), TTH 10.0% (8.2–11.7), probable TTH 27.3% (24.8–29.9), all TTH 37.3% (34.5%–40.1%). Female gender and low socioeconomic status were risk factors for migraine but not for TTH. Headache on ≥15 days/month was reported by 87 respondents, a prevalence of 7.6% (6.1–9.1). Female gender, low socioeconomic status, and frequent use (≥10 days/month) of acute headache drugs were risk factors. The likely prevalence of medication overuse headache was 0.9% (0.3–1.4), of chronic migraine 1.4% (0.7–2.1), and of chronic TTH 3.3% (2.3–4.4), but caution is needed in interpreting these estimates. Conclusions: While the prevalences of migraine and tension-type headache are comparable with those in Europe and the United States, a remarkably high percentage of the population of Georgia have headache on ≥15 days/month. This study demonstrates the importance of socioeconomic factors in a developing country and unmasks the unmet needs of people with headache disorders. more...
- Published
- 2009
- Full Text
- View/download PDF
125. Headache Disorders in Developing Countries: Research Over The Past Decade
- Author
-
Farrah J. Mateen, Shekhar Saxena, Tarun Dua, and Timothy J. Steiner
- Subjects
medicine.medical_specialty ,Biomedical Research ,business.industry ,Headache ,Alternative medicine ,Developing country ,General Medicine ,medicine.disease ,Study Characteristics ,Clinical research ,Search terms ,Migraine ,medicine ,Humans ,Neurology (clinical) ,Low and middle income ,Headache Disorders ,Psychiatry ,business ,Developing Countries - Abstract
The majority of people with primary headache disorders live in the developing world. The contribution of low and middle income (LAMI) countries to headache research has not been previously characterized. A search was performed for clinical research publications between the years 1997 and 2006, using the search terms ‘headache’ OR ‘headache disorders’ AND ‘primary’ OR ‘migraine’ AND ‘each of the LAMI countries’ in 67 databases. Articles in English or with abstracts in English translation were included. These publications were scrutinized for study characteristics. Two hundred and twenty-seven publications from 32 LAMI countries were found. Half (50.2±) of these were from three middle-income countries (Brazil, Turkey and Iran), whereas 24 (10.6±) came from low-income countries. Most of the research focused on migraine. Only 29.5± of the articles involved treatment of headache. The understanding of headache disorders in LAMI countries is derived from a limited number of publications from relatively few countries. Identifying gaps in headache research in the developing world is strategic for targeting research policy. more...
- Published
- 2008
- Full Text
- View/download PDF
126. Proposals for the organisation of headache services in Europe
- Author
-
Michel Lanteri-Minet, Jose Miguel Lainez, Rigmor Jensen, Dominique Valade, Timothy J. Steiner, and Fabio Antonaci
- Subjects
Service (business) ,Health Services Needs and Demand ,medicine.medical_specialty ,Outpatient Clinics, Hospital ,Headache epidemiology ,business.industry ,Headache ,MEDLINE ,Public relations ,Europe ,Order (exchange) ,Health care ,Emergency Medicine ,Internal Medicine ,medicine ,Humans ,Medicine ,Pain Clinics ,Outpatient clinic ,Headache Disorders ,business ,Psychiatry ,Delivery of Health Care ,Specialization ,Healthcare system - Abstract
The mission of the European Headache Federation (EHF) is to improve life for those affected by headache disorders in Europe. Progress depends upon improving access to good headache-related health care for people affected by these disorders. Education about headache-its nature, causes, consequences and management-is a key activity of EHF that supports this aim. It is also important to achieve an organisation of headache-related services within the health systems of Europe in order that they can best deliver care in response to what are very high levels of need. This publication assesses this need, and sets out proposals for service organisation, on three levels, to meet the resultant demand. more...
- Published
- 2008
- Full Text
- View/download PDF
127. Ethical Issues Arising from Commercial Sponsorship and from Relationships with the Pharmaceutical Industry—Report and Recommendations of the Ethics Subcommittee of the International Headache Society
- Author
-
Timothy J Steiner
- Subjects
Ethics Committees ,medicine.medical_specialty ,book.periodical ,Internationality ,Drug Industry ,Health Planning Guidelines ,Ethical issues ,Conflict of Interest ,business.industry ,Headache ,Alternative medicine ,Public consultation ,General Medicine ,Public relations ,Clinical trial ,Cephalalgia ,Advertising ,Interim ,medicine ,Humans ,Neurology (clinical) ,business ,book ,Societies, Medical ,Pharmaceutical industry - Abstract
Preface These recommendations, the second set developed for the International Headache Society (IHS) by its Ethics Subcommittee, evolved over 3 years. This extended period allowed time for public consultation, an important part of the formulation process, and for consequent revision. The recommendations were presented in this final form to IHS Council in late 2005, and approved for publication in Cephalalgia. The delay from then until now would have been better avoided. The reasons for it, which did not lie with the Subcommittee, are not of current interest. What matters is that these recommendations remain entirely relevant to their purpose. In one area – the registration of clinical trials – matters have moved on in the interim. As the Subcommittee anticipated, registration of trials is becoming standard practice [1]. This goal is not yet achieved, but laudable and largely voluntary initiatives by the pharmaceutical industry have brought about much recent progress. Clear international consensus has yet to emerge on what needs to be included in a clinical trials registry, and when. This does not help, since it is not entirely certain what the desired end is. But it seems likely that, with or without further regulation, this end will be both clear and in sight in not too long. Headache will benefit, along with all other fields of medicine. more...
- Published
- 2008
- Full Text
- View/download PDF
128. Interictal burden attributable to episodic headache: findings from the Eurolight project
- Author
-
Daiva Rastenyte, Michel Lanteri-Minet, Lars Jacob Stovner, Timothy J. Steiner, Jose Miguel Lainez, Elena Ruiz de la Torre, Cristina Tassorelli, Christian Lampl, Zaza Katsarava, Colette Andrée, and Hallie Thomas more...
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Interictal burden ,Neurology ,Cross-sectional study ,Migraine Disorders ,Medizin ,Clinical Neurology ,Eurolight project ,03 medical and health sciences ,0302 clinical medicine ,Cost of Illness ,Epidemiology ,medicine ,Humans ,media_common.cataloged_instance ,Ictal ,European Union ,030212 general & internal medicine ,European union ,Psychiatry ,Migraine ,media_common ,Public health ,Neurology & Neurosurgery ,Global Campaign against Headache ,business.industry ,Headache ,General Medicine ,Middle Aged ,medicine.disease ,Tension-type headache ,Europe ,Cross-Sectional Studies ,Anesthesiology and Pain Medicine ,Anxiety ,Female ,Neurology (clinical) ,Headaches ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background Most primary headaches are episodic, and most estimates of the heavy disability burden attributed to headache derive from epidemiological data focused on the episodic subtypes of migraine and tension-type headache (TTH). These disorders give rise directly but intermittently to symptom burden. Nevertheless, people with these disorders may not be symptom-free between attacks. We analysed the Eurolight dataset for interictal burden. Methods Eurolight was a cross-sectional survey using modified cluster sampling from the adult population (18–65 years) in 10 countries of the European Union. We used data from nine. The questionnaire included headache-diagnostic questions based on ICHD-II and several question sets addressing impact, including interictal and cumulative burdens. Results There were 6455 participants with headache (male 2444 [37.9 %]). Interictal symptoms were reported by 26.0 % of those with migraine and 18.9 % with TTH: interictal anxiety by 10.6 % with migraine and avoidance (lifestyle compromise) by 14.8 %, both much more common than in TTH (3.1 % [OR 3.8] and 4.7 % [OR 3.5] respectively). Mean time spent in the interictal state was 317 days/year for migraine, 331 days/year for TTH. Those who were “rarely” or “never” in control of their headaches (migraine 15.2 %, TTH 9.6 %) had significantly raised odds of interictal anxiety, avoidance and other interictal symptoms. Among those with migraine, interictal anxiety increased markedly with headache intensity and frequency, avoidance less so but still significantly. Lost productive time was associated with high ORs (up to 5.3) of anxiety and avoidance. A third (32.9 %) with migraine and a quarter (26.7 %) with TTH (difference: p more...
- Published
- 2016
129. The burden of headache disorders in Nepal: estimates from a population-based survey
- Author
-
Mattias Linde, Kedar Manandhar, Ajay Risal, and Timothy J. Steiner
- Subjects
Male ,Cross-sectional study ,RECOMMENDATIONS ,0302 clinical medicine ,Quality of life ,Cost of Illness ,Surveys and Questionnaires ,030212 general & internal medicine ,Young adult ,education.field_of_study ,Public health ,Burden of disease ,COST ,General Medicine ,Middle Aged ,Medication-overuse headache ,PREVALENCE ,MAJOR DISORDERS ,Female ,Life Sciences & Biomedicine ,Research Article ,DOOR SURVEY ,Adult ,medicine.medical_specialty ,Adolescent ,Headache Disorders ,Population ,Clinical Neurology ,WILLINGNESS-TO-PAY ,03 medical and health sciences ,Young Adult ,Nepal ,medicine ,Humans ,Ictal ,education ,Migraine ,Aged ,Population-based study ,Science & Technology ,Disability ,Neurology & Neurosurgery ,business.industry ,Neurosciences ,Sequela ,South-East Asia region ,GLOBAL BURDEN ,medicine.disease ,Tension-type headache ,Anesthesiology and Pain Medicine ,Cross-Sectional Studies ,Global campaign against headache ,HEALTH-CARE ,Physical therapy ,Quality of Life ,Neurology (clinical) ,Neurosciences & Neurology ,business ,METHODOLOGY ,030217 neurology & neurosurgery ,Demography - Abstract
Background Headache disorders, particularly migraine and tension-type headache (TTH), are among the most prevalent global public-health problems. Medication-overuse headache (MOH) is a common sequela of mismanagement of these. Migraine and MOH are highly disabling. Formulation of responsive health policy requires reliable, locally-derived, population-based data describing both individual and societal impact of headache disorders. South-East Asia is the only one of WHO’s six world regions in which no such national data have yet been gathered. Methods In a nationwide population-based cross-sectional study, a representative sample of Nepalese-speaking adults (18–65 years) were randomly selected by stratified multistage cluster sampling. Trained interviewers made unannounced door-to-door visits and enquired into headache and its attributable burden using a culturally-adapted and validated Nepalese translation of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire. Results Among 2100 participants, 1794 (85.4 %) reported headache during the preceding year (male: 689 [38.4 %], female 1105 [61.6 %]; mean age 36.1 ± 12.6 years). Mean headache frequency was 3.8 ± 6.2 days/month, mean headache intensity 2.1 ± 0.7 on a 0–3 scale, and mean attack duration 41.9 ± 108.5 h. All aspects of symptom burden (frequency, intensity and duration) were greater among females (p more...
- Published
- 2016
130. Structured education can improve primary-care management of headache: the first empirical evidence, from a controlled interventional study
- Author
-
Mark Braschinsky, Ave Kivisild, Jaanus Korjas, Zaza Katsarava, Sulev Haldre, Anna Iofik, Mart Kals, Timothy J. Steiner, and Silvia Koljal
- Subjects
myalgia ,Adult ,Male ,medicine.medical_specialty ,Neurology ,Referral ,Headache Disorders ,Pain medicine ,Medizin ,Clinical Neurology ,Education ,03 medical and health sciences ,0302 clinical medicine ,General Practitioners ,Intervention (counseling) ,Medicine ,Humans ,030212 general & internal medicine ,Disease management (health) ,Medical diagnosis ,Practice Patterns, Physicians' ,Effect measurement ,Neurology & Neurosurgery ,Global Campaign against Headache ,Primary Health Care ,business.industry ,Headache ,Disease Management ,General Medicine ,Middle Aged ,Primary care ,Management ,Anesthesiology and Pain Medicine ,Physical therapy ,Education, Medical, Continuing ,Female ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background Headache disorders are under-recognized and under-diagnosed. A principal factor in their suboptimal management is lack of headache-related training among health-care providers, especially in primary care. In Estonia, general practitioners (GPs) refer many headache patients to neurological specialist services, mostly unnecessarily. GPs request “diagnostic” investigations, which are usually unhelpful and therefore wasteful. GP-made headache diagnoses are often arcane and non-specific, and treatments based on these are inappropriate. The aim of this study was to develop, implement and test an educational model intended to improve headache-related primary health care in Estonia. Methods This was a controlled study consisting of baseline observation, intervention and follow-up observation using the same measures of effect. It involved six GPs in Põlva and the surrounding region in Southern Estonia, together with their future patients presenting consecutively with headache as their main complaint, all with their consent. The primary outcome measure was referral rate (RR) to neurological specialist services. Secondary measures included number of GP-requested investigations, GP-made headache diagnoses and how these conformed to standard terminology (ICD-10), and GP-recommended or initiated treatments. Results RR at baseline (n = 490) was 39.5 %, falling to 34.7 % in the post-intervention group (n = 295) (overall reduction 4.8 %; p = 0.21). In the large subgroup of patients (88 %) for whom GPs made clearly headache-related ICD-10 diagnoses, RR fell by one fifth (from 40 to 32 %; p = 0.08), but the only diagnosis-related RR that showed a statistically significant reduction was (pericranial) myalgia (19 to 3 %; p = 0.03). There was a significant increase towards use of more specific diagnoses. Use of investigations in diagnosing headache reduced from 26 to 4 % (p more...
- Published
- 2016
131. The prevalence of primary headache disorders in Ethiopia
- Author
-
Hallie Thomas, Dawit Kibru Worku, Redda Tekle-Haimanot, Timothy J. Steiner, and Mehila Zebenigus
- Subjects
Male ,Rural Population ,Headache Disorders, Primary ,Urban Population ,Cross-sectional study ,Epidemiology ,Pilot Projects ,Random Allocation ,0302 clinical medicine ,Surveys and Questionnaires ,Prevalence ,Medicine ,030212 general & internal medicine ,Young adult ,education.field_of_study ,Global Campaign against Headache ,Sub-Saharan Africa ,Headache ,General Medicine ,Middle Aged ,Medication-overuse headache ,Female ,Rural population ,Research Article ,Adult ,medicine.medical_specialty ,Adolescent ,Migraine Disorders ,Population ,Clinical Neurology ,Young Adult ,03 medical and health sciences ,Humans ,education ,Psychiatry ,Migraine ,Aged ,Neurology & Neurosurgery ,business.industry ,medicine.disease ,Tension-type headache ,Cross-Sectional Studies ,Anesthesiology and Pain Medicine ,Neurology (clinical) ,Ethiopia ,business ,030217 neurology & neurosurgery ,Demography ,Primary Headache Disorders - Abstract
Background Knowledge of the epidemiology of primary headache disorders in sub-Saharan Africa (SSA) remains very limited. We performed a population-based survey in rural and urban areas of Ethiopia, using methods similar to those of an earlier study in Zambia and tested in multiple other countries by Lifting The Burden. Methods In a cross-sectional survey we visited households unannounced in four regions of Ethiopia: the mostly urban populations in Addis Ababa and its environs and rural populations of selected districts in Oromia, Amhara and South Nations Nationalities and People’s Regions States (SNNPRS). We used cluster-randomized sampling: within clusters we randomly selected households, and one adult member (18–65 years old) of each household. The HARDSHIP structured questionnaire, translated into the local languages, was administered face-to-face by trained interviewers. Demographic enquiry was followed by diagnostic questions based on ICHD-II criteria. Results From 2,528 households approached, 2,385 of 2,391 eligible members (1,064 [44.7%] male, 596 [25.0%] urban) consented to interview (participating proportion 99.8%). Headache in the preceding year was reported by 1,071 participants (44.9% [95% CI: 42.4–46.3]; males 37.7%, females 49.9%), and headache yesterday by 170 (7.1% [6.2–8.2]; males 45 [4.1%], females 125 [9.2%]). Adjusted for gender, age and habitation (urban/rural), 1-year prevalence of migraine was 17.7%, of tension-type headache (TTH) 20.6%, of all headache on ≥15 days/month 3.2%, and of probable medication-overuse headache (pMOH) 0.7%. The adjusted prevalence of headache yesterday was 6.4%. Very few cases (1.6%) were unclassifiable. All headache disorders were more common in females. TTH was less common in urban areas (OR: 0.3; p more...
- Published
- 2016
132. Validation of a Georgian language headache questionnaire in a population-based sample
- Author
-
Maka, Kukava, Anna, Dzagnidze, Marina, Janelidze, Eka, Mirvelashvili, Mamuka, Djibuti, Guenther, Fritsche, Rigmor, Jensen, Lars J, Stovner, Timothy J, Steiner, and Zaza, Katsarava
- Subjects
Adult ,Male ,Pilot phase ,endocrine system ,medicine.medical_specialty ,animal structures ,Tension headache ,Original ,Population ,Clinical Neurology ,Pilot Projects ,Georgia (Republic) ,Sensitivity and Specificity ,Validity ,stomatognathic system ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Tensiontype headache ,education ,Migraine ,education.field_of_study ,integumentary system ,Questionnaire ,business.industry ,Cluster headache ,Headache ,Population based sample ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,stomatognathic diseases ,Anesthesiology and Pain Medicine ,Female ,Neurology (clinical) ,Trigeminal autonomic cephalalgias ,business ,Trigeminal autonomic cephalalgia ,Primary Headache Disorders - Abstract
In a pilot phase of a survey of the prevalence of primary headache disorders in the Republic of Georgia, we validated a Georgian language questionnaire for migraine (MIG), tension-type headache (TTH), MIG+TTH and trigeminal autonomic cephalalgias (TAC). A population-based sample of 186 people with headache completed the questionnaire and were blindly examined by one of two headache experts. The questionnaire diagnoses were: MIG 49, TTH 76, MIG+TTH 45 and TAC 16. The physicians' diagnoses were: MIG 59, TTH 77, MIG+TTH 34, TAC 2 and "symptomatic headache" in 14 subjects. Sensitivity and specificity for MIG were 0.75 and 0.96, for TTH 0.79 and 0.86, and for MIG+TTH 0.61 and 0.84 respectively. Of 16 TAC diagnoses, the physicians confirmed cluster headache in two patients only. The questionnaire can be utilised to investigate the prevalence of MIG and of TTH. It offers preliminary screening only for TAC, which should be confirmed during a face to face examination. more...
- Published
- 2007
- Full Text
- View/download PDF
133. The Global Burden of Headache: A Documentation of Headache Prevalence and Disability Worldwide
- Author
-
Zaza Katsarava, Knut Hagen, Rigmor Jensen, John-Anker Zwart, Ann I. Scher, Lars Jacob Stovner, Richard B. Lipton, and Timothy J. Steiner
- Subjects
Employment ,Male ,medicine.medical_specialty ,Internationality ,Population ,Adult population ,Risk Assessment ,World health ,Disability Evaluation ,03 medical and health sciences ,Age Distribution ,0302 clinical medicine ,Daily headache ,Risk Factors ,Epidemiology ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,Sex Distribution ,education ,Psychiatry ,education.field_of_study ,business.industry ,Headache ,General Medicine ,medicine.disease ,Migraine ,Meta-analysis ,Physical therapy ,Female ,Neurology (clinical) ,Sick Leave ,Headache Disorders ,business ,030217 neurology & neurosurgery - Abstract
This study, which is a part of the initiative 'Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide', assesses and presents all existing evidence of the world prevalence and burden of headache disorders. Population-based studies applying International Headache Society criteria for migraine and tension-type headache, and also studies on headache in general and 'chronic daily headache', have been included. Globally, the percentages of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache and 3% for chronic daily headache. Our calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for the two genders, and into the five most disabling for women. more...
- Published
- 2007
- Full Text
- View/download PDF
134. Over-the-Counter Triptans for Migraine
- Author
-
Peer Tfelt-Hansen and Timothy J. Steiner
- Subjects
medicine.medical_specialty ,Migraine Disorders ,Nonprescription Drugs ,Pharmacy ,Triptans ,Piperidines ,Germany ,medicine ,Humans ,Pharmacology (medical) ,Intensive care medicine ,Naratriptan ,Sumatriptan ,business.industry ,medicine.disease ,Rizatriptan ,Tryptamines ,United Kingdom ,Migraine with aura ,Serotonin Receptor Agonists ,Surgery ,Psychiatry and Mental health ,Treatment Outcome ,Migraine ,Over-the-counter ,Neurology (clinical) ,medicine.symptom ,business ,medicine.drug - Abstract
In 2006, the triptans sumatriptan 50mg and naratriptan 2.5mg were approved as over-the-counter (OTC) drugs in pharmacies in the UK and Germany, respectively. Both drugs have been used in a large number of patients with migraine and are considered to have good safety profiles. The implications of OTC triptan availability for clinical practice are that more migraine patients will use a triptan and will tend to medicate early when their headache is still mild, which should be beneficial. The problem with OTC access to triptans is medication overuse; therefore, patients should be warned of this and advised to use a triptan on fewer than 10 days per month. Pharmacists should be educated regarding migraine types and symptoms and on contraindications to triptans, so they are then able to discern the patients who should receive triptans and, as importantly, those who should not. The annual cost of migraine is euro27 billion in Europe, $US1.4 billion in the UK and $US16.6 billion in the US. By far the greatest opportunity for cost-savings comes from the potential to reduce costs associated with lost productivity from migraine. OTC availability of triptans will inevitably result in easier access to these medications, which, in turn, may result in improved treatment and lower migraine-related disability. There is currently a lack of empirical evidence that treating migraine effectively does in fact recover lost productivity; well designed studies are required to show this. The availability of triptans OTC is a logical development for the better management of a common, benign, self-limiting but nonetheless burdensome disorder that is currently grossly undertreated. We welcome this development, but recognise that advice at the point of sale is crucial for effective and safe use of these drugs. more...
- Published
- 2007
- Full Text
- View/download PDF
135. Reliability and Validity of a Nepali-language Version of the Hospital Anxiety and Depression Scale (HADS)
- Author
-
Ajay Risal, Kedar Manandhar, Mattias Linde, Rajendra Koju, Timothy J. Steiner, and Are Holen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Nepali ,Psychometrics ,Population ,Anxiety ,Hospital Anxiety and Depression Scale ,Hospitals, University ,03 medical and health sciences ,0302 clinical medicine ,Cronbach's alpha ,Nepal ,Residence Characteristics ,Surveys and Questionnaires ,Medicine ,Humans ,030212 general & internal medicine ,education ,Psychiatry ,Language ,education.field_of_study ,Inpatients ,business.industry ,Depression ,Construct validity ,Reproducibility of Results ,General Medicine ,Translating ,language.human_language ,Scale (social sciences) ,language ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background In several languages and settings, the Hospital Anxiety and Depression Scale (HADS) has demonstrated reliable and valid screening properties in psychiatry. Objective To develop a Nepali version of HADS with acceptable reliability and construct validity for use among hospital patients and in the general population. Method The original English version was translated into Nepali using a forward-backward translation protocol. Psychometric properties were tested by factor analysis and Cronbach’s alpha. The translated scale was administered to three groups of adult in-patients in a university hospital in three trials, and to a sample of adults from the community in a fourth trial. Some of the 14 items were reworded reiteratively to achieve viable semantic and statistical solutions. Results The two-factor solution with anxiety and depression subscales eventually explained 40.3% of the total variance. Cronbach’s alpha was 0.76 for anxiety (HADS-A) and 0.68 for depression (HADS-D). All seven HADS-A items showed at least acceptable item-to-factor correlations (range 0.44-0.74), and full construct validity was achieved for this subscale. Item-to-factor correlations for six HADS-D items were also at least acceptable (range 0.42-0.70); one item (D4) had persistently low correlations throughout all trials, although construct validity was still satisfactory. Conclusion Reiterated rewording of items guided by statistical testing resulted in a Nepali version of HADS with satisfactory psychometric properties. more...
- Published
- 2015
136. Measuring Neuroticism in Nepali: Reliability and Validity of the Neuroticism Subscale of the Eysenck Personality Questionnaire
- Author
-
Rajendra Koju, Mattias Linde, Kedar Manandhar, Timothy J. Steiner, Are Holen, and Ajay Risal
- Subjects
Adult ,Psychometrics ,media_common.quotation_subject ,Population ,03 medical and health sciences ,0302 clinical medicine ,Cronbach's alpha ,Nepal ,Surveys and Questionnaires ,Personality ,Medicine ,Humans ,Big Five personality traits ,education ,media_common ,Language ,Neuroticism ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Construct validity ,Reproducibility of Results ,General Medicine ,Translating ,Anxiety Disorders ,Eysenck Personality Questionnaire ,business ,Factor Analysis, Statistical ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Background The Neuroticism subscale of the Eysenck Personality Questionnaire Revised Short Form (12 items) (EPQRS-N) has proven to be a reliable and valid measure in multiple languages. Objective To develop a single-factor Nepali-language version of the EPQRS-N for use in the adult population of Nepal. Method The original English version of EPQRS-N was translated into Nepali using a forward-backward translation protocol. The first set of translated items was modified after testing by factor analysis with principal component extraction in an outpatient sample. Items with low factor correlations or poor semantic consistencies were reworded to fit the gist of the original items in a Nepali cultural context; the revised version was then tested in a representative random sample from the general population. Again, the same statistical procedures were applied. Results The first trial gave three factors. Based on the factor distribution of the items or their semantic quality, five were reworded. In the second trial, a two-factor solution emerged; the second factor had only one item with high correlation, which also had modest correlation with the first factor. Accordingly, a forced one-factor solution was chosen. This gave an internal consistency (Cronbach’s alpha) of 0.80, with item-to-factor correlations from 0.40 to 0.73, and item-to-sum correlations from 0.31 to 0.61. Conclusion The final Nepali version of EPQRS-N achieved satisfactory internal consistency. The item distribution coincided with the original English version, providing acceptable construct validity. It is psychometrically adequate for use in capturing the personality trait of neuroticism, and has broad applicability to the adult population of Nepal because of the diversity of the participant samples in which it was developed. more...
- Published
- 2015
137. Undertreated Hypertension and its Implications for Public Health in Nepal: Nationwide Population-Based Survey
- Author
-
Rajendra Koju, Mattias Linde, Are Holen, Kedar Manandhar, Ajay Risal, and Timothy J. Steiner
- Subjects
Adult ,Employment ,Male ,medicine.medical_specialty ,Alcohol Drinking ,National Health Programs ,Health Status ,Population ,Context (language use) ,Logistic regression ,Representativeness heuristic ,Young Adult ,Nepal ,Risk Factors ,Prevalence ,Medicine ,Humans ,Risk factor ,education ,education.field_of_study ,Microlife ,business.industry ,Public health ,General Medicine ,Middle Aged ,Blood pressure ,Cross-Sectional Studies ,Logistic Models ,Cardiovascular Diseases ,Population Surveillance ,Hypertension ,Female ,business ,Demography - Abstract
Background Hypertension (HTN), a major risk factor for cardiovascular diseases (CVDs), is a substantial global public health problem. Occasional studies indicate a high prevalence of HTN in the Nepalese population, but no nationwide population-based data exist so far. We opportunistically used a survey of major disorders of the brain in Nepal to measure blood pressure (BP) in participants selected randomly from the adult general population. Objective To establish the prevalence of elevated BP (eBP), and factors associated with it, regardless of any antihypertensive therapy being taken. We took this to be indicative of unmet health-care need. Method This was a cross-sectional study, conducted by unannounced household visits, employing multistage random cluster sampling. To achieve representativeness, 15 districts out of 75 in the country were investigated: one district from each of the three physiographic divisions in each of the five development regions of Nepal. One adult aged 18-65 years was selected from each household and interviewed by structured questionnaire. BP was recorded in a standardised manner by digital device (Microlife 3BM1-3®). Result From 2,109 eligible households, 2,100 adults (99.6%) participated. The prevalence of eBP (>140/90 mmHg on ?2 readings) was found to be 15.1%. Multivariate logistic regression showed significant and independent associations with demographic variables (higher age, male gender), with life-style factors (daily alcohol consumption, BMI ?25), and with living at high altitude (?2000 m). Conclusion In the context of the survey we could not collect data on antihypertensive therapy being taken but, clearly, whatever this might have been, it was failing to meet treatment needs. Almost one in six adults met criteria for hypertension, carrying risk implications for CVDs and their substantial public-health consequences. Two remediable associated factors were identified, although in a cross-sectional survey we could not prove causation. Kathmandu University Medical Journal Vol.13(1) 2015; 3-7 more...
- Published
- 2015
138. Elevated blood pressure and headache disorders in China - associations, under-treatment and implications for public health
- Author
-
Xiutang Cao, Xiangyang Qiao, Timothy J. Steiner, Gang Zhao, Ruozhuo Liu, Xiaosu Yang, Mianwang He, Jiachun Feng, Shengyuan Yu, and Yannan Fang
- Subjects
Adult ,Male ,medicine.medical_specialty ,China ,Headache Disorders, Primary ,Adolescent ,Cross-sectional study ,Migraine Disorders ,Population ,Clinical Neurology ,Blood Pressure ,Overweight ,Logistic regression ,Young Adult ,Asian People ,medicine ,Prevalence ,Humans ,Young adult ,education ,Aged ,education.field_of_study ,Public health ,business.industry ,Headache ,Population-based survey ,General Medicine ,Anthropometry ,Middle Aged ,medicine.disease ,Anesthesiology and Pain Medicine ,Blood pressure ,Cross-Sectional Studies ,Logistic Models ,Global campaign against headache ,Migraine ,Hypertension ,Physical therapy ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Demography ,Research Article - Abstract
Background:Both hypertension (HTN) and headache disorders are highly prevalent worldwide. Our purpose, in anationwide study of the Chinese general population, was to evaluate any association between primary headachedisorders and elevated blood pressure (eBP). We could not collect data on antihypertensive therapy, but took theview that, whatever such therapy might be taken, eBP was a sign that it was failing to meet treatment needs.Therefore, as a secondary purpose, important from the public-health perspective, we would present the prevalenceof eBP (treated or not) as indicative of unmet health-care need in China.Methods:This was a questionnaire-based nationwide cross-sectional door-to-door survey using clusterrandom-sampling, selecting one adult (18–65 years) per household. Headache was diagnosed by ICHD-IIcriteria and eBP as systolic blood pressure≥140 mmHg and/or diastolic blood pressure≥90 mmHg.Chi-squared test and multivariate logistic regression analysis were used to assess the strength andsignificance of associations. We set significance atP≤0.05.Results:Of 5,041 survey participants (participation rate 94.1 %), 154 were excluded because of missing BPdata, leaving 4,987 for analysis [mean age: 43.6 ± 12.8 years; male 2,532 (mean age: 43.4 ± 12.9 years); female2,455 (mean age 43.9 ± 12.8 years)]. There were 466 participants with migraine, 535 with tension typeheadache (TTH) and 48 with all causes of headache on≥15 days/month. The prevalence of eBP was 22.1 %(males 22.9 %, females 21.3 %). No associations of eBP with any of the headache disorders survivedmultivariate adjusted analysis. The demographic and anthropometric variables most strongly associated witheBP were higher age (AOR 3.7) and being overweight (AOR 2.4), seen in both genders. Less strong were malegender, lower educational level and urban habitation.Conclusions:We found no clear-cut associations between eBP and any headache disorder. The associationswith demographic and anthropometric variables may have acted as confounders in past reports to the contrary. We did find an alarmingly high prevalence of eBP, recognizing that this signals substantialunder-treatment in China of a serious condition, and therefore a major public-health concern. © 2015 He et al.Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 InternationalLicense (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in anymedium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commonslicense, and indicate if changes were made more...
- Published
- 2015
139. Impact of headache disorders in Italy and the public-health and policy implications: a population-based study within the Eurolight Project
- Author
-
Cristina Tassorelli, F Balsamo, Colette Andrée, B Carugno, Marta Allena, Giuseppe Nappi, Timothy J. Steiner, and Grazia Sances
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Neurology ,Headache Disorders ,Migraine Disorders ,Population ,Clinical Neurology ,Young Adult ,Lost productivity ,Age Distribution ,Sex Factors ,Risk Factors ,Surveys and Questionnaires ,medicine ,Headache Disorders, Secondary ,Prevalence ,Humans ,Young adult ,education ,Health policy ,Migraine ,Aged ,education.field_of_study ,Neurology & Neurosurgery ,Disability ,business.industry ,Public health ,Health Policy ,Tension-Type Headache ,General Medicine ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,Medication-overuse headache ,Stratified sampling ,Anesthesiology and Pain Medicine ,Impact ,Global campaign against headache ,Italy ,Female ,Neurology (clinical) ,Public Health ,business ,Research Article - Abstract
Background Migraine, tension-type headache (TTH) and medication-overuse headache (MOH) are disabling lifelong illnesses. The Eurolight project, a partnership activity within the Global Campaign against Headache, assessed the impact of headache disorders in ten countries in Europe using a structured questionnaire coupled with various sampling methods. Here we present the findings from the Italian population. Methods Questionnaires were distributed to a stratified sample (N = 3500) of the adult (18–65 years) inhabitants of Pavia province (1.05 % of the general population), randomly selected in cooperation with the local health service. Questions included demographic and diagnostic enquries, and assessment of various aspects of impact and health-care utilisation. Results Altogether 500 questionnaires were returned of which 487 were adequately completed for analysis (58 % female, 42 % male). Among these, gender-adjusted lifetime prevalence of headache was 82.5 %, higher in females than in males (91.2 % vs 72.4 %; p more...
- Published
- 2015
140. Headache disorders are third cause of disability worldwide
- Author
-
Lars Jacob Stovner, Zaza Katsarava, Rigmor Jensen, Paolo Martelletti, Timothy J. Steiner, and Gretchen L. Birbeck
- Subjects
medicine.medical_specialty ,Inclusion (disability rights) ,Population ,Medizin ,Clinical Neurology ,Epidemiology ,medicine ,CAMPAIGN ,Meaning (existential) ,education ,Psychiatry ,Disease burden ,Health policy ,education.field_of_study ,Science & Technology ,Neurosciences ,General Medicine ,GLOBAL BURDEN ,medicine.disease ,PREVALENCE ,Anesthesiology and Pain Medicine ,Neurology (clinical) ,Years of potential life lost ,Editorial ,Migraine ,Neurosciences & Neurology ,Psychology ,Life Sciences & Biomedicine ,METHODOLOGY - Abstract
From time to time, there is news that is of particular consequence to all people affected by headache. In December 2012, Lancet published the Global Burden of Disease Study 2010 (GBD2010). We wrote then [1]: “Few reports are likely to have more profound meaning for people with headache, or carry greater promise for a better future, than the seven papers (and one in particular [2]) that were presented.” So it was: the essential finding – that migraine was the seventh highest specific cause of disability worldwide – has been widely cited in both scientific and informal literature, pointedly noted by health commentators, trumpeted loudly by lay organisations and quietly harnessed by those seeking grants for headache research. It has given legitimacy to arguments that headache disorders contribute in a big way to public ill-health and disability [3], and strong backing to pleas for political recognition of this fact [4]. Now there is more, from the Global Burden of Disease Study 2013 (GBD2013), and it is of similarly arresting significance. Published in Lancet earlier this month [5], its key findings for those whose interests focus on headache are threefold: migraine is the sixth highest cause of disability worldwide; medication-overuse headache (MOH) is included in these surveys for the first time and enters the top twenty causes of disability at 18th; and adding together just these two puts headache disorders third among the worldwide causes of disability, measured in years of life lost to disability (YLDs). Thus in the 23 years of the Global Burden of Disease project (GBD), from 1990 to 2013, headache has come from nowhere – wholly ignored, not thought even worth measuring – into the leading three of the several hundred contributors to the global burden of disease that GBD counts. The background and a little of the history of this extraordinary transition should be told. What we are reporting here are the outcomes of huge, sustained, coordinated effort. GBD itself is a massive, ongoing, iterative enterprise [6]. It was undertaken initially, in 1990 and 2000, by the World Health Organization (WHO) but now is led by the Institute of Health Metrics and Evaluation (IHME) of the University of Washington, Seattle, WA, USA. Its stated purpose now is to set out “a comprehensive picture of what disables and kills people across countries, time, age, and sex”; towards this, it provides “a tool to quantify health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and disparities can be eliminated” [6]. The data in GBD2013 came through a consortium of more than 1,000 researchers in over 100 countries, capturing premature death and disability in 188 countries from more than 300 diseases [6]. Our objective has been to secure among these diseases the rightful inclusion of migraine, tension-type headache (TTH) and MOH: headache disorders that we know cause substantial disability [3]. The Global Campaign against Headache was launched in 2003 with a clear ultimate purpose: to reduce the burden of headache worldwide [7]. At that time, 12 years ago, it was not at all clear what this burden was, either in scope or scale. As a result of some lobbying during discussions with WHO in the years prior to the Campaign’s launch, GBD2000 included migraine [8]. No other headache disorders made it, but this was nevertheless a major advance for those concerned about headache, not just because GBD1990 had ignored headache totally but far, far more because migraine was found – on the evidence submitted – to be in the leading 20 causes (19th) of disability worldwide [8]. This “discovery” propelled headache disorders into WHO’s priorities [3, 4]. For the Campaign this was merely a call to arms, because also clear at that time was that the evidence submitted to GBD2000 was seriously deficient. Of course it related only to migraine, which was neither the most prevalent nor the most disabling of headache disorders, but this was not the issue. Migraine was certainly the best studied of the headache disorders, from all aspects including epidemiologically, and the epidemiological evidence then available from all studies of acceptable quality had been thoroughly collated (it was later published as a review [9]). The problem was that it focused strongly on North and South America and Western Europe, with a small Far-East cluster of studies in Japan, Taiwan and the Korean peninsula; left unrepresented were most of the Western Pacific Region (including mainland China), all of South East Asia (including India), all of the Eastern Mediterranean Region, most of Africa and all of Eastern Europe (including Russia). The people unrepresented in these territories were more than half the world’s population. Not long after the Global Campaign launched, data collection began for GBD2010 (which was initially to be GBD2005). Filling the largest of the data gaps was therefore the first priority of Lifting The Burden (LTB), the UK-registered charity conducting the Campaign [10, 11]. LTB had two objectives for GBD2010: to secure inclusion of the other headache disorders of public-health importance – TTH and MOH – and to show, as we then believed, that headache disorders collectively were among the top ten causes of disability worldwide. It became something of a race against time, firstly to develop the methodology for population-based door-to-door studies with a validated diagnostic questionnaire based on ICHD-II [12] and then to implement it in the big countries: China, India and Russia, home to 2.5 billion people. These things were done, and, with much better information, GBD2010 reported migraine more realistically as the seventh highest specific cause of disability measured in YLDs [1, 2]. This of course achieved LTB’s first objective. As for the second, TTH was included in the survey, but with a very low disability weight (DW) allocated to it. GBD2010 reported TTH as the second most prevalent disorder in the world (after dental caries), and migraine third [2], but despite this TTH added rather little compared with migraine to the global disability burden. What about MOH? This was initially included but not in the end reported because, it was argued – correctly, we believe, that prevalence data were not good enough to support regional estimates of burden attributable to this disorder. The particular difficulties of estimating MOH prevalence were recently discussed [13, 14]. Nonetheless, a DW was allocated to MOH, which was of crucial importance when it came to GBD2013. In the interim, between GBD2010 and GBD2013, LTB had supported further Global Campaign studies in Nepal in South East Asia, in Saudi Arabia and Pakistan in Eastern Mediterranean and in Zambia and Ethiopia in Africa – huge knowledge gaps – while collaborating with GBD in collating data published by other workers. The particular importance of the LTB studies lay in their use of similar methodology [15], the inclusion of MOH in their enquiries and the purposive selection of countries for survey. GBD2013 was therefore considerably better informed than GBD2010, not only with more comprehensive regional data but also, and in particular, with greatly enhanced data on MOH (and a DW available from GBD2010 for YLD estimates). LTB has prioritised this work on data gathering and our collaboration with GBD above all else. It has involved multiple complex studies in all world regions, and taken most of our resources, but as a policy we believe it has been strategically correct. If the ultimate purpose of the Campaign is to reduce the burden of headache worldwide, it must first be known what this burden is – the Campaign’s first objective [7]. At the same time, working with GBD does much to achieve the Campaign’s second objective, which is creation of awareness of this burden. Indeed this work of data gathering continues, with studies ongoing or planned in countries in Central and South America, North and West Africa and South East Asia. We have not forgotten children and adolescents, for which studies can be school-based [16]. All of these will not only benefit future iterations of GBD but also, just as importantly, serve as needs-assessment studies informing health policy locally, in the countries and regions where the data are gathered. To end, it would be easy to claim the findings of GBD2013 as a triumphal conclusion of prolonged hard effort, since on a technical level they are, but that would overlook their tragic meaning. As we reported earlier [1], GBD measures disease burden as it is – alleviated by whatever treatments are made available. Headache disorders, we said at the time of GBD2010, were among the top ten causes of disability because they were common and disabling, but we asked: “For what conceivable reason do headache disorders remain among these ignominious top ten when they are largely treatable?” [1]. Now we must ask the chastening question: “Why are they among the top three?” more...
- Published
- 2015
141. Muscles and their role in episodic tension-type headache: implications for treatment
- Author
-
Sait Ashina, Timothy J. Steiner, A. Moore, and Lars Bendtsen
- Subjects
medicine.medical_specialty ,Central nervous system ,Relaxation Therapy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Muscle, Skeletal ,Sensitization ,Aspirin ,Analgesics ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Tension-Type Headache ,Peripheral ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Nociception ,Muscle relaxation ,Anesthesia ,Nociceptor ,Disease Progression ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Background and Objective Tension-type headache (TTH) imposes a heavy burden on the global population but remains incompletely understood and poorly managed. Databases and Data Treatment Here, we review current knowledge of peripheral factors involved in the mechanism of TTH and make recommendations for the treatment of episodic TTH based on these. Results Peripheral activation or sensitization of myofascial nociceptors is most probably involved in the development of muscle pain and the acute episode of TTH. Repetitive episodes of muscle pain may sensitize the central nervous system resulting in progression of TTH to the chronic form. Thus, muscular factors may be responsible not only for the acute headache episode but also for chronification of the disorder. Simple analgesics and non-steroidal anti-inflammatory drugs are the mainstays of management of individual headache episodes. Ibuprofen 400 mg and aspirin 1000 mg are recommended as drugs of first choice based on treatment effect, safety profile and costs. Non-pharmacological therapies include electromyographic biofeedback, physiotherapy and muscle relaxation therapy. Future studies should aim to identify the triggers of peripheral nociception and how to avoid peripheral and central sensitization. There is a need for more effective, faster acting drugs for acute TTH. Conclusion Muscular factors play an important role in episodic TTH. Ibuprofen 400 mg and aspirin 1000 mg are recommended as drugs of first choice. more...
- Published
- 2015
142. Headache disorders and public ill-health in India: prevalence estimates in Karnataka State
- Author
-
Girish B, Kulkarni, Girish N, Rao, Gopalkrishna, Gururaj, Lars J, Stovner, and Timothy J, Steiner
- Subjects
Adult ,Male ,Headache Disorders, Primary ,Global Campaign against Headache ,Epidemiology ,Health Status ,India ,Middle Aged ,Medication-overuse headache ,Health policy ,Tension-type headache ,Cross-Sectional Studies ,Surveys and Questionnaires ,Headache disorders ,Prevalence ,Humans ,Female ,Public Health ,Migraine ,Research Article ,Population-based study - Abstract
Background Primary headache disorders are among the commonest disorders, affecting people in all countries. India appears to be no exception, although reliable epidemiological data on headache in this highly populous country are not available. Such information is needed for health-policy purposes. Our aim was to estimate the prevalence of each of the headache disorders of public-health importance, and examine their sociodemographic associations, in urban and rural populations of Karnataka, south India. Methods In a door-to-door survey, 2,329 biologically unrelated adults (aged 18–65 years) were randomly sampled from urban (n = 1,226) and rural (n = 1,103) areas in and around Bangalore and interviewed by trained researchers using a pilot-tested, validated, structured questionnaire. ICHD-II diagnostic criteria were applied. Results The observed 1-year prevalence of any headache was 63.9 %, with a female preponderance of 4:3. The age-standardised 1 year prevalence of migraine was 25.2 %; prevalence was higher among females than males (OR: 2.1 [1.7-2.6]) and among those from rural areas than urban (OR = 1.5 [1.3-1.8]). The age-standardized 1 year prevalence of TTH was 35.1 %, higher among younger people. The estimated prevalence of all headache on ≥15 days/month was 3.0 %; that of pMOH was 1.2 %, five-times greater among females than males and with a rural preponderance. Conclusions There is a very high 1 year prevalence of migraine in south India (the mean global prevalence is estimated at 14.7 %). Explanations probably lie in cultural, lifestyle and/or environmental factors, although the observed associations with female gender and rural dwelling are usual. Levels of TTH, pMOH and other headache on ≥15 days/month are similar to global averages, while the very strong association of pMOH with female gender requires explanation. Until another study is conducted in the north of the country, these are the best data available for health policy in a population of over 1.2 billion people. more...
- Published
- 2015
143. The burden of primary headache disorders in Zambia: national estimates from a population-based door-to-door survey
- Author
-
Gretchen L. Birbeck, Pachuau Zairemthiama, Edward Mbewe, Ravi Paul, and Timothy J. Steiner
- Subjects
Male ,Headache Disorders, Primary ,Epidemiology ,DISEASE ,RECOMMENDATIONS ,Cost of Illness ,education.field_of_study ,Sub-Saharan Africa ,Global Campaign against Headache ,Burden of disease ,Headache ,General Medicine ,Middle Aged ,Medication-overuse headache ,PREVALENCE ,Female ,Life Sciences & Biomedicine ,Research Article ,Adult ,medicine.medical_specialty ,Population ,Clinical Neurology ,QUESTIONNAIRE ,Zambia ,ORGANIZATION ,Population based ,Primary care ,SYSTEMATIC ANALYSIS ,medicine ,Humans ,CAMPAIGN ,COMMUNITY-BASED SURVEY ,Psychiatry ,education ,Migraine ,0604 Genetics ,Science & Technology ,Neurology & Neurosurgery ,business.industry ,Neurosciences ,1103 Clinical Sciences ,GLOBAL BURDEN ,medicine.disease ,Tension-type headache ,Anesthesiology and Pain Medicine ,Cross-Sectional Studies ,Neurosciences & Neurology ,Neurology (clinical) ,business ,Demography ,Primary Headache Disorders - Abstract
Background Three headache disorders – migraine, tension-type headache (TTH) and medication-overuse headache (MOH) – are major contributors to population ill-health. Policy-makers need local knowledge of these to guide priority-setting. Earlier we reported the prevalence of these disorders in Zambia; here we describe the burdens attributable to them. Methods This was a cross-sectional population-based survey of adults aged 18-65 years, selected by cluster-randomized sampling in the mostly urban Lusaka Province and mostly rural Southern Province. Interviewers visiting households used a structured questionnaire. Diagnoses made algorithmically applied ICHD-II criteria. Burden enquiry focused on the previous 3 months and the day before interview. Disability was estimated by applying disability weights (DWs) from the Global Burden of Disease Survey 2010. Results From 1,134 households, 1,085 unrelated adults (450 male, 635 female) were interviewed (refusal rate 4.3%). The gender- and habitation-adjusted 1-year prevalence of migraine was 22.9%, of TTH 22.8%, of headache on ≥15 days/month 11.5%, of probable MOH (pMOH) 7.1%. Reported mean intensity of migraine attacks was 2.7, representing severe pain. People with migraine spent 10.0% of their time in the ictal state (DW: 0.433); they were therefore 4.3% disabled overall. Disability from TTH was much lower. People with pMOH (time with headache: 37.5%; DW: 0.220) were 8.3% disabled overall. Average lost productive time in the preceding 3 months for migraine was 4.1 days from work (6.3% loss) and 4.2 days (4.7% loss) from household work. Losses for pMOH were 4.8 days (7.4% loss) from work and 4.5 days (5.0% loss) from household work. In the population aged 18-65 years (effectively the working population), estimated disability from migraine was 0.98%, with 1.4% of workdays lost, and from pMOH was 0.59%, with 0.53% of workdays lost. Headache yesterday was reported by 28.3% of participants, whose average productivity yesterday was 55.9% of expectation. Conclusions Zambia loses 1.93% of GDP to headache, and action is required to mitigate this loss and the associated suffering. Structured headache services with their basis in primary care are the most efficient, effective, affordable and equitable solution. They could be implemented within the existing health-care infrastructure of Zambia. These matters require urgent political attention. more...
- Published
- 2015
144. Methodological Issues in Systematic Reviews of Headache Trials: Adapting Historical Diagnostic Classifications and Outcome Measures to Present‐Day Standards
- Author
-
Rebecca Gray, Douglas C McCrory, Frederick R. Taylor, Peer Tfelt-Hansen, and Timothy J. Steiner
- Subjects
medicine.medical_specialty ,Migraine Disorders ,law.invention ,Randomized controlled trial ,Recurrence ,law ,Outcome Assessment, Health Care ,medicine ,Humans ,Medical diagnosis ,Intensive care medicine ,Randomized Controlled Trials as Topic ,business.industry ,Outcome measures ,medicine.disease ,Surgery ,Clinical trial ,Review Literature as Topic ,Treatment Outcome ,Systematic review ,Neurology ,Migraine ,Research Design ,Meta-analysis ,International Classification of Headache Disorders ,Neurology (clinical) ,business - Abstract
Recent efforts to make headache diagnostic classification and clinical trial methodology more consistent provide valuable advice to trialists generating new evidence on effectiveness of treatments for headache; however, interpreting older trials that do not conform to new standards remains problematic. Systematic reviewers seeking to utilize historical data can adapt currently recommended diagnostic classification and clinical trial methodological approaches to interpret all available data relative to current standards. In evaluating study populations, systematic reviewers can: (i) use available data to attempt to map study populations to diagnoses in the new International Classification of Headache Disorders; and (ii) stratify analyses based on the extent to which study populations are precisely specified. In evaluating outcome measures, systematic reviewers can: (i) summarize prevention studies using headache frequency, incorporating headache index in a stratified analysis if headache frequency is not available; (ii) summarize acute treatment studies using pain-free response as reported in directly measured headache improvement or headache severity outcomes; and (iii) avoid analysis of recurrence or relapse data not conforming to the sustained pain-free response definition. more...
- Published
- 2005
- Full Text
- View/download PDF
145. Comparative Efficacy of Eletriptan and Zolmitriptan in the Acute Treatment of Migraine
- Author
-
Jean Schoenen, Hans-Christoph Diener, Carolyn R. Sikes, Nancy Muirhead, Timothy J. Steiner, and E. A. MacGregor
- Subjects
Adult ,Male ,Indoles ,Pyrrolidines ,Adolescent ,Migraine Disorders ,Population ,Zolmitriptan ,Placebo ,Double-Blind Method ,medicine ,Humans ,Eletriptan ,education ,Adverse effect ,Oxazolidinones ,Aged ,education.field_of_study ,Dose-Response Relationship, Drug ,Naratriptan ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Tryptamines ,Sumatriptan ,Migraine ,Anesthesia ,Linear Models ,Female ,Neurology (clinical) ,business ,medicine.drug - Abstract
Eletriptan 40 mg and 80 mg have shown greater efficacy in acute migraine than oral sumatriptan 100 mg and naratriptan 2.5 mg. This study continues the systematic series of active comparator trials in the eletriptan clinical development programme. In a multicentre double-blind, double-dummy, parallel-groups trial, 1587 outpatients with migraine by IHS criteria were randomised in a 3 : 3 : 3 : 1 ratio to eletriptan 80 mg, eletriptan 40 mg, zolmitriptan 2.5 mg or placebo. Of these, 1312 treated a single migraine attack and recorded baseline and outcome data to be included in the intention-to-treat population. The primary analysis was between eletriptan 80 mg and zolmitriptan. For the primary efficacy end-point of 2-h headache response, rates were 74% on eletriptan 80 mg, 64% on eletriptan 40 mg, 60% on zolmitriptan ( P < 0.0001 vs. eletriptan 80 mg) and 22% on placebo ( P < 0.0001 vs. all active treatments). Eletriptan 80 mg was superior to zolmitriptan on all secondary end-points at 1, 2 and 24 h, in most cases with statistical significance. Eletriptan 40 mg had similar efficacy to zolmitriptan 2.5 mg in earlier end-points, and significantly ( P < 0.05) lower recurrence rate and need for rescue medication over 24 h. All treatments were well tolerated; 30-42% of patients on active treatments and 40% on placebo reported all-causality adverse events that were mostly mild and transient. On patients' global ratings of treatment, both eletriptan doses scored significantly better than zolmitriptan. more...
- Published
- 2003
- Full Text
- View/download PDF
146. The Prevalence and Disability Burden of Adult Migraine in England and their Relationships to Age, Gender and Ethnicity
- Author
-
Ann I. Scher, Joshua N. Liberman, Walter F. Stewart, K. Kolodner, Timothy J. Steiner, and Richard B. Lipton
- Subjects
Adult ,Male ,medicine.medical_specialty ,Activities of daily living ,Adolescent ,Aura ,Migraine Disorders ,Population ,Ethnic group ,Black People ,White People ,Age Distribution ,Epidemiology ,Prevalence ,medicine ,Humans ,Disabled Persons ,Sex Distribution ,education ,Psychiatry ,Response rate (survey) ,education.field_of_study ,business.industry ,Public health ,General Medicine ,Middle Aged ,medicine.disease ,England ,Migraine ,Female ,Neurology (clinical) ,business ,Demography - Abstract
This study estimates the 1-year prevalence of migraine in adults in England in relation to the major demographic variables of age, gender and ethnicity, and describes some of its features, including aspects of consequential disability. A telephone survey was conducted of a random sample ( n = 4007) of the population aged 16-65 years of mainland England using a previously validated diagnostic interview. The response rate was 76.5%. Overall, 7.6% of males and 18.3% of females reported migraine with or without aura within the last year meeting diagnostic criteria closely approximate to those of the International Headache Society. Prevalence of migraine varied with age, rising through early adult life and declining in the late 40s and early 50s. Prevalence was higher in Caucasians than in other races. Attack rates were ≥ 1/month in most migraineurs, and most experienced interference with daily activities in ≥ 50% of their attacks. On average, an estimated 5.7 working days were lost per year for every working or student migraineur, although the most disabled 10% accounted for 85% of the total. Results were in keeping with those from surveys in other countries. If these findings in mainland England are projected to the entire UK population, we estimate that 5.85 million people aged 16-65 years experience 190 000 migraine attacks every day and lose 25 million days from work or school each year because of them. Migraine is an important public health problem in the UK, associated with very substantial costs. more...
- Published
- 2003
- Full Text
- View/download PDF
147. Aspirin in Episodic Tension-Type Headache: Placebo-Controlled Dose-Ranging Comparison with Paracetamol
- Author
-
Timothy J. Steiner, R Lange, and Michael Voelker
- Subjects
Adult ,Male ,Adolescent ,Visual analogue scale ,Population ,Placebo ,law.invention ,Double-Blind Method ,Randomized controlled trial ,law ,medicine ,Humans ,Adverse effect ,education ,Acetaminophen ,Aged ,Pain Measurement ,education.field_of_study ,Aspirin ,Dose-Response Relationship, Drug ,business.industry ,Tension-Type Headache ,General Medicine ,Middle Aged ,medicine.disease ,Treatment Outcome ,England ,Migraine ,Anesthesia ,Female ,Neurology (clinical) ,business ,medicine.drug - Abstract
Most people with episodic tension-type headache (TTH) treat themselves with over-the-counter analgesics. In the absence of clear evidence of dose-related efficacy of the two most commonly used analgesics, aspirin (acetylsalicylic acid) and paracetamol (acetaminophen), this study compared two doses of each with placebo. In a double-blind, double-dummy, randomized parallel-groups comparative trial, 638 consenting subjects aged 16-65 years with episodic TTH (but not migraine) by IHS criteria were recruited from the UK general population by advertisement. They treated one episode of moderate or severe TTH with a single dose of 500 or 1000 mg aspirin, 500 or 1000 mg paracetamol or placebo. The primary objective was to compare aspirin 1000 mg with placebo, and the primary end-point was subjective pain relief (total or worthwhile) 2 h after treatment ('response'). Additionally, pain intensity on a 100-mm visual analogue scale and functional impairment were monitored regularly for 4 h and at 24 h, although rescue medication was allowed after 2 h. The analysis was of the intention-to-treat population of 542 who took treatment (all providing outcome data). Treatment groups were matched at baseline. Aspirin 1000 mg (75.7% response rate; P = 0.0009) and to a lesser extent aspirin 500 mg (70.3%; P = 0.011) and paracetamol 1000 mg (71.2%; P = 0.007), but not paracetamol 500 mg (63.8%; P = 0.104), were statistically more effective than placebo despite a high placebo-response rate (54.5%). Outcome was not affected by headache intensity at baseline. Secondary end-points including functional recovery (by median times of 4.0-13.5 h) were consistent with these findings, although a minority of subjects recorded long-duration functional impairment (37-54 h). Adverse events reported by 13.4-18.9% of subjects were mild or moderate, and transient. No safety concerns arose. more...
- Published
- 2003
- Full Text
- View/download PDF
148. Health-care systems for headache: patching the seam between primary and specialist care
- Author
-
Timothy J. Steiner
- Subjects
medicine.medical_specialty ,business.industry ,Pain medicine ,Public and Lay Organizations ,Alternative medicine ,Headache ,Health care ,General Medicine ,Primary care ,medicine.disease ,Key words Evaluation ,Secondary care ,Needs assessment ,Health services ,Anesthesiology and Pain Medicine ,Medicine ,Neurology (clinical) ,Medical emergency ,business ,Psychiatry ,Specialist care - Abstract
Health services are rarely highly successful in meeting the needs of people with headache disorders, who everywhere are low in the priority queue. Taking the UK as an example within Europe, this paper briefly reviews the present organisation of headache services, and proposes change. The solution does not appear to lie in expanding specialist headache centres in secondary care to which most people with needs fail to gain access. A three-tier system with emphasis on primary care will, it is argued, deliver care more cost-effectively and more responsively to patients' needs. more...
- Published
- 2003
149. Headache yesterday in Russia: its prevalence and impact, and their application in estimating the national burden attributable to headache disorders
- Author
-
Mark Obermann, Zaza Katsarava, Asya Sborowski, Michail Chernysh, V. V. Osipova, Ilya Ayzenberg, Timothy J. Steiner, and Guzelya Tabeeva
- Subjects
Male ,Pediatrics ,Activities of daily living ,Medizin ,Russia ,Cost of Illness ,Surveys and Questionnaires ,Headache yesterday ,Activities of Daily Living ,Prevalence ,GLOBAL CAMPAIGN ,education.field_of_study ,Global Campaign against headache ,COST ,Headache ,General Medicine ,Middle Aged ,Yesterday ,MIGRAINE ,Workforce ,Russian population ,Female ,Life Sciences & Biomedicine ,Research Article ,Adult ,medicine.medical_specialty ,Adolescent ,Headache Disorders ,Population ,Clinical Neurology ,QUESTIONNAIRE ,UNITED-STATES ,VALIDATION ,Lost productivity ,Young Adult ,medicine ,Socioeconomic burden ,Humans ,education ,Aged ,Estimation ,0604 Genetics ,Science & Technology ,Neurology & Neurosurgery ,business.industry ,Neurosciences ,1103 Clinical Sciences ,CARE ,Health Surveys ,Anesthesiology and Pain Medicine ,Neurology (clinical) ,Neurosciences & Neurology ,business ,METHODOLOGY ,Demography ,POPULATION SURVEYS - Abstract
Background Evaluation of the prevalence and impact of headache on the preceding day (“headache yesterday”; HY) is a new approach, allowing more precise estimation of headache-attributed burden without recall error. The aim of the study was to estimate the national burden attributable to headache disorders in Russia by applying measures of prevalence of HY and its impact on productivity and daily activities in the general population. Methods We interviewed a representative population-based sample face-to-face by visiting randomly selected households throughout Russia. We randomly selected one adult aged 18–65 years from each. We followed a structured questionnaire including diagnostic questions, enquiry into occurrence of HY and various aspects of attributed burden. Results Participation rate was 74.3%. One in seven participants (14.5%; men 9.1%: women 19.3%) reported HY. Approximately half of these had one of the subtypes of headache occurring on ≥15 days/month; the remainder had episodic migraine or tension-type headache almost equally. Mean duration of headache was 6.0 ± 4.4 hours. In 88.3% headache intensity was moderate or severe (mean 2.1 on a scale 1–3) and in 73.9% HY impaired daily activity. Loss of productivity at work due to headache totalled 2.6 million person-years/year, or 4.0% of workforce capacity. This estimate exceeded by 70% a previous estimate from the same survey based on recall over the preceding 3 months. There was greater impact on other daily activities. Conclusion Recall-error-free estimation shows lost productivity every day due to headache in the Russian population is enormously high. Measures to redress these losses – effective structured health-care services supported by educational programmes – should be seen as a public-health priority while almost certainly being cost-saving. © 2015 Ayzenberg et al.; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) more...
- Published
- 2015
150. Evaluation of headache service quality indicators: pilot implementation in two specialist-care centres
- Author
-
Rigmor Jensen, Raquel Gil Gouveia, Anja Schoppe, Timothy J. Steiner, Sara Schramm, Zaza Katsarava, and Charly Gaul
- Subjects
Adult ,Male ,medicine.medical_specialty ,media_common.quotation_subject ,Clinical Neurology ,Medizin ,Staffing ,Pilot Projects ,Hospitals, Special ,Headache care ,Patient satisfaction ,Germany ,Headache disorders ,Health care ,medicine ,Humans ,Service quality evaluation ,Quality (business) ,Medical diagnosis ,Quality Indicators, Health Care ,media_common ,Science & Technology ,Neurology & Neurosurgery ,Portugal ,business.industry ,Medical record ,Neurosciences ,Health services research ,General Medicine ,Middle Aged ,medicine.disease ,Triage ,Global campaign against headache ,Anesthesiology and Pain Medicine ,Patient Satisfaction ,Physical therapy ,Female ,Health Services Research ,Neurosciences & Neurology ,Neurology (clinical) ,Medical emergency ,business ,Life Sciences & Biomedicine ,Research Article - Abstract
Background Evaluating quality of health care is increasingly recognized as an important contributor to the advancement of health-care delivery. We recently developed a set of quality indicators for headache care, intended to be applicable across countries, cultures and settings so that deficiencies in headache care worldwide might be recognized and rectified. These indicators themselves require evaluation and proof of fitness for purpose. This pilot study begins this process. Methods We tested the quality indicators in the tertiary headache centres of the University of Duisburg-Essen in Essen, Germany, and the Hospital da Luz in Lisbon, Portugal. Using seven previously-developed enquiry instruments, we interrogated health-care providers (HCPs), including doctors, nurses, psychologists and physiotherapists, as well as consecutive patients and their medical records. Results The questionnaires were easily understood by both HCPs and patients and were not unduly time-consuming. The results from the two headache centres were comparable despite their differences in structure, staffing and language. These findings met the purpose of the study. Diagnoses were made according to ICHD criteria and critically evaluated during follow-up. However, diagnostic diaries and instruments assessing burden and response to treatment were not always in place or routinely utilised. Triage systems adjusted waiting times to urgency of need. Treatment plans included pathways to other specialities. Patients felt welcomed, reassured and educated, and were mostly satisfied. Discussion points arose over inclusion of psychological therapies in treatment plans; over recording of outcomes; over indicators of efficiency and equitability (protocols to limit wastage of resources, systems to measure input costs and means of ensuring equal access to the services); and over protocols for reporting serious adverse events. Conclusion This pilot study to assess feasibility of the methods and acceptability of the instruments of headache service quality evaluation was successful. The project is ready to be taken into its next stages. © 2015 Katsarava et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. more...
- Published
- 2015
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.