Migraine As a Public Health Problem

I hope you’ve had a chance to read about the groundbreaking report, “Atlas of Headache Disorders and Resources in the World 2011,” issued by the World Health Organization (WHO) and Lifting the Burden.

This report represents the most ambitious attempt, to date, to collect and distribute information on the global public health burden of headache disorders. Headache disorders cause tremendous costs to society, in terms of pain, disability, damaged quality of life, and productivity loss. This report is an important step to attracting the attention of policymakers who have, so far, ignored the problem of head pain.

But, as the authors of this report note, there is so much more work to be done!

The report identifies three overarching barriers to better care for headache patients, described as clinical, social or political/economic. I’ve provided a brief description of each and a modest suggestion for future research so that we can better understand how to overcome each of these barriers.

Clinical barriers: The authors noted that healthcare providers often don’t have the knowledge to provide effective headache management. I agree, more education ought to be done. But if 50% of people have some experience with a headache disorder, then perhaps all primary care physicians ought to be trained to ask patients about headache symptoms as part of a routine check-up, in much the same way that they ask about other matters of public health, like exercise, and seat belt habits, etc.

Social barriers: As we’ve talked about before on this blog, there’s such little awareness of headache among the general public. People don’t think that headache disorders are serious. But we don’t know much about how these social barriers work. Do people in pain diminish their own symptoms? Or do they worry that they won’t be taken seriously? More research needs to be done so that we understand why people don’t go to their doctors even when they’re in a lot of pain.

Political/economic barrers: Most policymakers don’t recognize headache disorders as a serious problem and this report is an excellent first step to attracting their attention. But if I were a policymaker reading this report, I’d want to know where I ought to be investing my money first. Public health burden is not evenly distributed across all types of headache disorders. Where am I going to get the most bang for my buck? It may be that a small group of chronic headache patients (perhaps people with medication overuse headache) are causing a disproportionate amount of the ‘days lived with disability.’ Alternatively, perhaps it’s easier and more cost-effective to launch a program that educates those people who have minor headache problems and self-medicate.

In just a few days, I’m heading to Washington, DC for the annual Headache on the Hill to talk to my legislators about improving care for headache disorders. This is a great report. I can’t wait to tell them about it.

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