21st Century Headache: Mapping New Territory

DOI: https://doi.org/10.1186/s10194- 021- 01233- 7

Abstract-Summary Headache prevalence and burden is changing as society evolves, with headache now occurring earlier in life.

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Contributing factors, mostly associated with changing life style, such as stress, bad posture, physical inactivity, sleep disturbance, poor diet and excess use of digi- tal technology may be associated with the phenomenon that could be labelled as ‘twenty-first century headache’.

The headache-related impact on productivity and absenteeism negatively influ- ences an individual’s behaviour and quality of life, and is also associated with a high economic cost.

Since the majority of sufferers opt to self-treat rather than seek medical advice, substantial knowledge on headache prevalence, causation and burden is unknown globally.

The broad use of digital technology to gather real world data on headache trig- gers, burden and management strategies, in self-treated population will allow these sufferers to access appropriate support and medication, and therefore improve qual- ity of life.

Background Headache disorders are among the main causes of disability worldwide; however, the majority of sufferers are never professionally diagnosed and instead, turn to over-the-counter (OTC) medications to self-manage symptoms [8].

Predominantly experienced by those aged 15–49 years, headache incidence in school aged children is increasing, indicating that headache disorders are being reported earlier in life than they were before [8, 119].

There is accumulating evidence in recent literature that modern lifestyle in industrial countries may have an effect on headache incidence, prevalence and impact.

Headache Triggers Associated with twenty-first Century Lifestyle The recently increased use of digital technology is associated with increased risk of obesity, fatigue and headache; thus, headache incidence has been linked to pro- longed (>8 h/day) computer use in IT professionals in China and to excessive (>4 h/ day) video game use in adolescents in Brazil [120, 121].

Increased smartphone usage has been linked to headache, sleep disturbance, cog- nitive impairment and fatigue, with call frequency significantly correlated with headache risk [122].

The coronavirus disease 2019 (COVID-19) pandemic has been associated with

both increased and decreased headache frequency [123].

To being reported as a symptom of infection, headache frequency and severity increased in uninfected individuals due to psychological stress, social isolation, sleep disruption and poor dietary habits [124, 125].

Headache Impact on Cognitive and Daily Functionality The cognitive impact of migraine has been well characterised, with multiple studies showing that migraine sufferers experience greater memory deficits during an attack compared with other headache types; however, the evidence for the impact of TTH on cognitive functioning is limited [126, 127].

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Personal and Societal Burden

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Headache disorders contribute to distraction and poor concentration that define presenteeism at work; recent studies in Europe showed that only 50% of headache sufferers with presenteeism completed their normal working day [128, 129].

Absenteesim is also a problem: approximately 22% of migraine sufferers and

10% of TTH sufferers take several days per year off work due to headache [130].

The cognitive impact and loss of productivity may also be linked to anxiety, avoidance behaviour, reduced social interactions and lifestyle compromise reported by 16% of migraine sufferers and 20% of TTH sufferers [131, 132].

Changing the Paradigm: Non-Doctor Headache This population of headache sufferers, that could be referred to as the ‘non-doctor treated headache’ (NDH) population, relies on OTC medication for symptom relief [133].

There are limited data on the management of headache in the NDH population with respect to headache type, reduction in quality of life, triggers, OTC medication and non-pharmacological management techniques [134].

While randomised controlled trials (RCTs) adequately assess professionally diagnosed and managed headache, the NDH population should be captured by real world evidence studies, a number of which have been successfully undertaken and delivered important insights in headache-related behaviour and experiences [135]. The digital technology can serve as a double-edged sword: while possibly attrib- uting to rising incidence and prevalence of headache, it provides an enormous pool of real world data.

An increasing number of smartphone applications capture and record headache

frequency, intensity, triggers, duration and medication choice [136].

Conclusions Because causal factors seem to evolve with socioeconomic development, it is important to identify the true burden and triggers related to ‘twenty-first century headache’ in real world settings [8, 119].

Clinical experts and modern analysis techniques, such as artificial intelligence and machine learning, should be engaged in the analysis of these data to help iden- tify NDH-relevant and specific outcome measures that should be further validated in RCTs assessing the impact of twenty-first century headache on cognitive abili- ties, functionality and society.

Providing new guidelines to trained pharmacists and establishing an educational programme for the general population will empower headache sufferers to manage better their condition and decrease the burden of twenty-first century headache.

Acknowledgement A machine generated summary based on the work of Goadsby, Peter J.; Lantéri- Minet, Michel; Michel, Martin C.; Peres, Mario; Shibata, Mamoru; Straube, Andreas; Wijeratne, Tissa; Ebel-Bitoun, Caty; Constantin, Luminita; Hitier, Simon. 2021 in The Journal of Headache and Pain.

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Burden of Migraine in Patients With Preventive Treatment Failure Attending European Headache Specialist Centers: Real-World Evidence From the BECOME Study