Migraine: a major debilitating chronic non-communicable disease in Brazil, evidence from two national surveys

DOI: https://doi.org/10.1186/s10194- 019- 1036- 6

Abstract-Summary Even though migraine and other primary headache disorders are common and debil- itating, major health surveys in Brazil have not included them.

We repair this omission by combining data on non-communicable diseases (NCDs) in the Brazilian National Health Survey (PNS) 2013 with epidemiological data on migraine prevalence and severity in Brazil.

The purpose is to rank migraine and its impact on public healthh among NCDs

in order to support public-health policy toward better care for migraine in Brazil.

Migraine ranked second in prevalence among the NCDs, and as the highest cause

of disability among adults in Brazil.

On this evidence, migraine should be included in the next health surveys in Brazil.

Introduction Chronic non-communicable diseases (NCDs) are a principal concern in pub- lic health.

Among NCDs, neuropsychiatric (neurological and mental health) disorders have been identified as the single largest group of contributors to public ill health [34, 226], while pain conditions also play a important role [227].

Brazil has implemented public-health policies to reduce the burden of NCDs, but the targets are restricted to hypertension, diabetes, cardiovascular diseases (includ- ing stroke) and mental health disorders.

These policies are driven by NCD surveillance: the National Health Survey (PNS-Pesquisa Nacional de Saúde) in 2013 gathered information on distribution and magnitude of these selected NCDs, and identified risk factors and the social, economic and environmental associations [228].

PNS, the most comprehensive survey on health and its determinants ever held in the country, did not encompass headache disorders [228], and public-health policies based on PNS do not target them.

The purpose was to rank migraine and its attributed disability among NCDs, so

supporting public-health policy toward better care for migraine in Brazil.

Methods PNS was approved by the National Research Ethics Committee, under protocol number 328.159, on 26 June, 2013.

Previous publications showed the validity of a self-reported history of doctor

diagnosed NCD in other surveys [229, 230] and in PNS [231, 232].

PNS captured proportions (%) and total numbers of participants, 18  years or

older, who reported positively to each.

The estimated number of 1,537 was inflated by 2.5 design effect, to yield

N = 3,843 subjects to be interviewed [233–235].

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Trained lay interviewers followed a structured questionnaire validated for the diagnosis of primary headache disorders according to the International Classification of Headache Disorders (ICHD-II) [236].

Impact on health was established using MIDAS (Migraine Disability Assessment

Scale), which estimates lost productive time [237].

Those with MIDAS scores ≥10 were expected to be candidates for migraine

prevention (having at least 3 attacks per month), and considered disabled.

Results In terms of population prevalence and absolute number with high or very high dis- ability, spine disorders (meaning back pain, neck pain, low back pain or sciatica, vertebrae or disc problems) far exceeded all other NCDs: prevalence 3.03%, 4.4 million affected.

Migraine, however, clearly exceeded spine disorders: 3.75%, and 5.5 million

disabled.

Migraine had been included as a NCD in PNS, and the same prevalences found

as in BHES, it would have ranked as the most common NCD.

MIDAS grade IV described impact equivalent to disability rated by participants

in PNS as high or very high, migraine would have ranked second in Brazil.

If MIDAS ≥10 was indicative of high disability, migraine would have ranked first. An estimated 5.5 million people in Brazil (or 9.5 million if probable migraine is included, as it should be [51]) are apparently in need of migraine preventative therapy.

Discussion Migraine is among the most prevalent NCDs in Brazil, and the most disabling in terms of numbers reporting impact equated with severe disability.

Probable migraine has often been neglected in epidemiological studies but, at

least in those concerned with public health, it should not be [51].

Although the methodology used here was imperfect, combining data from two very different surveys and extrapolating numbers, the findings mirror those obtained in the Global Burden of Disease (GBD) studies: migraine is among the most preva- lent disorders worldwide, and the second most disabling behind low back pain [34, 47].

Other studies showed high numbers of probable migraine prevalence in different populations [238–240], therefore, a high global burden of migraine is trully sub- stantial in Brazil.

Quite clearly, migraine and other headache disorders should be prioritized in

health-care policies.

For better estimates to inform policy, migraine should be included in the next

health surveys in Brazil.

Conclusion Migraine is the second most common NCD in Brazil, and the most disabling NCD. Migraine should be part of the next health surveys in Brazil, to inform public-

health strategies promoting better diagnosis and treatment.

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Acknowledgement A machine generated summary based on the work of Peres, Mario Fernando Prieto; Queiroz, Luiz Paulo; Rocha-Filho, Pedro Sampaio; Sarmento, Machado; Katsarava, Zaza; Steiner, Timothy J. 2019 in The Journal of Headache and Pain.

Undifferentiated headache: broadening the approach to headache in children and adolescents, with supporting evidence from a nationwide school-based cross- sectional survey in Turkey