The burden of headache disorders in the Eastern Mediterranean Region, 1990–2016: findings from the Global Burden of Disease study 2016

DOI: https://doi.org/10.1186/s10194- 019- 0990- 3

Abstract-Summary Using the findings of the Global Burden of Disease Study (GBD), we report the burden of primary headache disorders in the Eastern Mediterranean Region (EMR) from 1990 to 2016.

Years lived with disability (YLDs) were calculated by multiplying prevalence

and disability weight (DW) of migraine and tension-type headache (TTH).

During the same period, age-standardised YLD rates of migraine and TTH in EMR increased by 0.7% and 2.5%, respectively, in comparison to a small decrease in the global rates (0.2% decrease in migraine and TTH).

The age-standardised YLD rates of both headache disorders were higher in

women with female to male ratio of 1.69 for migraine and 1.38 for TTH.

All countries of the EMR except for Somalia and Djibouti had higher age-

standardised YLD rates for migraine and TTH in compare to the global rates.

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Libya and Saudi Arabia had the highest increase in age-standardised YLD rates

of migraine and TTH, respectively.

The findings of this study show that primary headache disorders are a major and

a growing cause of disability in EMR.

Extended: During the same period, the relative contribution of migraine YLDs and TTH YLDs to the overall YLDs in EMR increased from 6.0% (95% UI 4.3–7.8) to 6.7% (95% UI 4.9–8.5) and from 1.00% (95% UI 0.75–1.30) to 1.16% (95% UI 0.86–1.49), respectively.

During the same period, age-standardised YLD rates of migraine remained gen-

erally unchanged in EMR countries.

Introduction GBD 2016, provided more accurate estimations of prevalence and burden of head- ache by countries, regions, and super regions [34].

According to GBD 2016, prevalence of headache disorders was variable across

different geographic regions.

Although prevalence of headache is an important epidemiologic measure, the burden of disability related to headache, as measured by YLD, is more informative for health policy making.

GBD 2016 emphasized that primary headache disorders are an important health

priority.

Estimating the burden of headache is the first step to implement further measures to reduce its burden such as educating health care providers, developing primary care management, and allocating resources.

We reported the prevalence and burden of primary headache disorders (including migraine and TTH) in Eastern Mediterranean Region (EMR) countries from 1990 to 2016 using data and methods of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016.

Methods The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) is a standardised analytical method that used all eligible sources to estimate the epidemiological data, including prevalence, mortality, years of life lost (YLL), YLDs, and disability-adjusted life years (DALYs), for 328 causes by sex, age, and location from 1990 to 2016.

In the previous GBD iteration (GBD 2015), in addition to migraine and TTH,

medication overuse headache (MOH) was also included as a separate disorder.

We presented numbers and rates of prevalence and YLDs of migraine and TTH

in 2016 and the changes from 1990 to 2016 for all EMR countries.

From the EMR, data sources from Iran [208–210], Pakistan [100], Tunisia [211], and UAE [212] for migraine, and data sources from Iran [208, 210, 213], Pakistan [100], and Qatar [214] for TTH were used in GBD 2016; however, data inputs from all over the world were used to model the burden of migraine and TTH in EMR countries.

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Personal and Societal Burden

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Results In the EMR, female to male ratio of age-standardised YLDs were 1.69 for migraine and 1.38 for TTH.

From 1990 to 2016, age-standardised YLD rates of migraine and TTH remained

generally unchanged.

Comparing the overall all-age YLD rates of migraine and TTH combined, Kuwait

had the highest and Djibouti had the lowest YLD rates.

During the same period, age-standardised YLD rates of migraine remained gen-

erally unchanged in EMR countries.

The ratio of observed to expected age-standardised YLD rate for migraine ranged

from 0.82 in Djibouti to 1.31 in Palestine.

Similar to migraine, age-standardised YLD rates of TTH showed an overall con-

sistency between 1990 and 2016 in EMR countries.

Observed to expected age-standardised YLD rate ratio for TTH ranged from

0.85 in Djibouti to 1.42 in Iran.

Discussion Our study provides a comprehensive assessment of the values and trends of preva- lence and burden of primary headache disorders in EMR countries and their trends from 1990 to 2016.

Risk factors for progression of episodic migraine to chronic migraine can explain

a part of the higher burden of headache in the EMR.

Given the limited data sources from the EMR countries, the role of risk factors of chronic migraine in higher burden of headache in the EMR should be interpreted cautiously.

The significant and increasing non-fatal burden of headache inform policy mak- ers and health care providers of EMR countries that primary headache should be a health care priority, and intervention strategies focusing on improvement of diagno- sis and treatment of headache must be implemented.

Although we estimated prevalence and YLDs of the primary headache disorders with considerable burden (including migraine, TTH, and MOH—as a sequel of the first two syndromes), we could not include all primary headache disorders classified in ICD-10 classification [215].

Conclusion Findings from this study show that primary headache disorders are a large cause of disability in the EMR.

Our findings inform policy makers of the EMR countries that headache is a health care priority, and preventive and management interventions must be imple- mented to address the growing burden of headache in this region.

More studies are needed to provide more accurate data on the prevalence and severity of primary headache disorders in EMR as well as more efficient preventive and management methods to reduce the burden of headache.

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Acknowledgement A machine generated summary based on the work of Vosoughi, Kia; Stovner, Lars Jacob; Steiner, Timothy J.; Moradi-Lakeh, Maziar; Fereshtehnejad, Seyed- Mohammad; Farzadfar, Farshad; Heydarpour, Pouria; Malekzadeh, Reza; Naghavi, Mohsen; Sahraian, Mohammad Ali; Sepanlou, Sadaf G.; Tehrani-Banihashemi, Arash; Majdzadeh, Reza; Feigin, Valery L.; Vos, Theo; Mokdad, Ali H.; Murray, Christopher J. L. 2019 in The Journal of Headache and Pain.

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