A machine generated summary based on the work of Ruggeri, Matteo; Drago, Carlo; Rosiello, Francesco; Orlando, Valentina; Santori, Costanza. 2020  in PharmacoEconomics.

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Headache in Resource-Limited Settings

DOI: https://doi.org/10.1007/s11916- 017- 0651- 7

Abstract-Summary This review summarizes the unmet need of headache burden and management in resource-limited settings.

It provides a general overview of the nuances and peculiarities of headache dis-

orders in resource-limited settings.

The review delivers perspectives and explanations for the emerging burden of

both primary and secondary headache disorders.

A critical analysis of headache disorders is made within the context of growing

burden non-communicable disorders in low-resource countries.

Challenges are examined and prospective feasible solutions tailored to exist- ing resources are provided to address headache disorders in resource-limited settings.

Many low-resource countries are entering into the third epidemiological transi- tion featuring increasing burden of non-communicable disorders of which headache disorders contribute a significant proportion.

Life expectancy is rising in some resource-restricted countries; this increases

prevalence of secondary headache attributed to neurovascular causes.

Many low-resource countries are still burdened with tropical infectious causes of

secondary headache.

Many low-resource settings do not have access to generic headache medications

such as triptans.

Addressing the increasing burden of headache disorders in resource-limited set- tings is important to avert accrued disability which in turn lowers productivity and socioeconomic performance in a young booming population.

Introduction: Burden and Peculiarities of Headache Disorders in Resource- Limited Settings Resource-limited health settings predominantly involve many developing countries in Africa, Asia, Latin America, and the Caribbean [357].

Compared to high-resource regions, understanding the status quo of health prob-

lems such as headache needs a different perspective in low-resource settings.

It is important to recognize the disparity that exists within low-resource settings i.e., some of these countries have slightly better health resources compared to oth- ers [357].

Demographic and Epidemiologic Transition: Implications for Headache Disorders These peculiarities have important implications when examining headache disor- ders in resource-restricted settings as described in the following paragraphs.

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Rapid population growth coupled with unfavorable lifestyle changes can give rise to emergence of chronic progressive conditions such as headache disor- ders [358].

Sleep disruption, lack of exercise, irregular mealtimes, and higher levels of stress accompanying fast-paced urban-like lifestyle changes happening in many resource- restricted settings can lead to more prevalent primary headaches [358].

Levels of physical activity are on the decline in some low-resource settings

[359–363].

Unfavorable change in lifestyle has clear health implications, particularly within the context of lifestyle-related disorders such as obesity and hypertension which are also known risk factors for migraine and secondary headache disorders.

Higher levels of stress, poor sleep hygiene, and irregular mealtimes are all fea- tures of unfavorable lifestyle which are linked to higher headache frequency and low quality of life [358].

Primary Headache Disorders as Non-Communicable Disorders There is emerging burden from primary headache disorders in resource-restricted settings [226, 358].

Headache disorders are largely mis−/underdiagnosed and thus mis−/underman-

aged in most resource-restricted settings [364].

There exists a vicious cycle in low-resource settings between increasing head- ache burden, its under−/mismanagement, poor socioeconomic performance, and limited health resources.

Primary headache disorders such as migraine and tension-type headache account for the most prevalent neurological conditions in resource-restricted settings as well as in the rest of the world [226].

Recent community-based studies from resource-restricted settings revealed the

prevalence of primary headache disorders to be increasing [226, 358].

In resource-restricted settings, higher level of headache-related YLDs and DALYs are also driven by increasing population and increasing life expec- tancy [226].

Despite historic accounts that claim headache to be solely a burden of rich coun- tries, recent studies reveal that prevalence between rich- and low-resource settings is similar [358].

Secondary Headache Disorders The burden of secondary headache disorders in low-resource countries is on the rise because of increasing life expectancy.

Besides, the prevailing tropical causes of secondary headache such as neuroin- fections are still rampant and continue to contribute to secondary headache burden in resource-restricted settings.

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The aforementioned points indicate that the burden of headache disorders in resource-restricted settings is comparable to a double-edged sword; these settings are laden by both emerging primary headache and endemic secondary headache disorders.

This overlap of burdens has important implications when considering public health policy and management of headache disorders within resource-restricted settings.

Headache Therapy in Resource-Limited Settings Improving headache training at various health care settings can be useful in resource- restricted settings.

Traditional, non-medicinal, and holistic forms of therapy are preferred as these

fit the cosmovision and culture of many in low-resource settings [365].

Considering devices for headache therapy is impossible for most of these resource-restricted settings—for obvious reasons of cost, maintenance, and lack of expertise.

The Millennium Development Goals (MDGs) were designed to combat infec- tious diseases in low-resource settings and did not address non-communicable dis- orders [366].

Healthcare systems in low-resource settings (e.g., Africa) are primarily designed to respond to epidemics of infectious diseases and not to a chronic burden like head- ache that needs a sustained policy and commitment from different sectors [367].

These matters need to be attended so as to address the burden of headache in

resource-restricted settings.

Conclusion The burden of headache disorders in resource-limited settings is due to increase in both primary and secondary headache.

The rise in primary headache is mostly associated with unhealthy lifestyle choices, low socioeconomic status, and increment in non-communicable disorders. That the exploding population growth in low-resource countries is young makes it vulnerable to higher incidence of primary headache; since primary headache is naturally common in the young age group.

Management policies should emphasize lifestyle approaches such as regular aerobic exercise which lowers primary headache prevalence (e.g., migraine) along with reducing comorbid conditions such as obesity.

The advantage from lifestyle modification is twofold i.e., reducing migraine

chronification and lowering risk for secondary headache causes such as stroke.

Acknowledgement A machine generated summary based on the work of Woldeamanuel, Yohannes W. 2017 in Current Pain and Headache Reports.

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The relationship between headache-attributed disability and lost productivity: 2. Empirical evidence from population-based studies in nine disparate countries