Prevalence and burden of headache disorders in Lithuania and their public- health and policy implications: a population-based study within the Eurolight project

DOI: https://doi.org/10.1186/s10194- 017- 0759- 5

Abstract-Summary The Eurolight project assessed the impact of headache disorders in ten EU coun- tries, using the same structured questionnaire but varying sampling methods.

In Lithuania, sample selection employed methods in line with consensus recom-

mendations for population-based burden-of-headache studies.

Of 1137 people in the pre-identified sample, 573 (male 237 [41.4%], female 336 [58.6%]; mean age 40.9 ± 13.8 years) completed interviews (participation propor- tion: 50.4%).

Gender-adjusted 1-year prevalences were: any headache 74.7%; migraine 18.8%; tension-type headache (TTH) 42.2%; all headache on ≥15 days/month 8.6%; prob- able medication-overuse headache (pMOH) 3.2%.

Migraine (OR: 3.6) and pMOH (OR: 2.9) were associated with female gender. All headache types except TTH were associated with significantly diminished

quality of life.

Lost per-person times due to TTH were much less, but to pMOH and other head-

ache on ≥15 days/month much higher.

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Among the entire workforce, lost productivity to migraine was estimated at

0.7%, to TTH 0.3% and to pMOH or other headache on ≥15 days/month 0.5%.

The multiple burdens from headache in Lithuania indicate substantial ill-health

and unmet need for health care.

Of particular concern is the high prevalence of headache on ≥15 days/month,

seen also in Russia and Georgia.

Health policy in Lithuania must heed WHO’s advice that effective treatment of headache, clearly desirable for its health benefits, is also expected to be cost-saving. Extended: All headache types were associated with diminutions, which were sig-

nificant for all but TTH.

Health policy in Lithuania must take note of these findings, and of WHO’s advice that effective treatment of headache is desirable not only for its health benefits but also because it is likely to be cost-saving [528].

We present the Lithuania findings as national estimates.

Background Disorders, migraine and tension-type headache (TTH) are often lifelong illnesses which, as well as causing pain and disability, also diminish productivity, hinder family and social relationships and impoverish quality of life (QoL).

Medication-overuse headache (MOH), usually a sequela of migraine or TTH caused by mistreatment of one or the other, occurs by definition on most days and is especially damaging to QoL.  Epidemiologically, many published studies demon- strate that headache disorders are ubiquitous and common [89].

In Europe, meanwhile, despite many studies reporting migraine prevalence, there were still major knowledge gaps regarding TTH and MOH, and for all head- ache types there were few published data on headache-attributed burden [443, 529]. Multiple scientific and lay organisations collaborated with headache experts in

these countries, and not all were able to draw population-based samples.

These procedures came close to matching the recommended methodology for

population-based burden-of-headache studies [51].

Methods In order to obviate recall error [50, 51], we assessed burden on the preceding day: in respect of HY, we enquired into duration and intensity of the headache, and lost productivity as a consequence of it.

According to the algorithm used to convert questionnaire responses to diagnoses [50], headache occurring on ≥15 days/month was first set aside from episodic head- aches (frequency  <  15  days/month), and diagnosed according to reported acute medication consumption either as probable MOH (pMOH) or other headache on ≥15 days/month.

When a participant reporting HY described one type of headache only, we

assumed HY was of this type.

We recorded headache frequency in days/month, duration in hours (for HY only, this was categorized as <1, 1–4, 5–12 and > 12 h), and intensity in terms meaning “mild”, “moderate” or “severe”, which we converted to a numerical rating scale of 1–3 (0 being no pain) and treated as continuous data.

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Results TTH (OR: 1.1 [0.8–1.6]) and other headache on ≥15 days/month (OR: 1.3 [0.6–2.6] were reported more commonly, but insignificantly so, by males.

The gender-adjusted 1-year prevalences were 18.8% for migraine, 42.2% for

TTH, 3.2% for pMOH and 5.4% for other headache on ≥15 days/month.

Of the 70 reports of HY, one third were in participants with pMOH (n = 10) or

other headache on ≥15 days/month (n = 13).

Participants with migraine scored 27.1 ± 6.0 (Student’s t-test, 2-sided: p = 0.0025 versus no headache), those with TTH 28.4  ±  6.0 (p  =  0.126), those with pMOH 25.8 ± 4.8 (p = 0.0048) and those with other headache on ≥15 days/month 24.9 ± 4.8 (p < 0.0001).

Discussion At population level, lost paid worktime for those with TTH can likewise be esti- mated at 0.3% (0.7*42.2%) overall, and those for pMOH or other headache on ≥15 days/month (very approximately from small numbers) at 0.5%.

The gender-adjusted 1-year prevalences were 20.8% for migraine (compared with 18.8% for Lithuania), 30.8% for TTH (42.2% for Lithuania) and 10.4% for all headache on ≥15 days/month (8.6% for Lithuania) [98].

The countries differ is in pMOH: among the 10.4% in Russia with headache on ≥15  days/month, 68.1% were overusing acute medication [98], giving rise to an estimated prevalence of pMOH of 7.1% against Lithuania’s 3.2%.

Georgia had a larger participating sample of 1145, of whom 15.6% were diag- nosed with migraine, 37.3% with TTH and 7.6% with any headache on ≥15 days/ month (including, perhaps, 0.9% with pMOH) [97].

Conclusions The symptom, disability, lost-productivity and impaired-QoL burdens signal sub- stantial ill-health, and therefore unmet need for health care [91].

This is a message that has been repeated to policy-makers in countries all over the world [530], but here, from this study, is empirical evidence to underpin it in Lithuania.

As in other countries, the high impact on individuals is matched by high eco-

nomic burden; both are unmitigated by failures in health care.

Health policy in Lithuania must take note of these findings, and of WHO’s advice that effective treatment of headache is desirable not only for its health benefits but also because it is likely to be cost-saving [528].

Acknowledgement A machine generated summary based on the work of Rastenytė, Daiva; Mickevičienė, Dalia; Stovner, Lars Jacob; Thomas, Hallie; Andrée, Colette; Steiner, Timothy J. 2017 in The Journal of Headache and Pain.

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