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

Abstract

BackgroundThe Eurolight project assessed the impact of headache disorders in ten EU countries, using the same structured questionnaire but varying sampling methods. In Lithuania, sample selection employed methods in line with consensus recommendations for population-based burden-of-headache studies.MethodsThe survey was cross-sectional. We identified, from the Residents’ Register Service, a sample of inhabitants of Kaunas city and surrounding Kaunas region reflecting age (in the range 18–65 years), gender and rural/urban distributions of Lithuania. Medical students called unannounced at their homes and conducted face-to-face interviews employing a structured questionnaire.ResultsOf 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 proportion: 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%; probable 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. Migraine caused a mean 4.5% loss in paid worktime per affected male and 3.5% per affected female. Lost per-person times due to TTH were much less, but to pMOH and other headache on ≥15 days/month much higher. 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 total of 1.5% may translate directly into lost GDP. Alternative calculations based on headache yesterday (with little recall error) produced, for all headache, a corroborating 1.7%. Similar losses from household work would also drain the nation’s economy. Our findings were comparable to those from earlier studies using similar methods in Russia and Georgia.ConclusionsThe multiple burdens from headache in Lithuania indicate substantial ill-health and unmet need for health care. The heavy burdens on individuals are matched by heavy economic burden. 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.

The Global Burden of Headache

“…Studies in Georgia, 17,30 Lithuania, 19 Moldova, 18 and Russia 20,31 using standardized methodology found broadly similar results (►Table 1): 1-year prevalence of all headache disorders in the range of 53 to 75% and of migraine in the much narrower range of 16 to 20%. Except in Moldova (18%), the prevalence of TTH was consistently higher than that of migraine (31-42%).…”

“…The effect was similar with all headache types in Georgia, 30 was greatest with headache on 15 days per month and, among episodic headaches, more with migraine than TTH, in Russia, 31 and was observed only with migraine and headache on 15 days per month, not TTH, in Lithuania. 19 Nearly a quarter (17.7% of males, 28% of females) of participants with migraine in Eurolight lost >10% of their productive time and nearly half (44.7% of males, 53% of females) of those with probable MOH (pMOH) lost >20%. 27 Societal impact was consequently high: the burden of indirect costs, attributable mostly to lost productivity, was equated to 1.5% lost gross domestic product (GDP) in Lithuania and to 1.8% lost GDP in Russia (►Table 2).…”

“…27 Societal impact was consequently high: the burden of indirect costs, attributable mostly to lost productivity, was equated to 1.5% lost gross domestic product (GDP) in Lithuania and to 1.8% lost GDP in Russia (►Table 2). 19,31 Eurolight assessed impact in a range of additional domains, both ictal and interictal and both on people with headache and on others (their partners and children): in all of these domains, impact was high. 27 For example, onequarter of people with migraine reported interictal symptoms, including anxiety in 11% and avoidance of activities with consequential lifestyle compromise in 15%; both of these were positively associated with frequency and severity of migraine attacks.…”

“…12 These were employed and validated in multiple countries, 13 along with an instrument to help health care providers evaluate and adjust headache treatment. [14][15][16] Populationbased studies using these standardized methods in Georgia, 17 Moldova, 18 Lithuania, 19 Russia, 20 China, 21 India, 22 Nepal, 23 Pakistan, 24 Zambia, 25 Ethiopia, 26 Saudi Arabia (unpublished), Morocco (unpublished), and nine European Union countries 27 have provided data to successive iterations of GBD, each, as a consequence, better informed to make more dependable YLD estimates. 28 The result is a better, albeit still incomplete, understanding of the impact of headache disorders worldwide.…”

The burden of headache is associated to pain interference, depression and headache duration in chronic tension type headache: a 1-year longitudinal study

“…The Eurolight project estimated that indirect costs accounted for 92% of the financial burden of TTH [ 6 ]. In fact, recent data derived from the Eurolight project have confirmed that the burden of TTH is also substantial in middle-income European countries such as Lithuania [ 7 ]. Similarly, headache burden is also similar in low-income countries, e.g., Ethiopia [ 8 ].…”