The burden of primary headache disorders in Zambia: national estimates from a population-based door-to-door survey

Abstract

BackgroundThree headache disorders – migraine, tension-type headache (TTH) and medication-overuse headache (MOH) – are major contributors to population ill-health. Policy-makers need local knowledge of these to guide priority-setting. Earlier we reported the prevalence of these disorders in Zambia; here we describe the burdens attributable to them.MethodsThis was a cross-sectional population-based survey of adults aged 18-65 years, selected by cluster-randomized sampling in the mostly urban Lusaka Province and mostly rural Southern Province. Interviewers visiting households used a structured questionnaire. Diagnoses made algorithmically applied ICHD-II criteria. Burden enquiry focused on the previous 3 months and the day before interview. Disability was estimated by applying disability weights (DWs) from the Global Burden of Disease Survey 2010.ResultsFrom 1,134 households, 1,085 unrelated adults (450 male, 635 female) were interviewed (refusal rate 4.3%). The gender- and habitation-adjusted 1-year prevalence of migraine was 22.9%, of TTH 22.8%, of headache on ≥15 days/month 11.5%, of probable MOH (pMOH) 7.1%. Reported mean intensity of migraine attacks was 2.7, representing severe pain. People with migraine spent 10.0% of their time in the ictal state (DW: 0.433); they were therefore 4.3% disabled overall. Disability from TTH was much lower. People with pMOH (time with headache: 37.5%; DW: 0.220) were 8.3% disabled overall. Average lost productive time in the preceding 3 months for migraine was 4.1 days from work (6.3% loss) and 4.2 days (4.7% loss) from household work. Losses for pMOH were 4.8 days (7.4% loss) from work and 4.5 days (5.0% loss) from household work. In the population aged 18-65 years (effectively the working population), estimated disability from migraine was 0.98%, with 1.4% of workdays lost, and from pMOH was 0.59%, with 0.53% of workdays lost. Headache yesterday was reported by 28.3% of participants, whose average productivity yesterday was 55.9% of expectation.ConclusionsZambia loses 1.93% of GDP to headache, and action is required to mitigate this loss and the associated suffering. Structured headache services with their basis in primary care are the most efficient, effective, affordable and equitable solution. They could be implemented within the existing health-care infrastructure of Zambia. These matters require urgent political attention.

The prevalence of primary headache disorders in Ethiopia

“…Headache yesterday was reported much less frequently in Ethiopia (6.4% adjusted) than Zambia (19.1% adjusted [17, 18]). The reasons are clear: not only pMOH but all causes of headache on ≥15 days/month (key drivers of headache yesterday) were much more common in Zambia, and highly associated with urban dwelling in a more urbanised population.…”

“…This would have required at least one of the very few headache experts in the country to take time out from the health service in order to re-interview a subset of participants in the field; we could not justify this. The questionnaire already had a record of successful use in many countries and cultures [2, 17, 18, 30–35]. …”

“…The few studies of headache prevalence, including one in Ethiopian textile mill workers [7], have mostly been in select sub-populations rather than population-based [7–15], with estimates varying considerably but generally far lower than global means [16]. The consequent perception that headache disorders were relatively uncommon in SSA, and not of significant public-health concern, was reversed after the completion of a survey in Zambia [17, 18]. This study, supported by Lifting The Burden (LTB), a UK-registered non-governmental organization conducting the Global Campaign in official relations with the World Health Organization (WHO) [19], reported highly prevalent migraine (22.9%), TTH (22.8%) and probable medication-overuse headache (pMOH) (7.1%) [17].…”

“…This study, supported by Lifting The Burden (LTB), a UK-registered non-governmental organization conducting the Global Campaign in official relations with the World Health Organization (WHO) [19], reported highly prevalent migraine (22.9%), TTH (22.8%) and probable medication-overuse headache (pMOH) (7.1%) [17]. These were associated with heavy disability burden and lost productivity, calling for action and recognition within public health policy [18]. …”

The challenge of managing headache disorders in a tertiary referral neurology clinic in Rwanda

“…Headache disorders impose a major burden on their sufferers, with intensity ranging from impaired quality of life and financial cost to severe associated illnesses, such as depression, which is 3 times more common in people with migraine or severe headaches than in healthy individuals 3,5-7. While headache disorders are a major public health concern in sub-Saharan Africa,8 there is scarce literature on neurological diseases in this region 2. Very little study of the epidemiology of headache in tropical countries has been conducted,9 and there are also un known published data on headache disorders in Rwanda.…”