Headache-attributed burden and a health-care needs assessment in Delhi and National Capital Region of India: estimates from a cross-sectional population-based study

TL;DR

This study shows that headaches in northern India are common and cause significant burden, with a quarter of adults needing healthcare for headache disorders.

Contribution

The study provides population-level estimates of headache burden and healthcare needs in northern India using standardized methods.

Findings

Migraine caused more individual health loss than tension-type headache, with females more affected.

One quarter of adults aged 18–65 would benefit from professional headache care.

Headache impaired participation in household activities more than paid work.

Abstract

We have previously shown headache to be highly prevalent in Delhi and National Capital Region of northern India, as we did earlier in Karnataka State in the south. Here we present a complementary study performed contemporaneously of headache-attributed burden, along with a population health-care needs assessment.

In a cross-sectional study using the standardised methodology of the Global Campaign against Headache, we randomly selected households, and one member aged 18–65 years from each, making unannounced visits. Trained interviewers used the HARDSHIP questionnaire incorporating enquiry into various aspects of headache-attributed burden: symptom burden, lost health, impaired participation in daily activities, quality of life (QoL) and willingness to pay (WTP) for treatment. Enquiry included questions about headache yesterday (HY).

Of N = 2,066, participants reporting headache in the past year spent 9.5% of their time with headache of moderate intensity (1.8 on the scale of 1–3). Population-level estimates of all time spent with headache were in the range 5.5–6.6%. On this measure, migraine (8.2%) was, at individual level, much more burdensome than tension-type headache (TTH) (1.7%), and females with migraine or TTH were more burdened (8.7% and 2.0% respectively) than males (6.0% and 1.0%). Migraine accounted for substantial health loss (3.6%) at individual level (disability weights from the Global Burden of Disease study factored in), but both measures of overall burden (QoL and WTP) found it greatest among those with probable medication-overuse headache (pMOH) or other causes of headache on ≥ 15 days/month (H15+), with TTH least. For all headache types, participation was more impaired in household than in paid work, the latter being little affected (overall, males 0.3 lost days/month, females 0.1). Impaired participation in social or leisure activities was close to unmeasurably low. Impaired participation from HY was 1.8% across all domains of activity. One quarter (26%) of the population aged 18–65 years would be expected to benefit from health care, meeting our criteria for need: 16.1% with migraine, 6.4% with H15+.

Headache disorders in northern India are not only prevalent but also associated with high burden. One quarter of the adult population would benefit from professional headache care.

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