The burden of headache disorders in Pakistan: National estimates from a population-based door-to-door survey and a healthcare needs assessment

BackgroundIn Pakistan, we have shown that both migraine (one-year prevalence of 22.5%) and tension-type headache (TTH: 44.6%) are more common among the adult population than reported globally. Here, to inform local health policy and add to knowledge of the global burden of headache, we estimate the lost health and other burdens attributable to headache in this populous Eastern Mediterranean Region country.MethodsIn a cross-sectional survey using cluster-randomized sampling, we visited households unannounced in Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan. We randomly selected and interviewed one adult member (aged 18-65 years) of each household, using a validated Urdu version of the HARDSHIP (i.e. Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation) structured questionnaire. Burden enquiry was in multiple domains.ResultsIn total, there were 4223 participants. Those with headache spent on average 6.4% of their time with headache of moderate intensity, with females worse affected than males. Participants with migraine were worse affected than those with TTH. Those with probable medication-overuse headache or other headache on ≥15 days/month spent 39.7% and 30.2% of their total time with headache. Quality of life, productivity and participation in social or leisure activities were impaired. Factoring in prevalence and adjusting for age and gender, we estimated that 4.9-5.9% of all time in this population was spent with headache, and, on average, 3.1 and 3.8 days were lost from paid and household work in the preceding three months. Over half (57.5%) of the population were assessed as needing care, but education promoting effective self-care might reduce this to 28.7% in need of professional care.ConclusionsThe burdens of headache in Pakistan are therefore very substantial in terms of health and productivity losses. These findings are important to national health and economic policies. The benefits in health gain from nationwide implementation of structured headache services, cost-effective in themselves, should be accompanied by enhancements in productivity, offsetting the cost of these services.