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.

Abstract

Background: 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.

Methods: 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).

Results: 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+.

Conclusion: 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.