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7/29/2019 Who Atlas Headache Disorders
1/35
AtlAso headache disordersand resources in theworld 2011
A collaborative project of World Health Organization and
Lifting The Burden
7/29/2019 Who Atlas Headache Disorders
2/35
4 AtlAs of heAdAche disorders And resources in the world 2011 5foreword
Foreword
h mg m mm
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pb- mp. i k , , - mg
.
who mb mp
g pm b,
p , b , p pgmm
b mm b g
. amg m Project Atlas, pb
g Atlas o Headache Disorders ,
b b who gm g,
Liting The Burden: Gb cmpg g h.
t Gb cmp g m p gm
g, m ,
bj b p, pb
p gb b b
.
i mg pp p a b
, b pb,
xp g g, , mp
pp - b, g ppp
m. i p p
pp, p pp
b m b
m b mg . t ,
g m p m m
, m: pmg, mp
, - , g,
m m, p g mp p g g
.
t k m g m pj b xp
mj f p g mgm
. t pb
k b ; mp
mgm, p p-mk.
Lord Walton of Detchant,
Kt TD MA MD DSc FRCP FMedSci
m P, w ng
cb l P, uK h l
WHO Lirary Cataloguing-in-Pulication Data
a 2011.
1. h pmg. 2. h p . 3. h pmg. 4. c
. 5. d . 6.d . i. w
h og.
isBn 978 92 4 156421 2
(nlM : wl 342)
World Health Organization 2011
a g . P b w h
og b who b (..)
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(.: +41 22 791 3264; x: +41 22 791 4857; -m:
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who b (p://../b/g/pg_
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, g m b. d mp p ppxm
b m b gm.
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p mp mm
b w h og p
m m. e m
xp, m pp p g
b p .
a b p b k b w h
og m pb.
h, pb m bg b
k, xp mp. t pb
p m .
i w h og b b
mg g m .
P t, i
7/29/2019 Who Atlas Headache Disorders
3/35
6 AtlAs of heAdAche disorders And resources in the world 2011 7contents
AtlAs of heAdAche disorders And resources
in the world 2011
8
9
10
14
15
17
17
17
18
19
19
19
19
20
20
21
23
23
24
25
26
30
36
44
54
56
60
62
66
68
CoNteNts
Project teAm And PArtners
PrefAce
executive summAry
introduction
HeAdACHe disorders
epidemiology ANd burdeN
bArriers to CAre
purpose oF tHe AtlAs of H eAdAcHe disorder s
methods
QuestioNNAire developmeNt
ideNtiFiCAtioN oF respoNdeNts
dAtA ColleCtioN
dAtA mANAgemeNt ANd ANAlysis
results
dAtA QuAlity
rePresentativeness
liMitations
data orGanization and Presentation
tHemes
ePideMioloGy
iMPact on society, and national data
health-care utilization
diaGnosis and assessMent
treatMent
Proessional traininG
national Proessional orGanizations
issues
the wAy forwArd
references
list of resPondents
7/29/2019 Who Atlas Headache Disorders
4/35
8 AtlAs of heAdAche disorders And resources in the world 2011 9PrefAce
d sk sx, d t d, d B s
d c M:
w h og, G, s
P tm s P l Jb s:ng u s tg, tm,
n, Liting The Burden, l, u Kgm
M G G:
ng u s tg,
tm, n
M u s:
Liting The Burden, l, u Kgm
d n h:
u M, M, c
M a l:
w h og, G, s
M e l M c B:
Gp dg, M, Gm
M cp a Gg:
w h og, G, s
P P M:
sp u, rm, i
i lg h P (lic onlus),
rm, i
m b
b m. t g
p m g
mj pb - q
p g .
t g Atlas o Headac he Disorder s p
mp k pb- p,
m, gp, p
k. w m
p a m gg mp
q q , p
m b .
t bj pj m
g Atlas o Headac he Disorder s
gb mp
pp . w p
p p-mk p
g pp
, gm g,
x, Atlas o Headache Disorders
m b .
Project teAm And PArtners
tAtlas o Headac he Disorder s pj who -
q, G, p b d sk
sx d t d. d B s pg d c M g p.
t pj b Liting
The Burden k mp Gb cmpg g
h, b P tm s. P l
Jb s P s p xp pp,
d d g m
q. P s, b M u s,
pb pj mgm p .
rp p m i
h s, ep h , w
h a w ng. P
s M G G, pp b ng
u s tg, k q
b, q
mgm. d d d n h
. P s, m d h,
k pm pb g p.
t m m ,
p b g, p , g
p p p m
mp b P s, M s M
G. t p
a.
t b m mmb p ,
g p m m m pp, b
pj.
M a l p m pp pp
p m. a ppg
a pb m M e l
M c B (gp g) m Mcp
a Gg (mp g). P P Mpp p g sp u rm
i lg h P.
h , m m, b b, m
m p
xp m . i Gb
B d s, p 2004, mg
1.3 % b . o , ,
m b pb m b.
y, m k b pb - mp
. w gb b bb
mp, kg
- ,
g g mb pp b b
. t b
pb g , b p
x m g
p b g mg m
.
t w h o g (wh o) Project Atlas
bj g, mpg mg
m - .
w Project Atlas, m b
m m g
pb- p. tAtlas o Headac he Disorder s
mp . tAtlas o Headach e
Disorders p b
who b gm g,
Liting The Burden, m
Dr Shekhar Saxena
d, dpm M h sb ab,
w h og, G, s
Professor Timothy J Steiner
Gb cmpg d, Liting The Burden, l, uK;
P M (h Gb Pb h),
ng u s tg,
tm, n
preFACe
7/29/2019 Who Atlas Headache Disorders
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10 AtlAs of heAdAche disorders And resources in the world 2011 11executive summAry
AtlAs of heAdAche disorders And resources
in the world 2011
eXeCutive
summAry
dp m m b b,
m m
p xp m mm
, m k b pb-
mp . i k , m,
m pp , -
mg .
t gb q m m
g mj pb- pbm,
q p g .
METHODS
t Atlas o Headach e Disorders p q b
who b Liting The Burden: Gb
cmpg g h. M m
q g, g
p p p m 101 ,
pm m ob 2006 M 2009.
epmg mp m pb
g m , ppm b
g pp-b k
Gb cmpg.
Key messAgespHeadache disorders are ubiquitous, prevalent and
disabling. Yet they are under-recognized, under-
diagnosed and under-treated worldwide:
aminorityofpeoplewithheadachedisordersareprofessionally diagnosed;
managementguidelinesareusedroutinelyin55%of
respondingcountries,butmuchlesscommonlyinlow-incomecountries;
despitetherebeingarangeofdrugswithefcacyagainstheadache,countriesinallincomecategories
identifynon-availabilityofappropriatemedicationas
abarriertobestmanagement;
worldwide,onlyfourhoursarecommittedtoheadachedisordersinformalundergraduatemedical
training, and lack of education is seen as the key
issueimpedinggoodmanagementofheadache;
illness that could be relieved is not, andburdens,both individual and societal, persist unnecessarily;
nancialcoststosocietythroughlostproductivityareenormous.
pAmongproposalsfor change:
better professional education ranks far above allothers;
athirdofrespondingcountriesalsorecommend
improvedorganizationanddeliveryofhealthcare
for headache.
pGiven the very high indirect costs of headache,greaterinvestmentinhealthcarethattreatsheadache
effectivelymaywellbecost-savingoverall.
7/29/2019 Who Atlas Headache Disorders
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12 AtlAs of heAdAche disorders And resources in the world 2011 13executive summAry
AtlAs of heAdAche disorders And resources
in the world 2011eXeCutive summAry
Education in headache
p w, j mm
m g m g,
10 p g.
p B p k b
pp g (75 % p),
k k mpg
g mgm .
National professional headache organizations
p a p g
( p g) x
p. t mk
b g- pp m-m (71 76 %)
-m (16 %).
t g m b m , p
m m
g x.
p o p g g
, -
g g mgm
.
t p g m
g.
p p g (20 %)
pp pg g
, 10 % pm
g .
KEY FINDINGS
The burden of headache
p h , g mg -p
, mg m p mk.
t p m q
g 18 65
.
ag , 10 % mg,
1.7 4 % p p b
15 m m.
p im mp x
18 % p.
p h
pg m 12 % xp
7 % p.
Diagnosis of headache
p a m pp
p g.
t mg -p
b 40 %; m- 10 %.
p sp i h s g
pp g 56 %
p. ug a, e
M s-e a -
m g. l g
-m .
p ig , m g pp, g,
p g pp
g.
p im mp
24 % p,
m- -m .
CONCLUSIONS
h bq, p, bg
g b, b -g, -g
-. i b , b,
b , p. g p m g
- xp .
h m b mp,
q mp . M mp,
- p b kg g
m mb b
b pb -. G g
, g m
, g -g
pp b , m b -g .
Management of headache
p w, b 50 % pp
m b pm -g,
p.
up 10 % b g, g
a s -e a .
t p , b
pm p , mg, -p
mb .
M- p
(1 10 %) m.
o p
(5 12 %) m.
p Mgm g 55 %
pg . ug m
mm -m .
p t m b g g
, g fg . t
q g, b m b m.
amg p -mg g, gm m
b p. t m
x, b m xp.
dg g mb
, p mbm
m p .
c m g -b
ppp m b b mgm.
t pbb m mbm .
p amg mpm p, p
p, p p p, bg p p
g m g.
Organization of headache services
p a pg mm, pp
g, mp g
.
7/29/2019 Who Atlas Headache Disorders
7/35
14 AtlAs of heAdAche disorders And resources in the world 2011 15introduction
AtlAs of heAdAche disorders And resources
in the world 2011
iNtroduCtioN
dp , m m, b b,
m m
p xp m mm
(1), m k b pb-
mp . i k , m, m pp , -
mg .
t g b q m, g p
g p pp ,
mp m m , g g,
p pb- p.
heAdAche disorders
h p mb pm
, mg -p
p, p -g . t,
g m- ,
b pb- mp b, ,
m b pp g
.
MIGRAINE
t m g b (2),
b m p g
. Ppg, mm
p b p-pg fmm
b b .
w pp p mg k,
bg p p
k, .
u g pb, mg m
g . a mg b p
bg k m
; mg / k
m g . h p m , - /
pg, gg b p ;
p 2 3 . ak q , g,
m b b b
k, bj m
gg pp mg
g .
TENSION-TYPE HEADACHE
t m m -p p .
i g b g m g,
b m b (3). i m b -
mk pbm k.
t- p p g b ,
bgg g g g pk
30 . h m m, g,
b p g, k b
, mm pg m k. i k
p mpm mg. t
b-p g, , m g
. a xp b g mb
pp, p -p , k mg,
k-k p. t m
b p . c -p
mm b, g b 15
m m, mm mg g
p, m m bg.
MEDICATION-OvERUSE HEADACHE
c x m treat
(4), m
15 m m. i b.
a m m pm m
, , pbm, g
mm g p b
b g . q mp:
q m,
g k g k .
M- pp, p
kg mg. a p
bg p mg -
p . t g
m k. o m, p
bm m q, m k. i -
g, p , p ,fg m p . t
k m, m g. a
mm pbb k m g pm
m- p -mp
m, p
p q.
7/29/2019 Who Atlas Headache Disorders
8/3516 AtlAs of heAdAche disorders And resources in the world 2011 17introduction
AtlAs of heAdAche disorders And resources
in the world 2011
BArriers to cAre
n pg, g mg g
b g p g (13, 14). o x
p g 16 65 g u Kgm gp b
b p 5 , m
(15). a g
p p b
m g mp (16).
k b pb- p
-p . i
m b m b ,
b q bg b k
b . t b
b m m g
m,
p.
y g g mb p p
b, b, b
(17). xmp, p mp
g pp u s am (usa)
u Kgm, mg
-
m b g
(18). M -- m,
pp g. i p u
Kgm g-pp q ,
p mg g b m
m (19). i Jp,
mg b mg
b b (20). o 80 % d -
p
(21). i g k pp
b -p .
t b p b g , b
m b , p / m.
CLINICAL bARRIERS
lk kg mg - p pp
b mgm. t pbm
bg m m g
bj, q p . i
k b m p
, , m m g
m.
SOCIAL bARRIERS
P x m g
pb. h p b pb
m p,
g. i , m, m x pb.
t mp b b p p mg
k p m , p m b g
p b.
spg, p x
mg pp b m. a Jp
, xmp, m p
mg, p
qg m (20). t
p m m
m x. ag,
k b b m m.
POLITICAL / ECONOMIC bARRIER S
M gm kg b b
m b . t
g g
m mp g - g
mg b m (.g. b g kg )
ppp.
PurPose of the AtlAs ofheAdAche disorders
o gb b bb
mp, kg -
. t Atlas o Headache
Disorders, pj mpm m pmg
, p g pbm b . t
pp , m mp,
m p b pp b
kg.
t k k mp G b c mpg g
h (22).
iNtroduCtioN
n g m ,
p kg. o
, mg gb b mp
pp b p p
g, m b b, mp q . ab , bg:
, mg 1.3 %
b (yld ) (10). tg,
pbb b b (1). rp
k, x,
mg m , mpm (11). h
,
k, pp q k k b
b m b b p. t
k pm m
pp.
w b b
m b, . emp,
k, m m b q k k
b b . B
m bm p
( 50), m
pp m kg
p mp kg (12)
m. i u Kgm, xmp, m 25
m kg- - b
mg (6).
t , g g
, pb- mp
p
b p, b, mg q
.
ePidemiology And Burden
ag mg m mm
(5), pmg p
m. Pp-b m mg , g m q ,
m mm . t-p
m p, gp g
15 m m g m bg, b
b . m,
pp-b x -p .
i , m g g (
b) pp, p
p mp mmb
, m m.
n, p g , b
b g p ,
g pp g, , m ggp
. Pp-b p bg g,
g kg gp x m g.
P kg m m mg
11 % (1), -m g
m, m-. Mg mm
. exp m g
mg p k gg 3,000
mg k every day m g
pp (6).
ep -p m mm
, p b 70 % m pp (7). w
1- p pp g, g
42 % (1), g m m. c
-p 1 3 % (1).
i m p, m- -
g (8). t g
m 1 % m pp (9), m
m m, m .
o, gb p mg
(mpm ) 47 % (1).
7/29/2019 Who Atlas Headache Disorders
9/3518 AtlAs of heAdAche disorders And resources in the world 2011 19methods
AtlAs of heAdAche disorders And resources
in the world 2011
metHods
t Atlas o Headache Disorders p q b
who b Liting The Burden: Gb
cmpg g h (22). M m
g pm m
ob 2006 M 2009. epmg mp m pb g m
pp-b pm p M 2006 (1)
ppm b g Gb
cmpg -- c (23), i
r (24). t b s . p
mg m
(1). t m Gb cmpg --
b (23, 24). t,
pmg p p: ..,
pp b p - pb ,
pb, g m b g q.
QuestionnAire develoPment
t g m m
, q , eg, b
gp who Liting The Burden xp. t q- m b mp:
q p -
g (g ), pm- p (GP
) p pp
( ). a g m q
pp p -
q m .
t q p who
g, g m .
identificAtion ofresPondents
a p b m i
h s mmbp g, ep h mmb-g , p
w h a -mmb g, i
h cg ep h cg
, w ng (m
g ) p p
who x Atlas o Country
Resources or Neurological Disorders Atlas o Epilepsy Care
in the World. a mb ggp gp m;
, g , m
g p m
-pb .
t g mj
p g. e k
, pb, k p mg pm-
p p k p m.
dAtA collection
t pp p q b m, b
pj m p p
b m .
rp k g -
, m m mpb
p. Q q
. rp
pg mp q. w m-
p m bm,
p k .
i -p p m, mp
q .
dAtA mAnAgement AndAnAlysis
a pb m k mp, p
m p b g m
.
a ,
b ppg b g s (p )
8 .
a g p m p m s Pss 17
. v b
q b m
(m, m )
ppp. Gp g m b k b m , m ,
.
c gp x who g (a
rg [ar], rg am [aMr], e M-
rg [eMr], ep rg [eur], s-e
a r g [se ar] w P r g [w Pr])
w Bk m g g 2009 g
m (Gni) p p (-m: us$ 995 ;
m-m: us$ 996 3 945; pp m-m:
us$ 3 946 12 195; g- m: u s$ 12 196 m) (25).
7/29/2019 Who Atlas Headache Disorders
10/3520 AtlAs of heAdAche disorders And resources in the world 2011 21results | dAtA QuAlity
Yes
No
AtlAs of heAdAche disorders And resources
in the world 2011
results
rePresentAtiveness
i mp , g q
m 101 ( 65 mp ),
GP q m 47 ( mp) q m 48 (16 mp).
a q b m 101
(g 1.1): 18 a rg (39 %
g), 19 am (54 %), 13
e M (62 %), 38 ep rg
(72 %), s-e a (46 %) g w
P (30 %) (g 1.2). t mb mg gg
50 % p m g, b
p 86 % pp: 71 %
pp a, 95 % am, 83 % e
M, 86 % ep, 82 % s-e a
93 % w P (g 1.3).
rp (.., p m)
g q f -m g:
g (77 %) m g-m ,
g g : pp m- (54 %),
m- (46 %) -m (38 %). rp GP q k p
m b g-p k
m.
FIG. 1.1 w mp bg yes no
dAtA QuAlity
7/29/2019 Who Atlas Headache Disorders
11/3522 AtlAs of heAdAche disorders And resources in the world 2011 23results | dAtA QuAlity
AtlAs of heAdAche disorders And resources
in the world 2011
limitAtions
n b m 92 (48 %) 193 Mmb
s. ag pg p g
mj (86 %) pp, m b p b.P -m
k p; m b xp p-
p. i , m g
-p.
a m, x k p (b m
) m pm-
g . M p, p m g
, mp q
mg b g m
. h, m p mg
b p . M g-
p, m
b k k m.
h, xp p mg
b.
, q p pbb q
b. i m , m b b
mp ( xmp, -
), q
b b xp, b
xp m b . m ,
b p b k .
i p m, Atlas o Headache Disorde rs
m mp mp
mp.
dAtA orgAnizAtion AndPresentAtion
t m g g m
g b m g m. d p gp, mp x. B
p q, m m
ppp. B b m
k, m b p
m b.
i b pb p g m
. lm p m b kp
m pg .
imp g pm
gg m.
0
10
20
30
40
50
60
70
80
52
30
46
72
62
54
39
WORLDWPRSEAREUREMRAMRAFR
0
20
40
60
80
100
86
93
8286
83
95
71
WORLDWPRSEAREUREMRAMRAFR
FIG. 1.2 c-b p (% who g p
[ q ] mg p)
FIG. 1.3 Pp-b p (% pp who g p
[ q ] mg p)
AFR = a rgAMR = rg amEMR = e M rg
EUR = ep rgSEAR = s-e a rgWPR = w P rg
results
dAtA QuAlity
7/29/2019 Who Atlas Headache Disorders
12/3524 AtlAs of heAdAche disorders And resources in the world 2011 25results | themes | ePidemiology
tHemes epidemiology
AtlAs of heAdAche disorders And resources
in the world 2011
results
tHemesepmg mp m m
pb (1) ppm b g
Gb cmpg -- c (23), i
r (24). o pmg
p p : .., gm b g q; xp m g
b ( M). t q
m b b b
, m
g-g 18 65 . ag, mm
b 2.1 m pp-b mp
q m, pb p
b g (26, 27). t m "1-
p" m pg pp pg
p mg g
g p 12 m.
SALIENT FINDINGS
p appxm q g 18 65
m g
xp a, m 1- p
22 %.
p Mg p, , m 10 %
g g, xp a e M.
p h 15 m m 1.7 4 %
pp, g . M
m b m- , b
kg m m g.
p i m , m g,
b g pmg .
imPlicAtions
p t g b 2.1 m ,g mg -p , mg m p mk.
p r ,
m p. t
g 18 65 ppp m pb-
pp p .
p w, mg 1.3 %
b (yld) (10). t b
b g g m
pb (1). h-p mk
b m b . y, m ,
x who g, gp kg
m - p. M g-q pm-
g q .
Arica Americas Eastern
Mediterranean
Europe South-East
Asia
Western Pacifc
All headache 21.6
(n = 2)
46.5
(n = 1)
78.8
(n = 2)
56.1
(n = 8)
63.9
(n = 1)
52.8
(n = 4)
Migraine 4.0
(n = 2)
10.6
(n = 1)
6.8
(n = 2)
14.9
(n = 9)
10.9
(n = 1)
10.4
(n = 6)
Tension-type
headache
nr 32.6
(n = 1)
nr 80*
(n = 2)
34.8
(n = 1)
19.7
(n = 3)
Medication-overuse
headache (MOH)
nr nr nr 1.0
(n = 3)
1.2
(n = 1)
nr
Headache on 15 days /
month (including MOH)
1.7
(n = 2)
4.0
(n = 1)
nr 3.3
(n = 3)
1.7
(n = 1)
2.1
(n = 3)
TAbLE 2.1 M 1- p (%) g 18 65 , mg, -p
m- m pp-b b who g
n = nmb who g bg p m.nr= n p. t k b .* t p b 80 % -p 56.1 % b m m m
. t g m g m g q -p (b g m), mm p; g mg k .
7/29/2019 Who Atlas Headache Disorders
13/3526 AtlAs of heAdAche disorders And resources in the world 2011 27results | t hemes | imPAct on society, And nAtionAl dAtA
results
Yes
No
AtlAs of heAdAche disorders And resources
in the world 2011
societAl imPAct
rp k m b
mp , g m mp.
i . t p p
g 3.1 3.3.
SALIENT FINDINGS
p Gb, m mp
x : 18 %
p (g 3.2).
p rg mk: ep b m
m, b (32 %)
. g am (16 %),
w P (13 %), e M (8 %)
a (6 %), s -e a.
p a g x b g-m (
, 35 %) (6 10 %) (g 3.3).
FIG. 3.2 c m mp , b who g
(% p p mg pg)
FIG. 3.3 c m mp , b m g
(% p p mg pg)
tHemes impACt oN soCiety, ANd
NAtioNAl dAtA
FIG. 3.1 c m mp yes no no data
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FIG. 3.5 c g -pg m, b who g
(% p p mg pg)
results
tHemes impACt oN soCiety, ANd
NAtioNAl dAtA
nAtionAl heAlth rePorting
rp k
-pg m
xp . t p
g 3.4 3.5.
SALIENT FINDINGS
p w,
-pg m 12 %
p.
p t b g, b
pp g 18 %. t
b m.
p
w, xp : 7 % pg ,
g e M
(15 %), ep (11 %) am (5 %). n
-m .
imPlicAtions
p v - mp
, p q -
p p.
p Pp-b , m b -
b b, m g-
, g, b p -p
. i b pm mp mm bg .
M Gb cmpg
g h (22).
p i b g m p
m x
bb , g g p
b (28, 29). h, m
x .
Yes
No
FIG. 3.4 c g
-pg m yes no no data
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self-treAtment versusProfessionAl heAlth cAre
rp k m pg
pp pm -g g p (pm- p [PcP],
g, mpm m p
). t p mm g 4.1.
SALIENT FINDINGS
w, b 50 % pp m
b pm -g,
p. h, m 10 % p b
g, g , mg b xp, a s-e a.
consultAtion rAtes
ng pm- p k
pg g
. t p p g 4.2 4.3.
0
10
20
30
40
50
60
57
55687
101010101010
15
1010
5
20
15
10
5
20
3030
20
3028
20
50
43
50
40
30
50
58
WORLDWPRSEAREUREMRAMRAFR
OthersAlternativeNeurologistPCPSelf
FIG. 4.2 em pg p
(m p, j 100 %)
results
tHemes HeAltH-CAre utiliZAtioN
FIG. 4.1 em pg pp pm -g mg b p,
b who g (m p g)
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NeurologistPrimary care
0
5
10
15
20
25
30
35
40
7854
22
32
22
7810
4
10
38
23
OTHERSOTHER SECONDARYMOHCLUSTER HEADACHEM + TTHTTHMIGRAINE
NeurologistPrimary care
0
5
10
15
20
25
30
35
45
17
3
16
22
33
7
1010
3
14
2828
OTHERSOTHER SECONDARYMOHCLUSTER HEADACHEM + TTHTTHMIGRAINE
NeurologistPrimary care
0
5
10
15
20
25
30
35
6
911
3
16
22
33
3
6
13
1
13
3232
OTHERSOTHER SECONDARYMOHCLUSTER HEADACHEM + TTHTTHMIGRAINE
FIG. 4.3 em pg m , pm p ,
b who g (m p g, j 100 %) (TTH: tension-type headache; M+TTH: combined
migraine and T TH; MOH: medicatio n-overuse head ache; Other seco ndary: othe r secondar y headache)
A. AFR ICAN RE GION
b. REGION OF THE AMERICAS
D. EUROPEAN REGION
C. EASTERN MEDITERRANEAN REGION
results
tHemes HeAltH-CAre utiliZAtioN
NeurologistPrimary care
0
10
20
30
40
50
35
13
4
10
21
44
14
4
9
5
0
27
41
OTHERSOTHER SECONDARYMOHCLUSTER HEADACHEM + TTHTTHMIGRAINE
F. WESTERN PACIFIC REGION
E. SOUTH-EAST ASIA REGION
NeurologistPrimary care
0
5
10
15
20
25
30
35
5
89
1
2222
33
2
11
68
21
2626
OTHERSOTHER SECONDARYMOHCLUSTER HEADACHEM + TTHTTHMIGRAINE
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SALIENT FINDINGS
pGb, p ,
b pm p , mg, -
p mb . t-p
m p ( p 25),
b q mg -
p p f . Mg
g pbb (p p )
-p ,
m p pm . Pm-
p, m , m
-p , m f
g p. sp m
mg, pbb f (g
b).
prg, mg m q
pg am, ep,
s-e a w P. t
p ( p 25) g pbb f
b bb mg -
p . t-p m q
, b fg p, rg a e M.
pB m g, mg m
20 % -m
32 % g-m . c, fg
g b, -
p mk p 25 30 %
- m-m 18.5 20 %
pp m- g-m . a xp
pp g p ,
g pmg m a e
M rg m -p
g. c m p p . i ,
g g -p
, m g p
, p, g g .
h, m (
) b kp m.
p c 1 3.8 % p
. t
g m g. exp b
p mm m
, xp b xm
, mg m .
p M- p
m 1 % -m
10 % pp m- g-m .
p o p -
m g: 12 % -m , g 5 % g-m .
remediABle risK fActors
rp k b k
, , g mp
gg.
SALIENT FINDINGS
p Gb, g k g
mp: (20.8 %), g q , m
m ; m (15.8 %),
g p, p ;
g m (12.9 %), p m ;
(7.9 %), xmp b b
b.
p o m p mb k
- m-m g. t
g, p b, -
m mm -p .
dg m p k pp m-
g-m , g
m-.
imPlicAtions
p t pp pp m b -
g (b 50 %) xp, g m
-p m mg m
q / m k. n
b m p .
p t pp k g b
; q, pp b
b pb- mp. t p
m k m- .
p o , b 10 % pp
b g, g
pp (30). t pp b,
pp g g b g,
pm- p p, b
gp m -m mb
m. t q ppeople ,
b pp p patients . e
, g -b
gm xpg pm- mgm
(30).
p t pp pm g m
, b pm- p, g
m gp. w m
g mp -p , pm
mg -p
g m .
p c mp p b
. n mg p .
t , q
g m g.
p M b p p
m. B- m
k p , m m-
. t mp :
b pb q.
results
tHemes HeAltH-CAre utiliZAtioN
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0
10
20
30
40
50
60
10
57
2120
10
1
38
4545
25
55
40
23
40
33
60
40
60
40
10
WORLDWPRSEAREUREMRAMRAFR
Medication-overuse headacheTension-type headacheMigraine
0
10
20
30
40
50
30
1010
1
40
30
40
30
50
3835
13
HIGHUPPER MIDDLELOWER MIDDLELOW
Medication-overuse headacheTension-type headacheMigraine
FIG. 5.1 em pg pp p b p g,
b who g (m p)
FIG. 5.2 em pg pp p b p g,
b -m g (m p )
results
tHemes diAgNosis ANd AssessmeNt
diAgnostic rAtes
rp k m pg
p mg, -p m-
b g b
p. t p g 5.1 5.2.
SALIENT FINDINGS
p Gb, p g mg -
p b 40 % pp
, m- m
m (10 %) .
p t m g : pg
a rg, m b g b
b mb p.
p t b g
mg m g, m
m m- .
t -p .
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use of diAgnostic criteri A
ng p k xp
g , p ,
pp g p . t p
p g 5.3 5.5.
SALIENT FINDINGS
i p , xp g
pp g p 56 %
p. t , b,
i h s ( (26)
(27)). t m g ,
g m p
a , e M s -e a rg .
l-m m xp
g .
0
10
20
30
40
50
60
70
80
56
75
40
66
31
68
39
WORLDWPRSEAREUREMRAMRAFR
0
10
20
30
40
50
60
70
80
62
57
63
37
HIGHUPPER MIDDLELOWER MIDDLELOW
FIG. 5.4 c mkg p xp g pp g,
b who g (% p p mg pg)
FIG. 5.5 c mkg p xp g pp g,
b m g (% p p mg pg)
results
tHemes diAgNosis ANd AssessmeNt
Yes
No
FIG. 5.3 c mkg p xp
g pp g yes no no data
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use of investigAtions
rp k m pg
p, g, g p g
p g m p
. t b 5.6. rp
k pp g
g.
SALIENT FINDINGS
p ig g g, m xp
b m q
g g m. t
p eeG.
p rg , p
( ) xm.
p Gb, m-p pmg g
p g (70 %). t m-
( 55 %) g m g-
. r p m mmb (20 %)
, q b g, m 10 %
a 40 % w P rg ,
x b m, m 20 % - m-
m 27.5 % pp m- g-
m . a g (10 %).
WHO region MRI (%) CT (%) Sinus
examination (%)
EEG (%) CSF (%) Reractory
errors (%)
N PC N PC N PC N PC N PC N PC
Arican (n = 17) 0 1 28 5 15 15 5 5 5 5 19 3
Americas (n = 19) 15 8 30 10 10 8 15 28 2 10 13
Eastern Mediterranean
(n = 12)
10 2 60 10 18 28 13 5 5 5 10 25
Europe (n = 34) 10 3 30 4 10 5 9 1 2 1 5 7
South-East Asia (n = 5) 5 1 30 2 45 8 5 1 5 1 50 3 5
Western Pacifc (n = 8) 23 20 20 64 10 30 13 55 1 15 8 13
World (n = 95) 10 3 30 5 10 10 10 5 3 1 10 8
TAbLE 5.6 em pg p p pm g p g
(m p)
MRI = mg mgg; CT = X- mp mgp; EEG = pgp;CSF = bp f xm; N = p (g) ; PC = pm ; n = mb bg
use of Assessmentinstruments
ng k m m,
-p g,
g q b pp .
t p g 5.7 5.9.
SALIENT FINDINGS
p Gb, m m
24 % p. t m-
m Midas q (31 33)
hit-6 (34, 35).
p rg . em
b mb p, b m
m pp b q
b pp a
s-e a rg.
p l- m-m
m (5 12.5 %) pp m- g-
m (29 43 %).
results
tHemes diAgNosis ANd AssessmeNt
Yes
No
FIG. 5.7 c mkg p m
m q b pp yes no no data
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0
10
20
30
40
50
24
50
0
32
8
37
0
WORLDWPRSEAREUREMRAMRAFR
0
10
20
30
40
50
30
43
13
5
HIGHUPPER MIDDLELOWER MIDDLELOW
FIG. 5.8 c mkg p m m q b
pp , b who g (% p p mg pg)
FIG. 5.9 c mkg p m m q b
pp , b m g (% p p mg pg)
imPlicAtions
p t x g f q
, m m mpm
g. B p m
.
p l p g p q
p , m b f b
( m g) g
xp g . B m bg
, g ( pg p)
g -p mg -
p b pp m-
g-m . exp p. u-
g , b
b g mg g-m m b
b b p m, pp
p pm mpg.
i m g-m , mbm p
g mg -p
-g mg (, ,
k -p b m g).
p M- b pb
mb. a , p p ,
g b. i k
m . t g 10 %
mp m
q.
p P i h s g
g, b g
-m . l g
-m . t m , b
q p-pp. P pbm k b
mpx ichd-ii, bg 200
160 pg (27). t q
b mmm ,
mgm m pm : m-
b 15 g
(36).
p ig m b b ,
xp . t p
b , g.
p am mp
b p mgm. t p
m, m .
p exg m , b
g. t g p mpm gb,
p -p .
p t mp m pp p, b
ppp. Midas m m
(31 33), f b. a m -
pb halt x (37).
hit-6 mp m b, g p
q (34, 35). t p p
q-- m whoQl, m
b mgm pp
.
results
tHemes diAgNosis ANd AssessmeNt
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guidelines
ng p k g
mm mgm
p . t
p g 6.1 6.3.
SALIENT FINDINGS
p Gb, g mm
mgm m (55 %)
pg . n g 26
.
p rg mk: g mm
q
am , ep w P , m a
b e M s-ea r g.
p t pp b b -m
(g 6.3), m b xp. ab 40 %
pp -m .
results
tHemes treAtmeNt
0
10
20
30
40
50
60
70
80
55
75
0
76
3
74
22
WORLDWPRSEAREUREMRAMRAFR
0
10
20
30
40
50
60
70
80
68
6263
16
HIGHUPPER MIDDLELOWER MIDDLELOW
FIG. 6.2 c mkg mgm g mm p ,
b who g (% p p mg pg)
FIG. 6.3 c mkg mgm g mm p ,
b m g (% p p mg pg)
Yes
No
FIG. 6.1 c mkg mgm g
mm p yes no no data
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0
20
40
60
80
100
66
93
4744
21
45
22
96
ZolmitriptanSumatriptanRizatriptanNaratriptanFrovatriptanEletriptanAlmotri ptanErgotamine
FIG. 6.4 ab p -mg g (% p p mg pg)
AvAilABility of medicAtions
t m g
q: g, -m, p
-mg g pp m. rp-
k b b g
, mbm p.
t g g p m (m p),
p, - -fmm g (nsaid),
bb-g g mp, p / p
(g ) p -g
g mp.
t - m g mp
mpm, b pk (b g
g mpg) p ppp mg.
t p -m g g g (gm
gm) p (mp, p,
p, p, p, mp mp).
t pp g b-b k, f ,
mg, p, p (m p, p
px), p pm.
r g 6.4 6.9.
results
tHemes treAtmeNt
0
20
40
60
80
100292722262222134
555961
586560
79
73
16141716
1318
8
23
ZolmitriptanSumatriptanRizatriptanNaratriptanFrovatriptanEletriptanAlmotri ptanErgotamine
SPGPOTC
0
20
40
60
80
100
ZolmitriptanSumatriptanRizatriptanNaratriptanFrovatriptanEletriptanAlmotri ptanErgotamine
NoIn partYes
OTC = --; GP = GP pp ; SP = p pp
FIG. 6.5 rg p -mg g (% pg)
FIG. 6.6 rmbm p -mg g (% pg)
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SALIENT FINDINGS
Analge sics
p Pm p b
p, g m g. o
nsaid b (67 %). t g
m bb --.
p op / p b 65 % , bb-
g g mp mb (33 %).
t g m b p p .
p ag mb b
p, b g .
Anti -emeti cs
p Mpm b (100 %), mp
m (86 %). a pp , b
p -- pb b
.
p t g p b mb
.
Anti- migraine dr ugs
p t m b p -mg g
gm (96 % pg ),
b mp (93 %) (g 6.4). o p,
mp (66 %) m pg
. rp (47 %), p (45 %) p
(44 %) m b - b mp
(22 %) p (21 %) q
.
p a g pp- (GP p)
m , b gm, b, bb -
- m q (23 %) (g 6.5). t
mb p b ,
b b (g 6.6).
Prophylactic drugs
p t m b pp g b-bk
p (100 % pg ),
b m p (98 %) g
b pm (81 %), f (72 %), p (57 %)
mg (43 %) (g 6.7).
p a g pp- m (g
6.8). t mb, p, b
, b (g 6.9).
0
20
40
60
80
100
23
81
10098
57
43
72
100
OthersTopiramateTricyclic
antidepressants
Sodium
valproate
PizotifenMethysergideFlunarizineBeta-blockers
FIG. 6.7 ab pp g (% p p mg pg)
0
20
40
60
80
1003718252222105
54
75
636773
6876
971211
5
2219
TopiramateTricyclic
antidepressants
Sodium
valproate
PizotifenMethysergideFlunarizineBeta-blockers
SPGPOTC
0
20
40
60
80
100 39353428193231
222623
26
49
2627
403943
46
32
4241
TopiramateTricyclic
antidepressants
Sodium
valproate
PizotifenMethysergideFlunarizineBeta-blockers
NoIn partYes
OTC = --; GP = GP pp ; SP = p pp
FIG. 6.8 rg pp g (% pg)
FIG. 6.9 rmbm pp g (% pg)
results
tHemes treAtmeNt
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use of medicAtions
rp k p mg
g ( q , b
k b b).
SALIENT FINDINGS
Migraine
p m p mg, nsaid (
p) , , m p g (86 %
p). Pm (69 %) p
(52 %) . B g b who
m mg pbb g p
g g ( pp g ) g
m g (g 6.10).
pMpm p -m g
p mg (71 % ),
g xp s-e a.
p Gb, q-p p -mg g
gm (34 % p)
mp (33 %) (g 6.11). t mb
mk g , gm
p b ep w P,
mp ( - p ep).
p B-bk p mg pp g
(85 % ) g (g
6.12). t p (56 %) ,
g xp w P. sm p (40 %),
pm (34 %) f (34 %) ,
g .
Tension Type Headache
p m p -p ,
nsaid ( p) , , m p-
g (87 % p). Pm
(75 %) , b pbb g g g
g m g. ap (45.5 %) pp
b .
0
20
40
60
80
100
52
25
80
4546
53
61
6975
80
66
85
47
8386
100100
9085
74
83
WORLDWPRSEAREUREMRAMRAFR
Aspiri nParacetamol/acetaminophenOther NSAIDs
FIG. 6.10 M p g g m p mg, b who g
(m % p)
0
10
20
30
40
50
60
33
50
40
45
23
16
22
34
38
60
11
39
47
56
WORLDWPRSEAREUREMRAMRAFR
SumatriptanErgotamine
0
20
40
60
80
100
56
38
80
5054
6367
3438
20
39
54
37
6
40
63
20
47
23
3733 34
50
40
2923
53
22
8588
100
8792
7978
WORLDWPRSEAREUREMRAMRAFR
Tricyclic antidepressantsTopiramateSodium valporateFlunarizineBeta-blockers
FIG. 6.11 egm mp m p p -mg g who g
(m % p)
FIG. 6.12 M-p pp g mg, b who g (m % p)
results
tHemes treAtmeNt
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WHO region Acupuncture (%) Naturopathy (%) Physical therapy (%)
Arican (n = 18) 22 11 22
Americas (n = 19) 32 26 42
Eastern Mediterranean (n = 13) 31 15 23
Europe (n = 38) 50 32 68
South-East Asia (n = 5) 60 80 0
Western Pacifc (n = 8) 38 0 38
World (n = 101) 39 25 44
n = mb pg
TAbLE 6.13 t m q mpm p , b
who g (% p p mg pg )
AlternAtive orcomPlementAry therAPies
rp k m q
mpm p
. t p mm b 6.13.
SALIENT FINDINGS
p P p (44 % p), -
p (39 %) p (25 %) m q
b mg. a p
p g m g.
p o mpm p q
m bbk / x, b
pp, m, x g, p-
g p, g m m, -
, a, fxg mp.
imPlicAtions
p G, p p ppp
p, , xp
mp mgm m,
. M -m
g, g g mj -
pp mpm. h,
p g ( pp 58 59)
p , p, g
mm.
p i , , , pp
, mgm g
. i m, g -
p m b
m mp.
p t m b g, g fg
g q g. t ,
, g p mgm, g
g g g.
p w p mbm, b
p b mgm. G, b
g mb
(g p mbm m
g p ). G -
m g (
q- g (6, 12,
28, 29)), p mbm b b.
p t m p g m ppx
mg m b g ( > 96 %
pg ), b m
. a p xmp gm, m
m b p -mg g ,
p m m who m
2005 (38). egm - mp p ,
g mp
bm b g p, pp
p p g q
(39). m, -- b b
q x,
m p (39). tp, p
mp, b m b m
mm .
p tm -p , ,
m m . i k m
, m b : mpm
, m , m q.
p op / p b, b
p g mg -p .t . t p
, p p,
, bm k g
q p.
results
tHemes treAtmeNt
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FIG. 7.1 em mb g g m m
pg g p g, b who g (m p)
AtlAs of heAdAche disorders And resources
in the world 2011
undergrAduAte A ndPostgrAduAte medicAltrAiningP p k m mb
g m -
g m m. ng
k m p p-
g p g. t g mm
g 7.1 7.2.
rp k b g m
pm- p.
FIG. 7.2 em mb g g m m
pg g p g, b -m g (m p )
SALIENT FINDINGS
p w, j mm
m g m g, 10
p g. t p m
g , m mm am
ep. h, p b
g m g:
m 0 20 g m g m
0 720 p g. t m (4.8 -
g 37 p g) gg m
g k b . t pbb
f g pgmm
p; m f b
g ( xmp, m
p ).
imPlicAtions
p t k g g
g ( 4 6 ) mm,
g , p
g pp m p b pm
p g (40).
p a p g
mp,
mgm p m. B
m g mgm , pp j
m, -g ,
p.
p i, b mp g b -
m b m .
p i g
. B m b
pm , mp b g
g, m g m
g p p g.
results
tHemes proFessioNAl trAiNiNg
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56 AtlAs of heAdAche disorders And resources in the world 2011 57results | themes | nAtionAl ProfessionAl orgAnizAtions
0
20
40
60
80
100
61
50
85
70
3630
18
WORLDWPRSEAREUREMRAMRAFR
0
20
40
60
80
100
61
50
40
84
31
79
28
WORLDWPRSEAREUREMRAMRAFR
0
10
20
30
40
50
60
70
80
70
7671
16
HIGHUPPER MIDDLELOWER MIDDLELOW
AtlAs of heAdAche disorders And resources
in the world 2011
ng p k
p g
. i , k
p x p g
( xmp, g). i , p
k b (mb mmb) g
p (m p-p ).
t p mb :
b m (g 8.1 8.6).
results
tHemes NAtioNAl proFessioNAl
orgANiZAtioNs
FIG. 8.2 c p g p g, b who g (% p p mg p g)
FIG. 8.3 c p g p g, b m g (% p p mg pg)
FIG. 8.4 s (mb mmb) p g p g, b who g (m p)
Yes
No
FIG. 8.1 c p g
p g yes no no data
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58 AtlAs of heAdAche disorders And resources in the world 2011 59results | themes | nAtionAl ProfessionAl orgAnizAtions
AtlAs of heAdAche disorders And resources
in the world 2011
0 5 10 15 20 25 30 35 40
39
36
35
20
17
13
10Constructing curriculum in undergraduate training
Lobbying governments
Advising governments
Constructing curriculum in postgraduate training
Guidelines for management
Raising awareness
Organizing professional meetings
FIG. 8.6 a p g p
g (% p p mg pg)
results
tHemes NAtioNAl proFessioNAl
orgANiZAtioNs
SALIENT FINDINGS
p a p g ,
/ p g, x
(67 %) p.
p rg, g m mm ep(85 % ) am (79 %),
w P (50 %) s-e a (40 %)
mm e M (31 %) a (28 %).
p t mk b g-
m-m ( g 71 76 %) -
m (16 %).
p rg pp (mb
mmb) p g
p. Jg b m, g s-e
a (m 85). g ep (m 70),
w P (m 50), e M
(m 36), am (m 30) a (m 18).
lg am w P
b .
p s pp -m g:
(m 25 mmb), m (m 21), pp
m (m 50) g (m 113).
p o p g
p g mg (39 %),
- (36 %)
g g / mm
mgm (35 %). t p
g m g, g
. Mg ,
mg b xp, m- pm
49 % pg g-m , 38 % pp
m-m 21 % -
m .
p n m g pp
pg g (20 %),
pm g
(0 15 % b g, 10 % ).
p o 13 % bb gm -
(0 25 % b g, m mm w P
ep ). lbbg m-: m k (16 19 %)
g- pp m-m , (8 %)
m-m (5 %) -m .
p sg m g (17 %) gm
(0 32 % b g, m mm ep
w P).
imPlicAtions
p s p g ,
g g-g,
g pbb pm b
m , pg.
p n p g m k
g, mpg
g kg
. am g
mmb i h s,
p g mmbp
p kg 100 p .
p w p g -
pp b mm (xg p-
g ), g b k: p m
m g
x, m -p-
. i m k b 193
who Mmb s 101 pg -, pp g 35 %,
pbb . i , -
b p b g m g ,
p -m .
p B pm- . n
p g pp m
pmg m g b,
, p k g m
pm- p.
p lbbg g gm m ,
m-p pbb
.
0
20
40
60
80
100 95
36
2025
HIGHUPPER MIDDLELOWER MIDDLELOW
FIG. 8.5 s (mb mmb) p g p
g, b -m g (m p)
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60 AtlAs of heAdAche disorders And resources in the world 2011 61results | themes | issues
AtlAs of heAdAche disorders And resources
in the world 2011
0 5 10 15 20 25 30 35
34
33
33
29
26
22
22
21
20
13
11
11
10
9
7
6
6
5Lack of awareness of indirect costs
National poverty and/or social infrastructure problems
General problems of health-care organization/delivery
Excessive demand
Lack of research/data
Lack of political awareness
Iatrogenic and medical mismanagement
Headache-specific problems of health-care organization/delivery
Low priority for headache disorders
General lack of health-care resources
Lack of or need for management aids/support
Inadequate reimbursement
Lack of controls/regulation (including medication overuse)
Lack of public awareness
Non-availability of appropriate medication
Patient-related problems including co-morbiditiesbut excluding medication overuse
Headache-specific lack of health-care resources
Lack of professional education
FIG. 9.1 Pbm b g pp
(% pg)
encountered ProBlems
ng p k p mj
pbm b p
pp g .
t -x p p 18 g , g 9.1.
SALIENT FINDINGS
p t p mj pbm : p
k p (34 % pg -
), p- pbm g -mb b
xg m (33 %), -p k
- (33 %), -b ppp
m (29 %) k pb (26 %).
p l- m-m m k
g, pp m- g-
m p k -p .
p a m g -b ppp
m. t pg g-m, g p
b b ( pp 46 49).
rp m f m mbm,
b p , mp -
b. a mb p p g
m. o mm k
pp g.
results
tHemes issues
suggested chAnges
ng GP p k p
mj g mp pp
. t p,
g, g 9.2.
SALIENT FINDINGS
p amg g mp pp
, p b g
(75 % p).
p nx, mm b m (49 %) pg -
, -g, fg -g
.
p ab mp b
(37 %) mp g
(34 %) .
p o gg g mgm
, mp mbm, pp p , , bbg,
pp gp b
g m.
0 10 20 30 40 50 60 70 80
75
49
37
34
21
18
16
15
12
10
5Control/regulation
Lay support (groups)
Advocacy/lobbyi ng
Professional societies
Research
Improved reimbursements
Management aids/improvements
Improved health-care organization/delivery
Improved health-care availability
Awareness-raising
Professional education
FIG. 9.2 cg gg b p mp pp
(% pg)
imPlicAtions
p M pbm b g
p f p g
-g mp. t
p g
Atlas o Headache Disorders .
p B k b pp
g, k k
mpg g mgm . t
b ( pp 54 55).
p i , b b b g
.
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62 AtlAs of heAdAche disorders And resources in the world 2011 63the wAy forwArd
AtlAs of heAdAche disorders And resources
in the world 2011
tHe wAy ForwArd
h bq, p, bg
g b, b -g, -g
-. i b , b,
b , p.
g p m g
- xp .
t g m g, g g ,
mg m p .
PoliticAl will is needed
t g p g
pbm x, m m . t
Atlas o Headache Disorde rs .
Knowledge gAPs must Befilled
Kg m p mp. -
pmg , pg pp-b m b,
m , p -p .
heAlth cAre for heAdAchemust Be imProved
i b , , b 50 % pp
pm -g,
p: m -p m
mg m q / m k.
o , g f q
, k, m m
mpm g. a xmp, m-
g b, b pb
mb, b k m .
t g (10 %)
mp m q.
G g m pp b
mgm, p b -xp pm .
M x ; k m p -
m p b b
. t - pp b
mpm.
t g g p p g
xp, m q
g, g m. s b
pb, g.
a m mp p m gm, p m
m . exg m m
. t g - pp
mpm g g, p -
p .
dg k b mp g b
b , gb, p gg
ppp m b . i ,
m g x, b m g
k m b b mgm.
i p, p b m b,
p gm,
b x, m
p ( p 53).
rmbm , m pp, k b g. rmbm b mp, b
m b . G -
m g , p mbm
pp b m pp.
heAdAche services must BeorgAnized
t m pp - mg,
-p m- . i
pm g
m .
h b ,
qb g mb pp
b m m. og
g, pp g, mp
-ppp , b b m b
pm . t g mj pp
b mg. t pp 10 %
b p g: p
q b b m
m m.
a g -b gm x xpg
pm- mgm , p
- m , g,
g p pm .
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64 AtlAs of heAdAche disorders And resources in the world 2011 65Key messAges
AtlAs of heAdAche disorders And resources
in the world 2011tHe wAy ForwArd
educAtion is centrAl toremediAl Action
a p m g
mp,
mgm p m. cg g m - ,
m p g.
e q mp . M mp, -
p b kg g
m mb pb-
mp. t b kg mp g
b m, p b m, g
.
B m b pm ,
mp b g g, m
, qg g g m.
s, b g m g
p.
w, b 50 % pp pm-g, p. t,
pp b
b pb-
mp. i b - p,
b m
q m- ,
g b.
nAtionAl ProfessionAlorgAnizAtions should BesuPPortedn p g,
x, pmg , pg- mgm , g g,
mpg kg g
k gp.
spp bm m
p g pp g .
greAter investment inheAdAche services issensiBleG g , g
m ,
g -g pp b
, m b -g .
Key messAgespHeadache disorders are ubiquitous, prevalent and
disabling. Yet they are under-recognized, under-
diagnosed and under-treated worldwide:
aminorityofpeoplewithheadachedisordersareprofessionally diagnosed;
managementguidelinesareusedroutinelyin55%of
respondingcountries,butmuchlesscommonlyinlow-incomecountries;
despitetherebeingarangeofdrugswithefcacyagainstheadache,countriesinallincomecategories
identifynon-availabilityofappropriatemedicationas
abarriertobestmanagement;
worldwide,onlyfourhoursarecommittedtoheadachedisordersinformalundergraduatemedical
training, and lack of education is seen as the key
issueimpedinggoodmanagementofheadache;
illness that could be relieved is not, andburdens,both individual and societal, persist unnecessarily;
nancialcoststosocietythroughlostproductivityareenormous.
pAmongproposalsfor change:
better professional education ranks far above allothers;
athirdofrespondingcountriesalsorecommend
improvedorganizationanddeliveryofhealthcare
for headache.
pGiven the very high indirect costs of headache,greaterinvestmentinhealthcarethattreatsheadache
effectivelymaywellbecost-savingoverall.
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66 AtlAs of heAdAche disorders And resources in the world 2011 67references
AtlAs of heAdAche disorders And resources
in the world 2011reFereNCes
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p uK g p. Cephalalgia. 1999; 19:328 329.
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68 AtlAs of heAdAche disorders And resources in the world 2011 69list of resPondents
AtlAs of heAdAche disorders And resources
in the world 2011list oF respoNdeNts
A
Afghani stanMs am
Alani aJ Kj, lm Gj
Algeri at Mm
Argenti nal Bm, c a,h Gmb
Austral iaB egg, r sk
Austri as ob
Azera ijana v M
b
bahraina a J
bangladeshakm a u, ab nr, a hq
baradoss Mq, a Mi, s Gk-B
belarush nm
belgiumM v, Jd, J r
benindm h, eam g, c p t sg
boliia (Plurinational State of)
J c d Q
botswanaJ Mk
brazilab vKmk, M PP, r cmp am v , r mG, w G
bulgariai v
burkina Fasoa Mg
C
Cameroona K njm
CanadaMk G, J vk,v s
Chilen B-ub
Chinasg-y y, y' G, Jl Jg, s w
China, Hong Kong Special
Admini strati e Regiont l, c Kk w, lP c
China (Proince of Taiwan)s-J wg, P-J wg
Colomia
M v Gm
Cte d'loiret s-d
Croatiav dm, J s,Mj
Cyprusc M
Czech RepulicJ Mk, Bm sk
D
Denmarkrgm J, Mg &hpg; Pd
Dominican Repulica rb
E
Ecuador a, a lv-P , Xm h g
EgyptMm s e-tm
El Saladorc a d M, lib r, M G
EstoniaMk Bk, Mktpp, t Jg
Ethiopiaabb Km, am Bk,G a, yb zt , r tk -hm
F
Finland
Mk kk, hkk K,Jkk aj
Franceemm d dg, nsp, M l-M,dmq v
G
Georgiaa dg, M Kk
Germanys e
Greececm Kgg,e G, asp
Guamrm a c
Guatemala
h B sk
H
Hondurastm em
Hungaryl v
I
IcelandM h
IndiaK rk, G Gj, Gr, G Kk, hm dP, sj c
Iran (Islamic Repulic of)am c, ng seb, am eb,hj sm
IrelandPk l
Israelam Mk
ItalyP M, cP, i
J
Jamaicaam a
Japanhk ig, hk og,y Km
K
KenyaMm M Q
L
Latial sk,d Jg
Lithuaniavm B
Luxemourgax B, K J
M
MadagascarM a
Malawit hkm-c
MalaysiaJ tk
Maltaa G db, nbv, J aq
Mauritiuslm t M dmq,y n mm
Mexicor K, l r P M,ag h o vq , c lp P, e M hc, c s
MoroccoB e, s Bbe a, z l
N
NepalJg P ag,a am, rmKm Mj
Netherlands dkk, r vag, G t , G sm
Nigeriaag a a, Bibm, o obk
Norwayl Jb s, ac P, l l
O
OmanM a-sb, Pc Jb,r a-z
P
Pakistanh a, Mmm w
Perue B
Polandam sp, nk P
PortugalJm c d s, JM P M
Q
Qatardk d
R
Repulic of KoreaKg-s l
Repulic of Moldoai M, s ob
Romaniaa-M r
Russian Federationa amk, npp, agk nk,i abg, v op,
S
Saudi AraiaM Mm, rmM, abm a t,Mmm a Jm
Senegal s d
Seriazk M,J z-tjk
Singaporec s,
SloeniaBj z
South AfricaK d rm, es, i d, iskmp
SpainMg Ja l
Sri Lankas sk, sjP
SwedenM lbg, e em,M em, K ekbm, Ml
Switzerlandh i, c a
Syrian Ara Repulicam a, s n,am K
T
Thailandrg ck, asp, a sb
Trinidad and ToagoK rm
Tunisiaam Mb, n amm, h, B ab,Mm lbb ck
TurkeyMm zg, n K,ak s , sb s p,M e, B Bk
U
Ugandae dmb, rg Mmnm Kmg, sp hakm
United Ara EmiratesJ s i, M tk,n s
United Kingdom of Great britain
and Northern IrelandPp ab, P d,tm s, a t
United Repulic of TanzaniaJ Mb, vm l,wm BP Mj
United States of Americaa i s, s w B,rbk
Uruguay
M d M
v
venezue la (bol iaria n
Repulic of)e P d P, vmm
viet N amng dg t, l d h,dg t t, P hgM
Y
Yemenab hkm smab , w q h ,hm a
Z
ZamiaB Kmg, l
cmmb lmb,Mp a
ZimaweJ Mk
w m g g , g
m b , bg m g bm
g m m q bg Atlas o Headache Disorders .
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