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The Journal of Headache and Pain

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Open Access 01-12-2018 | Research article

Health-care utilization for headache disorders in Nepal: a population-based door-to-door survey

Authors: Kedar Manandhar, Ajay Risal, Mattias Linde, Timothy J. Steiner

Published in: The Journal of Headache and Pain | Issue 1/2018

Abstract

Background

Headache disorders are an important global public-health problem, but under-diagnosed, undertreated and under-prioritized. Deficiencies in health care for headache, present everywhere, are likely to be greater in poorly-resourced countries. This study reports on health-care utilization for headache in Nepal, a low-income country with high headache burden.

Methods

We took data from a cross-sectional, nationwide population-based door-to-door survey, with multistage cluster random sampling. Face-to-face structured interviews included enquiry into consultations with professional health-care providers (HCPs), and investigations and treatments for headache. Analysis included associations with sociodemographic variables and indices of symptom severity.

Results

Of 2100 participants, 1794 reported headache during the preceding year (mean age 36.1 ± 12.6 years; male/female ratio 1:1.6). Of these, 58.4% (95% CI: 56.1–60.7%) had consulted at least once in the year with HCPs at any level, most commonly (25.0%) paramedical; 15.0% had consulted pharmacists, 10.8% general physicians and 7.6% specialists (of any type). Participants with probable medication-overuse headache consulted most (87.0%), followed by those with migraine (67.2%) and those with tension-type headache (48.6%; p < 0.001). A minority (11.9%) were investigated, mostly (8.9%) by eye tests. Half (50.8%) had used conventional medications for headache in the preceding month, paracetamol being by far the most common (38.0%), and 10.3% had used herbal therapies.

Consultation was positively associated with rural habitation (AOR = 1.5; p < 0.001). Proportions consulting increased in line with all indices of symptom severity.

Conclusions

Although over half of participants with headache had consulted professional HCPs, this reflects demand, not quality of care. Although 7.6% had seen specialists, very few would have been headache specialists in any sense of this term. High persistent burden, with only half of participants with headache using conventional medications, and these not best chosen, suggests these consultations fell far short of meeting need. Health policy in Nepal should recognise this, since the consequences otherwise are costly: lost health, diminished productivity and damaged national economy. On a positive note, the proportions consulting suggest that capacity exists at multiple levels within the Nepalese health system. With this to build upon, structured headache services in line with international recommendations appear achievable in Nepal. Educational programmes are the essential requirement.

World Health Organization and Lifting The Burden (2011) Atlas of headache disorders and resources in the world 2011. WHO, Geneva

Jensen R, Stovner LJ (2008) Epidemiology and comorbidity of headache. Lancet Neurol 7(4):354–361. https://doi.org/10.1016/s1474-4422(08)70062-0 CrossRefPubMed

Linde M, Gustavsson A, Stovner LJ, Steiner TJ, Barre J, Katsarava Z, Lainez JM, Lampl C, Lanteri-Minet M, Rastenyte D, Ruiz de la Torre E, Tassorelli C, Andree C (2012) The cost of headache disorders in Europe: the Eurolight project. Eur J Neurol 19(5):703–711. https://doi.org/10.1111/j.1468-1331.2011.03612.x CrossRefPubMed

Westergaard ML, Hansen EH, Glumer C, Olesen J, Jensen RH (2014) Definitions of medication-overuse headache in population-based studies and their implications on prevalence estimates: a systematic review. Cephalalgia 34(6):409–425. https://doi.org/10.1177/0333102413512033 CrossRefPubMed

Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, Carter A, Casey DC, Charlson FJ, Chen AZ, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Dilegge T, Erskine HE, Ferrari AJ, Fitzmaurice C, Fleming T, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Johnson CO, Kassebaum NJ et al (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet 388(10053):1545–1602. https://doi.org/10.1016/s0140-6736(16)31678-6 CrossRef

Vos T, Abajobir AA, Abbafati C, Abbas KM, Abate KH, Abd-Allah F, Abdulle AM, Abebo TA, Abera SF, Aboyans V, Abu-Raddad LJ, Ackerman IN, Adamu AA, Adetokunboh O, Afarideh M, Afshin A, Agarwal SK, Aggarwal R, Agrawal A, Agrawal S, Ahmad Kiadaliri A, Ahmadieh H, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Aiyar S, Akinyemi RO et al (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet (London, England) 390(10100):1211–1259. https://doi.org/10.1016/s0140-6736(17)32154-2 CrossRef

Zebenigus M, Tekle-Haimanot R, Worku DK, Thomas H, Steiner TJ (2016) The prevalence of primary headache disorders in Ethiopia. J Headache Pain 17(1):110. https://doi.org/10.1186/s10194-016-0704-z CrossRefPubMedPubMedCentral

Zebenigus M, Tekle-Haimanot R, Worku DK, Thomas H, Steiner TJ (2017) The burden of headache disorders in Ethiopia: national estimates from a population-based door-to-door survey. J Headache Pain 18(1):58. https://doi.org/10.1186/s10194-017-0765-7 CrossRefPubMedPubMedCentral

Kulkarni GB, Rao GN, Gururaj G, Stovner LJ, Steiner TJ (2015) Headache disorders and public ill-health in India: prevalence estimates in Karnataka state. J Headache Pain 16:67. https://doi.org/10.1186/s10194-015-0549-x CrossRefPubMedPubMedCentral

10.

Rao GN, Kulkarni GB, Gururaj G, Stovner LJ, Steiner TJ (2015) The burden attributable to headache disorders in India: estimates from a community-based study in Karnataka state. J Headache Pain 16:94. https://doi.org/10.1186/s10194-015-0574-9 CrossRefPubMedPubMedCentral

11.

Herekar AA, Ahmad A, Uqaili UL, Ahmed B, Effendi J, Alvi SZ, Shahab MA, Javed U, Herekar AD, Khanani R, Steiner TJ (2017) Primary headache disorders in the adult general population of Pakistan - a cross sectional nationwide prevalence survey. J Headache Pain 18(1):28. https://doi.org/10.1186/s10194-017-0734-1 CrossRefPubMedPubMedCentral

12.

Mbewe E, Zairemthiama P, Yeh HH, Paul R, Birbeck GL, Steiner TJ (2015) The epidemiology of primary headache disorders in Zambia: a population-based door-to-door survey. J Headache Pain 16:515. https://doi.org/10.1186/s10194-015-0515-7 CrossRefPubMed

13.

Mbewe E, Zairemthiama P, Paul R, Birbeck GL, Steiner TJ (2015) The burden of primary headache disorders in Zambia: national estimates from a population-based door-to-door survey. J Headache Pain 16:513. https://doi.org/10.1186/s10194-015-0513-9 CrossRefPubMed

14.

United States Central Intelligence Agency The World Factbook. https://www.cia.gov/library/publications/the-world-factbook/geos/np.html. Accessed 12 Mar 2018

15.

Manandhar K, Risal A, Steiner TJ, Holen A, Linde M (2015) The prevalence of primary headache disorders in Nepal: a nationwide population-based study. J Headache Pain 16:95. https://doi.org/10.1186/s10194-015-0580-y CrossRefPubMedPubMedCentral

16.

Manandhar K, Risal A, Linde M, Steiner TJ (2015) The burden of headache disorders in Nepal: estimates from a population-based survey. J Headache Pain 17:3. https://doi.org/10.1186/s10194-016-0594-0 CrossRefPubMed

17.

Risal A, Manandhar K, Steiner TJ, Holen A, Koju R, Linde M (2014) Estimating prevalence and burden of major disorders of the brain in Nepal: cultural, geographic, logistic and philosophical issues of methodology. J Headache Pain 15:51. https://doi.org/10.1186/1129-2377-15-51 CrossRefPubMedPubMedCentral

18.

Manandhar K, Risal A, Steiner TJ, Holen A, Koju R, Linde M (2014) Estimating the prevalence and burden of major disorders of the brain in Nepal: methodology of a nationwide population-based study. J Headache Pain 15:52. https://doi.org/10.1186/1129-2377-15-52 CrossRefPubMedPubMedCentral

19.

Steiner TJ, Gururaj G, Andree C, Katsarava Z, Ayzenberg I, Yu SY, Al Jumah M, Tekle-Haimanot R, Birbeck GL, Herekar A, Linde M, Mbewe E, Manandhar K, Risal A, Jensen R, Queiroz LP, Scher AI, Wang SJ, Stovner LJ (2014) Diagnosis, prevalence estimation and burden measurement in population surveys of headache: presenting the HARDSHIP questionnaire. J Headache Pain 15:3. https://doi.org/10.1186/1129-2377-15-3 CrossRefPubMedPubMedCentral

20.

Peters M, Bertolote JM, Houchin C, Kandoura T, Steiner TJ (2007) Tranlation protocol. J Headache Pain 8(Suppl 1):S40–S47

21.

Headache Classification Committee of the International Headache Society (IHS) (2013) The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33(9):629–808. https://doi.org/10.1177/0333102413485658 CrossRef

22.

Stovner LJ, Al Jumah M, Birbeck GL, Gururaj G, Jensen R, Katsarava Z, Queiroz LP, Scher AI, Tekle-Haimanot R, Wang SJ, Steiner TJ (2014) The methodology of population surveys of headache prevalence, burden and cost: principles and recommendations from the global campaign against headache. J Headache Pain 15:5. https://doi.org/10.1186/1129-2377-15-5 CrossRefPubMedPubMedCentral

23.

Takeshima T, Ishizaki K, Fukuhara Y, Ijiri T, Kusumi M, Wakutani Y, Mori M, Kawashima M, Kowa H, Adachi Y, Urakami K, Nakashima K (2004) Population-based door-to-door survey of migraine in Japan: the Daisen study. Headache 44(1):8–19. https://doi.org/10.1111/j.1526-4610.2004.04004.x CrossRefPubMed

24.

Wang SJ, Fuh JL, Young YH, Lu SR, Shia BC (2001) Frequency and predictors of physician consultations for headache. Cephalalgia 21(1):25–30. https://doi.org/10.1046/j.1468-2982.2001.00138.x CrossRefPubMed

25.

Rasmussen BK, Jensen R, Olesen J (1992) Impact of headache on sickness absence and utilisation of medical services: a Danish population study. J Epidemiol Community Health 46(4):443–446CrossRef

26.

Lipton RB, Scher AI, Steiner TJ, Bigal ME, Kolodner K, Liberman JN, Stewart WF (2003) Patterns of health care utilization for migraine in England and in the United States. Neurology 60(3):441–448CrossRef

27.

Lampl C, Buzath A, Baumhackl U, Klingler D (2003) One-year prevalence of migraine in Austria: a nation-wide survey. Cephalalgia 23(4):280–286. https://doi.org/10.1046/j.1468-2982.2003.00509.x CrossRefPubMed

28.

Lipton RB, Scher AI, Kolodner K, Liberman J, Steiner TJ, Stewart WF (2002) Migraine in the United States: epidemiology and patterns of health care use. Neurology 58(6):885–894CrossRef

29.

Edmeads J, Findlay H, Tugwell P, Pryse-Phillips W, Nelson RF, Murray TJ (1993) Impact of migraine and tension-type headache on life-style, consulting behaviour, and medication use: a Canadian population survey. Can J Neurol Sci 20(2):131–137CrossRef

30.

Steiner TJ (2005) Lifting The Burden: the global campaign to reduce the burden of headache worldwide. J Headache Pain 6(5):373–377. https://doi.org/10.1007/s10194-005-0241-7 CrossRef

31.

Steiner TJ, Antonaci F, Jensen R, Lainez MJ, Lanteri-Minet M, Valade D (2011) Recommendations for headache service organisation and delivery in Europe. J Headache Pain 12(4):419–426. https://doi.org/10.1007/s10194-011-0320-x CrossRefPubMedPubMedCentral

32.

Liu R, Yu S, He M, Zhao G, Yang X, Qiao X, Feng J, Fang Y, Cao X, Steiner TJ (2013) Health-care utilization for primary headache disorders in China: a population-based door-to-door survey. J Headache Pain 14:47. https://doi.org/10.1186/1129-2377-14-47 CrossRefPubMedPubMedCentral

33.

Stephens G, Derry S, Moore RA (2016) Paracetamol (acetaminophen) for acute treatment of episodic tension-type headache in adults. Cochrane Database Syst Rev (6):Cd011889. https://doi.org/10.1002/14651858.CD011889.pub2

34.

WHO Pharmaceuticals Newsletter 2002, No. 04. http://apps.who.int/medicinedocs/en/d/Js4943e/3.1.html. Accessed 12 Aug 2018

35.

Government of Nepal, Ministry of Health and Population (MOHP) [Nepal] (2014) National Health Policy-2071.

36.

Linde M, Edvinsson L, Manandhar K, Risal A, Steiner TJ (2017) Migraine associated with altitude: results from a population-based study in Nepal. Eur J Neurol 24(8):1055–1061. https://doi.org/10.1111/ene.13334 CrossRefPubMedPubMedCentral

37.

Katsarava Z, Mania M, Lampl C, Herberhold J, Steiner TJ (2018) Poor medical care for people with migraine in Europe - evidence from the Eurolight study. J Headache Pain 19(1):10. https://doi.org/10.1186/s10194-018-0839-1 CrossRefPubMedPubMedCentral

Title: Health-care utilization for headache disorders in Nepal: a population-based door-to-door survey
Authors: Kedar Manandhar
Ajay Risal
Mattias Linde
Timothy J. Steiner
Publication date: 01-12-2018
Publisher: Springer Milan
Published in: The Journal of Headache and Pain / Issue 1/2018
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI: https://doi.org/10.1186/s10194-018-0942-3

At a glance: The STEP trials

Springer Medicine

Health-care utilization for headache disorders in Nepal: a population-based door-to-door survey

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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