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Headache Disorders: Lifting the Burden (Part I)
An Interview with Dawn C. Buse, Ph.D., and Matthew S. Robbins, MD

Dawn C. Buse, Ph.D., is a licensed clinical psychologist and Director of Behavioral Medicine for the Montefiore Headache Center. She is also an Assistant Professor in the Department of Neurology of Albert Einstein College of Medicine of Yeshiva University and Assistant Professor in the Clinical Health Psychology Doctoral Program of Ferkauf Graduate School of Psychology of Yeshiva University. She serves on the American Headache Society’s Education Committee and Electronic Media Committee, and the “Occupational Burden of Headache-Outcome Measures for Headache” working group of the World Health Organization “Lifting the Burden” campaign.

Matthew S. Robbins, MD, is Assistant Professor of Neurology, Albert Einstein College of Medicine, Chief of Service-Neurology, Weiler/Einstein Division of Montefiore, and Director of Inpatient Services, Montefiore Headache Center.

Dr. Buse and Dr. Robbins collaborated on this joint interview which will be posted in two parts. This interview is Part I.

 

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Questions

1: Please describe the 2011 World Health Organization’s (WHO) first global atlas of headache disorders and its major findings.

2: As specialists in the treatment of headache disorders, were these findings a surprise to you?

3: The WHO report identified lack of healthcare provider education as a key issue in under-diagnosis and undertreatment, and described that worldwide, only four hours are committed to headache disorders in formal undergraduate medical training. Is this the case in the United States?

4: Does the idea “it’s just a headache” have an impact on the people seeking treatment for headaches, and on amount of time healthcare providers time spend learning how to treat them?

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Evelyn Corsini, MSW:

Please describe the 2011 World Health Organization’s (WHO) first global atlas of headache disorders and its major findings.

Dawn C. Buse, Ph.D., and Matthew S. Robbins, MD: The Atlas of Headache Disorders and Resources in the World, 2011 is a collaborative effort of the World Health Organization and the Lifting the Burden Global Campaign Against Headache1,2. The atlas was intended to gather and present data internationally on the prevalence, burden, and societal costs of headache worldwide. Data was collected in questionnaires from neurologists, primary care providers, and patient representatives in 101 countries, between October 2006 and March 2009, along with epidemiological data compiled in a systematic review of published studies.

A summary of the primary finding is that headache disorders are common, prevalent and disabling. Yet they are under-recognized, underdiagnosed and undertreated, everywhere, including in the United States.

EC: As specialists in the treatment of headache disorders, were these findings a surprise to you?

DB & MR: No, this report confirms our research and our clinical observations. The atlas proposes three types of barriers to care: 1) clinical barriers; 2) social barriers; and 3) political/economic barriers.

Recently we analyzed data from individuals with migraine in the US population to study barriers to care in this country. We postulated that, while effective medical care for migraine is a complex process, at minimum, persons with migraine must achieve these 3 steps to receive appropriate medical care.

  1. Consult a healthcare professional
  2. Receive an accurate diagnosis of migraine
  3. Receive prescriptions for appropriate pharmacologic treatment
We used data from the 2009 American Migraine Prevalence and Prevention study, a longitudinal study of 24,000 individuals with severe headache identified in 2004 and studied through 2009. Of the 775 eligible participants we identified with episodic migraine, we learned that only 26.3% of these persons with migraine had successfully completed all three steps.

The reasons varied. Strongest predictors for not completing all three steps were related to having or not having health insurance, increased headache-related disability, and high average headache pain. Among those who were diagnosed, household income was the strongest predictor of receiving appropriate treatment.

EC: The WHO report identified lack of healthcare provider education as a key issue in under-diagnosis and undertreatment, and described that worldwide, only four hours are committed to headache disorders in formal undergraduate medical training. Is this the case in the United States?

DB & MR: There is so much competition to cover subjects in a US medical school curriculum that very little time is spent on the common problem of headache. Students may spend more time learning about the “zebras”, the less common neurological problems, than headaches.

The amount of training on headaches in a neurology residency program depends on the kind of headache program at the facility and there are few headache programs in the United States in academically connected training centers. In addition, there is poor funding for research on headache disorders. These factors therefore limit advanced healthcare provider training in headache disorder.

EC: Does the idea “it’s just a headache” have an impact on the people seeking treatment for headaches, and on amount of time healthcare providers time spend learning how to treat them?

DB & MR: This is a big factor. However, this survey clearly demonstrates that it is not accurate to lightly dismiss headache disorders as a medical problem with no impact. The burden to individuals, and to society, especially through lost productivity, is enormous. Employers now estimate the financial costs of employees who come to work when they are not feeling well, and cannot function productively, and call this “presenteeism”.

Assessing and treating headache disorders likely requires more time than many healthcare providers can provide to a patient who reports the complaint of “headaches”. In addition, many healthcare providers are not familiar with, or not comfortable, prescribing medications which have been developed to abort and treat migraine headaches.

[This is the end of Part I. Part 2 will focus on resources that healthcare providers can easily access for more education about the assessment and treatment of headache disorders].


  1. http://www.who.int/mental_health/neurology/headache/en/index.html
  2. http://www.who.int/mental_health/management/who_atlas_headache_disorders.pdf

 

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4/23/2014
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