Migraine: A Worldwide Crisis?

It’s a commonly repeated statistic that migraine is one of the top 20 disabilities in the world. But with new research, it’s time for us to update our information.

I would like to say that with better treatments, improved awareness, and cutting-edge research, migraine is no longer in the top 20. I would like to say that.

Migraine: A Worldwide CrisisBut migraine has actually moved up the list, not down.

As the findings of the Global Burden of Disease Survey 2000 (GBD2000) became public in the years that followed, it became clear that migraine was a major global concern. It was #19 on the list of worldwide disabilities.

But there were problems with GBD2000. Major parts of the world were not properly represented. And let’s be honest – our understanding of migraine and the disability it causes has greatly increased in the years following.

Ten years later, the Global Burden of Disease Survey 2010 (GBD2010) attempted to fill in the gaps, with better statistics from more countries. The results are troubling.

In short, migraine is now easily on the list of the world’s top ten disabilities.*

Exactly where migraine is on the list depends on the various measurements used. But let’s look at a few statistics.

Migraine prevalence was listed as 14.7%. That’s over a billion people.

The world’s most common health issue? It’s in your mouth, actually – tooth decay. But after that – tension type headache and migraine.

Those with migraine tended to spend about 5.3% of their time having migraine attacks. That means that if you live to be 71, you will have spent 3 years, 9 months actually having migraine attacks.

People with tension type headache are, on average, 4% disabled. People with migraine 43.3%.

However, the focus on migraine attacks (the “ictal” state of migraine) is misleading. We now know that there are considerable health concerns – and even disability – in between migraine attacks.

If we really took this all into account, and better represented some of the common headache disorders on the list, just how much worldwide disability would headache disorders account for?

In one measurement, “Years Lost to Disability” (YLD), migraine comes 8th. Here’s the full list:

  • Low back pain
  • Major depressive disorder
  • Iron-deficiency anaemia
  • Neck pain
  • Chronic obstructive pulmonary disease
  • Other musculoskeletal disorders
  • Anxiety disorders
  • Migraine
  • Diabetes
  • Falls

Imagine the burden on society for all of these. In the case if migraine, if we only include disability during an actual attack, how much time is lost per year due to disability? For every 100 people on earth, 284.6 days are lost to disability from migraine every year. It would be as if every man, woman and child lost almost 3 days of life every year – except that the entire burden is on 14.7% of the population, so for those people it’s much more.

And we’re not talking about migraine before treatment. This measures migraine as it is, whether treated or not. In other words, migraine remains high on the list in spite of treatments that are being given.

Is migraine a worldwide crisis? There’s no doubt. And although headache disorders should actually probably be higher on the list – and may be, as we get better and more information – they should be falling due to treatment.

Although there is no miracle cure for everyone, there are excellent treatments that should easily knock migraine out of the top ten, if not out of the top twenty. Why aren’t people getting the treatment they need?

The authors of Migraine: the seventh disabler, published in The Journal of Headache and Pain, put it well (emphasis mine):

We might be satisfied by this; but rather we should be appalled. GBD measures disease burden as it is – alleviated by whatever treatments are made available. Headache disorders are among the top ten causes of disability because they are common and disabling; that is clear. Headache is one of the most frequent medical complaints: almost everybody has experienced it, at least 10% of adults everywhere are sometimes disabled by it, and up to 3% live with it on more days than not. But for what conceivable reason do headache disorders remain among these ignominious top ten when they are largely treatable? Another recent global survey, conducted collaboratively by WHO and Lifting The Burden, described “worldwide neglect of major causes of public ill-health, and the inadequacies of responses to them in countries throughout the world”. It drew attention to the very large numbers of people disabled by headache who do not receive effective health care. The barriers responsible for this might vary throughout the world, but poor awareness of headache in a context of limited resources generally – and in health care in particular – was constantly among them. The consequences are inevitable: illness that can be relieved is not, and heavy burdens, both individual and societal, persist when they can be mitigated.

To summarize: Even when good treatment is available, people are not getting the treatment.

Resources:

* Migraine is listed as the 8th most burdensome disease, 7th among non-communicable diseases, and 1st among neurological disorders.

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