Optimal health care for people with headache

Headache disorders are largely treatable, but effective care fails to reach most people. Drugs for headache are not the only things patients need, and these drugs will not make an impact without improvements in health care services overall.

The Global Campaign aims to bring better health care to people with headache.  This involves planning and implementing quality health care services.

Fourteen specialist centers in Europe evaluated the quality of their services based on 9 domains:

• Accurate diagnosis 
• Individualized management 
• Appropriate referral pathways 
• Education of patients 
• Convenience and comfort 
• Patient satisfaction 
• Care that is efficient and equitable
• Outcome assessment 
• Patient safety

They used 26 indicators of optimal care, and translated evaluation instruments to 10 languages.  They found that these quality indicators were useful for uncovering deficits and setting benchmarks for care.  The full paper can be downloaded here.

Moving forward

For researchers

• The next big step is to take the evaluation process into primary care, where most patients with headache are treated.

For clinicians

• Evaluate your clinic's approach to headache management according to these benchmarks.

For people with headache

• Be aware of standards for optimal headache management.  It does not start and end with painkillers.

References:

Schramm S, Uluduz D, Gouveia RG, Jensen R, Siva A, Uygunoglu U, Gvantsa G, Mania M, Braschinsky M, Filatova E, Latysheva N, Osipova V, Skorobogatykh K, Azimova J, Straube A, Eren OE, Martelletti P, De Angelis V, Negro A, Linde M, Hagen K, Radojicic A, Zidverc-Trajkovic J, Podgorac A, Paemeleire K, De Pue A, Lampl C, Steiner TJ, Katsarava Z. Headache service quality: evaluation of quality indicators in 14 specialist-care centres. J Headache Pain. 2016 Dec;17(1):111.

Peters M, Jenkinson C, Perera S, Loder E, Jensen R, Katsarava Z, Gil Gouveia R, Broner S, Steiner TJ. Quality in the provision of headache care. 2: defining quality and its indicators. J Headache Pain. 2012;13:449–457.

Photo:
© Portrait Images Asia By Nonwarit | Shutterstock

Migraine and altitude

Living at high altitude in Nepal is associated not only with higher migraine prevalence but also higher severity of attacks (measured in terms of frequency, duration, and intensity of pain). The prevalence of migraine is very high in Nepal: 34.7% (Manandhar, 2015).  In comparison, the global prevalence of migraine is about 11% (Stovner, 2007). 

A population-based study among 2100 Nepali showed that migraine prevalence increased from 27.9% to 45.5% with increasing altitude from 0 to 2499 meters. Higher altitude increased the likelihood of having migraine compared to living at under 500 meters (Linde 2017).  

At an altitude of 2500 meters or more, the prevalence was slightly lower at 37.9% (although still high in global terms); and headache symptoms were not as bad.  The authors suggested that there may be physiological adaptations that kicked in at very high altitudes.  However, the lower prevalence and severity of migraine might be due to self-selection.  People with really bad headaches might have chosen to live elsewhere.

The association with altitude was not seen in tension-type headache. Participants were selected from  among the local population, not among visitors who experience "high-altitude headache," a condition where the body is not given enough time to adjust to rapid ascent to above 2500 meters. The authors also tried to rule out genetic or cultural factors: prevalence was so much higher than in nearby China and India; even in Nepalese districts lying on the border with China.

This research is important because:

• Association with high altitude could explain the high prevalence of migraine in Nepal.
• The body's reactions to living at high altitude might be a key to understanding the causes of migraine.
• Globally, half a billion people live at altitudes above 1500 meters.  People with migraine who live at high altitudes might benefit from advice to live at altitudes below 500 meters.  

References:
Linde M, Edvinsson L, Manandhar K, Risal A, Steiner TJ. Migraine associated with altitude: results from a population-based study in Nepal. Eur J Neurol 2017;24(8):1055-1061.

Manandhar K, Risal A, Steiner TJ, Holen A, Linde M. The prevalence of primary headache disorders in Nepal: a nationwide population-based study. J Headache Pain 2015; 16: 95.

Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton RB, Scher AI, Steiner TJ, Zwart J-A. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007; 27:193-210.

Photo:
View on Namche Bazar, Khumbu district, Himalayas, Nepal
© Olga Danylenko | Shutterstock