The Burden of Headache

  • Lars Jacob Stovner
  • Luiz Paulo Queiroz
Reference work entry


Studies on headache burden are mostly performed to show the size of the public health problem. This chapter, dealing with the noneconomic aspects of headache burden, describes the methods and validated instruments to measure disability and reduction in the quality of life due to headache and refers some interesting results from such studies. Most studies until now have dealt with migraine, but there are also some studies on headache in general and cluster headache in particular. According to disease burden assessments by the World Health Organization, migraine alone may be among the 20 most disabling conditions worldwide. For tension-type headache, there are not sufficient data yet. Some data indicate that this headache type, due to its high prevalence, may entail a higher burden than migraine. Part of the headache burden may be due to psychiatric comorbidities of headache. A few studies indicate that headaches may lead to reductions in quality of life that are higher than in many other chronic disorders. The interictal burden of, e.g., migraine and cluster headache is probably mostly related to worry for later attacks and restrictions in lifestyle to avoid attacks, but some people also fail to recover completely. It has also been shown that migraine, in several ways, influences the lives of partners and children.


Cluster Headache Migraine Patient Headache Disorder Medication Overuse Headache Sufferer 
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  1. Anttila P, Metsahonkala L, Mikkelsson M, Helenius H, Sillanpaa M (2001) Comorbidity of other pains in schoolchildren with migraine or nonmigrainous headache. J Pediatr 138(2):176–180PubMedCrossRefGoogle Scholar
  2. Bingefors K, Isacson D (2004) Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain – a gender perspective. Eur J Pain 8(5):435–450PubMedCrossRefGoogle Scholar
  3. Boardman HF, Thomas E, Croft PR, Millson DS (2003) Epidemiology of headache in an English district. Cephalalgia 23(2):129–137PubMedCrossRefGoogle Scholar
  4. Brandes JL (2008) The migraine cycle: patient burden of migraine during and between migraine attacks. Headache 48(3):430–441PubMedCrossRefGoogle Scholar
  5. Colás R, Muñoz P, Temprano R, Gómez C, Pascual J (2004) Chronic daily headache with analgesic overuse: epidemiology and impact on quality of life. Neurology 62(8):1338–1342PubMedGoogle Scholar
  6. Cole JC, Lin P, Rupnow MF (2007) Validation of the migraine-specific quality of life questionnaire version 2.1 (MSQ v. 2.1) for patients undergoing prophylactic migraine treatment. Qual Life Res 16(7):1231–1237PubMedCrossRefGoogle Scholar
  7. D’Amico D, Solari A, Usai S, Santoro P, Bernardoni P, Frediani F et al (2006) Improvement in quality of life and activity limitations in migraine patients after prophylaxis. A prospective longitudinal multicentre study. Cephalalgia 26(6):691–696PubMedCrossRefGoogle Scholar
  8. Dahlöf CG, Dimenäs E (1995) Migraine patients experience poorer subjective well-being/quality of life even between attacks. Cephalalgia 15(1):31–36PubMedCrossRefGoogle Scholar
  9. De Diego EV, Lanteri-Minet M (2005) Recognition and management of migraine in primary care: influence of functional impact measured by the headache impact test (HIT). Cephalalgia 25(3):184–190PubMedCrossRefGoogle Scholar
  10. Dueland AN, Leira R, Burke TA, Hillyer EV, Bolge S (2004) The impact of migraine on work, family, and leisure among young women – a multinational study. Curr Med Res Opin 20(10):1595–1604PubMedCrossRefGoogle Scholar
  11. Duru G, Auray JP, Gaudin AF, Dartigues JF, Henry P, Lantéri-Minet M et al (2004) Impact of headache on quality of life in a general population survey in France (GRIM2000 Study). Headache 44(6):571–580PubMedCrossRefGoogle Scholar
  12. Gobel H, Petersen-Braun M, Soyka D (1994) The epidemiology of headache in Germany: a nationwide survey of a representative sample on the basis of the headache classification of the International Headache Society. Cephalalgia 14(2):97–106PubMedCrossRefGoogle Scholar
  13. Guitera V, Muñoz P, Castillo J, Pascual J (2002) Quality of life in chronic daily headache: a study in a general population. Neurology 58(7):1062–1065PubMedGoogle Scholar
  14. Hagen K, Einarsen C, Zwart JA, Svebak S, Bovim G (2002) The co-occurrence of headache and musculoskeletal symptoms amongst 51 050 adults in Norway. Eur J Neurol 9(5):527–533PubMedCrossRefGoogle Scholar
  15. Hamelsky SW, Lipton RB, Stewart WF (2005) An assessment of the burden of migraine using the willingness to pay model. Cephalalgia 25(2):87–100PubMedCrossRefGoogle Scholar
  16. Hershey AD, Powers SW, Vockell AL, LeCates S, Kabbouche MA, Maynard MK (2001) PedMIDAS: development of a questionnaire to assess disability of migraines in children. Neurology 57(11):2034–2039PubMedGoogle Scholar
  17. Hu XH, Markson LE, Lipton RB, Stewart WF, Berger ML (1999) Burden of migraine in the United States: disability and economic costs. Arch Intern Med 159(8):813–818PubMedCrossRefGoogle Scholar
  18. Jensen RM, Lyngberg A, Jensen RH (2007) Burden of cluster headache. Cephalalgia 27(6):535–541PubMedCrossRefGoogle Scholar
  19. Kececi H, Dener S, Analan E (2003) Co-morbidity of migraine and major depression in the Turkish population. Cephalalgia 23(4):271–275PubMedCrossRefGoogle Scholar
  20. Kosinski M, Bayliss MS, Bjorner JB, Ware JE Jr, Garber WH, Batenhorst A et al (2003) A six-item short-form survey for measuring headache impact: the HIT-6. Qual Life Res 12(8):963–974PubMedCrossRefGoogle Scholar
  21. Kroner-Herwig B, Heinrich M, Vath N (2010) The assessment of disability in children and adolescents with headache: adopting PedMIDAS in an epidemiological study. Eur J Pain 14(9):951–958PubMedCrossRefGoogle Scholar
  22. Leonardi M, Steiner TJ, Scher AT, Lipton RB (2005) The global burden of migraine: measuring disability in headache disorders with WHO’s classification of functioning, disability and health (ICF). J Headache Pain 6(6):429–440PubMedCrossRefGoogle Scholar
  23. Linde M, Dahlöf C (2004) Attitudes and burden of disease among self-considered migraineurs – a nation-wide population-based survey in Sweden. Cephalalgia 24(6):455–465PubMedCrossRefGoogle Scholar
  24. Lipton RB, Hamelsky SW, Kolodner KB, Steiner TJ, Stewart WF (2000a) Migraine, quality of life, and depression: a population-based case-control study. Neurology 55(5):629–635PubMedGoogle Scholar
  25. Lipton RB, Hamelsky SW, Kolodner KB, Steiner TJ, Stewart WF (2000b) Migraine, quality of life, and depression: a population-based case-control study. Neurology 55(5):629–635PubMedGoogle Scholar
  26. Lipton RB, Stewart WF, Sawyer J, Edmeads JG (2001) Clinical utility of an instrument assessing migraine disability: the migraine disability assessment (MIDAS) questionnaire. Headache 41(9):854–861PubMedGoogle Scholar
  27. Lipton RB, Bigal ME, Kolodner K, Stewart WF, Liberman JN, Steiner TJ (2003a) The family impact of migraine: population-based studies in the USA and UK. Cephalalgia 23(6):429–440PubMedCrossRefGoogle Scholar
  28. Lipton RB, Liberman JN, Kolodner KB, Bigal ME, Dowson A, Stewart WF (2003b) Migraine headache disability and health-related quality-of-life: a population-based case-control study from England. Cephalalgia 23(6):441–450PubMedCrossRefGoogle Scholar
  29. Lucas C, Chaffaut C, Artaz MA, Lantéri-Minet M (2005) FRAMIG 2000: medical and therapeutic management of migraine in France. Cephalalgia 25(4):267–279PubMedCrossRefGoogle Scholar
  30. Martin BC, Pathak DS, Sharfman MI, Adelman JU, Taylor F, Kwong WJ et al (2000) Validity and reliability of the migraine-specific quality of life questionnaire (MSQ Version 2.1). Headache 40(3):204–215PubMedCrossRefGoogle Scholar
  31. Michel P, Dartigues JF, Lindoulsi A, Henry P (1997) Loss of productivity and quality of life in migraine sufferers among French workers: results from the GAZEL cohort. Headache 37(2):71–78PubMedCrossRefGoogle Scholar
  32. Morillo LE, Alarcon F, Aranaga N, Aulet S, Chapman E, Conterno L et al (2005) Prevalence of migraine in Latin America. Headache 45(2):106–117PubMedCrossRefGoogle Scholar
  33. Nachit-Ouinekh F, Dartigues JF, Henry P, Becg JP, Chastan G, Lemaire N et al (2005) Use of the headache impact test (HIT-6) in general practice: relationship with quality of life and severity. Eur J Neurol 12(3):189–193PubMedCrossRefGoogle Scholar
  34. Olesen J, Leonardi M (2003) The burden of brain diseases in Europe. Eur J Neurol 10(5):471–477PubMedCrossRefGoogle Scholar
  35. Osterhaus JT, Townsend RJ, Gandek B, Ware JE (1994) Measuring the functional status and well-being of patients with migraine headache. Headache 34(6):337–343PubMedCrossRefGoogle Scholar
  36. Sauro KM, Rose MS, Becker WJ, Christie SN, Giammarco R, Mackie GF et al (2010) HIT-6 and MIDAS as measures of headache disability in a headache referral population. Headache 50:383–395Google Scholar
  37. Shin HE, Park JW, Kim YI, Lee KS (2008) Headache impact test-6 (HIT-6) scores for migraine patients: their relation to disability as measured from a headache diary. J Clin Neurol 4(4):158–163PubMedCrossRefGoogle Scholar
  38. Smith TR, Nicholson RA, Banks JW (2010) Migraine education improves quality of life in a primary care setting. Headache 50(4):600–612PubMedCrossRefGoogle Scholar
  39. Steiner TJ (2005) Lifting the burden: the global campaign to reduce the burden of headache worldwide. J Headache Pain 6(5):373–377PubMedCrossRefGoogle Scholar
  40. Stewart WF, Lipton RB, Kolodner KB, Sawyer J, Lee C, Liberman JN (2000) Validity of the migraine disability assessment (MIDAS) score in comparison to a diary-based measure in a population sample of migraine sufferers. Pain 88(1):41–52PubMedCrossRefGoogle Scholar
  41. Stovner L, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A et al (2007) The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 27(3):193–210PubMedCrossRefGoogle Scholar
  42. Terwindt GM, Ferrari MD, Tijhuis M, Groenen SM, Picavet HS, Launer LJ (2000) The impact of migraine on quality of life in the general population: the GEM study. Neurology 55(5):624–629PubMedGoogle Scholar
  43. Wang SJ, Fuh JL, Lu SR, Juang KD (2001) Quality of life differs among headache diagnoses: analysis of SF-36 survey in 901 headache patients. Pain 89(2–3):285–292PubMedCrossRefGoogle Scholar
  44. Zwart JA, Dyb G, Hagen K, Odegard KJ, Dahl AA, Bovim G et al (2003) Depression and anxiety disorders associated with headache frequency. The Nord-Trondelag Health Study. Eur J Neurol 20(10):147–152CrossRefGoogle Scholar

Copyright information

© Lifting The Burden 2011

Authors and Affiliations

  1. 1.Department of NeuroscienceNorwegian National Headache Centre, Norwegian University of Science and Technology and St. Olavs HospitalTrondheimNorway
  2. 2.Department of NeurologyUniversidade Federal de Santa CatarinaFlorianópolisBrazil

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