GBD 2016: still no improvement in the burden of migraine
Authors: Uwe Reuter
Journal: The Lancet Neurology (2018)

Migraine is one of the most frequent neurological diseases, but its burden is generally underestimated, mainly because of the transient nature of primary headaches.1WHOhttp://www.who.int/news-room/fact-sheets/detail/headache-disordersDate: 2018Date accessed: September 26, 2018Google Scholar, 2Dodick DW Migraine.Lancet. 2018; 391: 1315-1330Summary Full Text Full Text PDF PubMed Scopus (233) Google Scholar In contrast to the perception that migraines are not a cause of substantial burden, migraine, together with low back pain, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder, was one of the five leading causes of years of life lived with disability (YLDs) in 2016, according to an analysis of the Global Burden of Diseases, Injuries, and Risk Factors (GBD) study.3GBD 2016 Disease and Injury Incidence and Prevalence CollaboratorsGlobal, 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. 2017; 390: 1211-1259Summary Full Text Full Text PDF PubMed Scopus (4135) Google Scholar According to a new analysis from the GBD study now reported in The Lancet Neurology,4GBD 2016 Headache CollaboratorsGlobal, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Neurol. 2018; 17: 954-976Summary Full Text Full Text PDF PubMed Scopus (758) Google Scholar almost 3 billion people had a headache disorder in 2016: 1·89 billion had a diagnosis of tension-type headache and 1·04 billion had a diagnosis of migraine. Migraine was responsible for 45·12 million YLDs, with a peak in prevalence in women between ages 15 and 49 years. YLDs due to migraine increased from 1990 to 2016 and were higher than those due to tension-type headache, although tension-type headache was the more prevalent disorder. Migraine is a transient neurological disorder: it typically improves with the menopause in women,2Dodick DW Migraine.Lancet. 2018; 391: 1315-1330Summary Full Text Full Text PDF PubMed Scopus (233) Google Scholar and more than 50% of patients with the diagnosis of chronic migraine remit spontaneously to episodic migraine within 3 years.5Henning V Katsarava Z Obermann M Moebus S Schramm S Remission of chronic headache: rates, potential predictors and the role of medication, follow-up results of the German Headache Consortium (GHC) Study.Cephalalgia. 2018; 38: 551-560Crossref PubMed Scopus (10) Google Scholar Migraine and tension-type headache do not lead to permanent physical disability or sequelae, which stands in sharp contrast with the effects of progressive neurological disorders, such as multiple sclerosis or Parkinson's disease. The transient symptoms make the estimation of the effect of migraine on a person's life difficult. In their estimation of YLDs, the GBD 2016 Headache Collaborators4GBD 2016 Headache CollaboratorsGlobal, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Neurol. 2018; 17: 954-976Summary Full Text Full Text PDF PubMed Scopus (758) Google Scholar used a disability weight, which reflects the loss of health during the time of acute migraine or tension-type headache as compared with a healthy person, showing that assessment of the burden of the disease is feasible. By use of disability-weight-adjusted YLDs, the effect of migraine, which accounts for as many as 5·6% of all YLDs,3GBD 2016 Disease and Injury Incidence and Prevalence CollaboratorsGlobal, 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. 2017; 390: 1211-1259Summary Full Text Full Text PDF PubMed Scopus (4135) Google Scholar can be compared with the effect of progressive neurological disorders: 45·12 million YLDs could be attributed to migraine in 2016, whereas Parkinson's disease accounted for 706 thousand YLDs and multiple sclerosis for 584 thousand YLDs.3GBD 2016 Disease and Injury Incidence and Prevalence CollaboratorsGlobal, 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. 2017; 390: 1211-1259Summary Full Text Full Text PDF PubMed Scopus (4135) Google Scholar Migraine usually affects patients during the ages of 15–49 years, with a peak in prevalence between ages 35 and 39 years. Other progressive disorders lead to substantial burden typically in the later stages of life.6GBD 2015 Neurological Disorders Collaborator GroupGlobal, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet Neurol. 2017; 16: 877-897Summary Full Text Full Text PDF PubMed Scopus (1200) Google Scholar Progressive neurological disorders should be treated to stop disease progression and thereby reduce YLDs, but a similar consensual view does not exist regarding whether migraine needs to be treated preventatively. By not using prevention therapy, YLDs in young individuals do possibly increase, especially in women, and therefore deprive these people of valuable disability-free life time. As medication overuse headache is not considered a separate entity in GBD 2016 (in contrast to previous GBD studies), the attribution of 70% of cases of medication overuse headache to migraine (as this was the underlying condition) might explain the jump in YLDs due to migraine to second place in the list of all disorders in 2016. Over time, the increase in the proportion of YLDs due to migraine—a non-communicable disease—might also reflect the decrease in the prevalence of communicable diseases, mainly in low-income and middle-income countries, such as Brazil.7GBD 2016 Brazil CollaboratorsBurden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016.Lancet. 2018; 392: 760-775Summary Full Text Full Text PDF PubMed Scopus (180) Google Scholar This decrease leads to an increase of life expectancy and decreased child mortality in these countries, and thereby alters the demographics of the population, which leads to a greater proportion of people being in the age groups at highest risk of migraine.8GBD 2016 DALYs and HALE CollaboratorsGlobal, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet. 2017; 390: 1260-1344Summary Full Text Full Text PDF PubMed Scopus (1306) Google Scholar The numbers of age-standardised YLDs did not change for migraine between 1990 and 2016, which led the GBD 2016 Headache Collaborators to conclude that improvements in migraine therapy are not being translated into an overall reduction in disability.4GBD 2016 Headache CollaboratorsGlobal, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Neurol. 2018; 17: 954-976Summary Full Text Full Text PDF PubMed Scopus (758) Google Scholar Another interesting finding relates to the Socio-Demographic Index of geographical regions and age-standardised YLDs. In contrast to our previous knowledge, the Socio-Demographic Index of a country seems not to be a major determining factor for the burden and prevalence of headache.4GBD 2016 Headache CollaboratorsGlobal, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Neurol. 2018; 17: 954-976Summary Full Text Full Text PDF PubMed Scopus (758) Google Scholar This finding deserves further research, because it is not in accordance with the assumption that work-related, financial, and commuting stress as seen in high-income countries leads to an increase in, or triggers, migraines.9Peroutka SJ What turns on a migraine? A systematic review of migraine precipitating factors.Curr Pain Headache Rep. 2014; 18: 454Crossref PubMed Scopus (82) Google Scholar Data for primary headache from GBD 2016 lead to the conclusion that migraine, in particular, is responsible for substantial burden of disease worldwide. Regrettably, no major improvements have been made since 1990 to reduce YLDs of patients with headache. Therefore, it is about time that communities, policy makers, and health-care providers and professionals focus on the improvement of headache therapy to reduce the burden experienced by patients with migraine and other headache disorders. UR reports personal fees from Allergan, CoLucid, Autonomic Technologies, Medscape, and Streamed Up; grants to Charité Universitätsmedizin Berlin and personal fees from Amgen, Electrocore, Eli Lilly, Novartis, and Teva; and grants from Alder Pharmaceuticals to Charité Universitätsmedizin Berlin. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016Although current estimates are based on limited data, our study shows that headache disorders, and migraine in particular, are important causes of disability worldwide, and deserve greater attention in health policy debates and research resource allocation. Future iterations of this study, based on sources from additional countries and with less methodological heterogeneity, should help to provide stronger evidence of the need for action. Full-Text PDF Open Access