Headache-attributed burden and its impact on productivity and quality of life in Russia: structured healthcare for headache is urgently needed.

BACKGROUND AND PURPOSE: The study evaluated headache-attributed burden and its impact on productivity and quality of life (QoL) in Russia. Its purpose was to support recommendations for change. METHODS: A countrywide population-based random sample of 2725 biologically unrelated adults (aged 18-65 years) in 35 cities and nine rural areas of Russia were interviewed in a door-to-door survey. The structured questionnaire enquired into symptom burden, functional disability, lost productive time and QoL (applying the WHOQoL-8 question set), as well as willingness to pay (WTP) for adequate headache treatment, if it were available. RESULTS: Mean lost paid-work days due to headache in the previous 3 months were 1.9 ± 4.2, and mean lost household work days were 3.4 ± 5.7. The estimated annual indirect cost of primary headache disorders was USD 22.8 billion, accounting for 1.75% of gross domestic product. QoL was reduced by all types of primary headaches. According to WHOQoL-8, it was significantly lower in those with headache on ≥15 days/month than in those with episodic headache (24.7 ± 4.6 vs. 28.1 ± 5.0; P < 0.05) and lower in those with migraine than in those with tension-type headache (TTH) (27.1 ± 4.9 vs. 28.8 ± 5.0; P < 0.05). Average WTP for adequate headache treatment was RUB 455 ± 494 per month (median RUB 300), a sum sufficient in most cases, and correlated with illness severity (higher for headache on ≥15 days/month than for migraine, and for migraine than for TTH). CONCLUSIONS: Headache is common, burdensome and costly in Russia and, manifestly, poorly mitigated by existing healthcare. Structured healthcare services for headache need to be urgently put in place.

The prevalence of primary headache disorders in Russia: a countrywide survey.

OBJECTIVE: To estimate the 1-year prevalences of primary headache disorders and identify their principal risk factors in the general population of Russia. METHODS: A countrywide population-based random sample of 2725 biologically unrelated adults in 35 cities and nine rural areas were interviewed in a door-to-door survey using a previously validated diagnostic questionnaire. RESULTS: Of the 2725 eligible adults contacted, 2025 (74.3%) responded (females 52.6%, mean age 39.5 ± 13.4 years). Of these, 1273 (62.9%) reported headache 'not related to flu, hangover, cold, head injury' occurring at least once in the previous year. The gender- and age-standardized 1-year prevalence of migraine was 20.8%. Female gender (odds ratio (OR) = 3.8; 95% confidence interval (CI) 2.8-5.1) and obesity (OR = 1.5; 1.1-2.1) were positively associated with this type of headache. The gender- and age-standardized 1-year prevalence of tension-type headache (TTH) was 30.8%. TTH was more prevalent in urban than in rural areas (OR = 1.6; 1.3-2.0). Headache on ≥15 days/month was reported by 213 (10.5%) respondents (gender- and age-standardized prevalence 10.4%), and associated with low socioeconomic status (OR = 3.4; 2.4-4.9), obesity (OR = 3.0; 2.1-4.3), female gender (OR = 2.9; 2.1-4.1) and age over 40 years (OR = 2.6; 1.9-3.6). The majority of these respondents (68.1%) overused acute headache medications. CONCLUSION: The study demonstrated a high prevalence of migraine and a very high prevalence of headache on ≥15 days/month, and revealed unmet health-care needs of people with headache in Russia.

The burden of headache in Russia: validation of the diagnostic questionnaire in a population-based sample.

BACKGROUND: We report validation of the Russian-language version of the Lifting The Burden headache screening and diagnostic questionnaire in a population-based sample of 501 individuals in four cities (Smolensk, Tchelyabinsk, Nishny Novgorod and Tver) and three rural areas (Tula, Tver and Gornyi) of Russia. METHODS: The structured questionnaire, based on ICHD-II criteria, was applied face to face by trained non-medical interviewers calling at randomly selected households. Response rates were about 73% in cities and 80% in rural areas. RESULTS: Of those responding, 301 reported headache in the previous year; of the total sample, 143 people with and 47 without headache according to the questionnaire were re-interviewed by telephone by one of the two neurologists unaware of the questionnaire diagnoses. Migraine (MIG), either definite (dMIG) or probable (pMIG), was diagnosed by the questionnaire in 72 cases, and tension-type headache (TTH), either definite (dTTH) or probable (pTTH), in 66 cases; the five others with headache were unclassifiable by questionnaire. Physicians diagnosed dMIG or pMIG in 65 cases, dTTH or pTTH in 89 cases and no headache in 31 cases; in five cases, headache was unclassifiable. The questionnaire had sensitivities and specificities of 77% and 82% for MIG (κ=0.58) and of 64% and 91% for TTH (κ=0.56). CONCLUSIONS: We concluded that the questionnaire can be utilized in a population-based countrywide survey of the burden attributable to primary headache disorders in Russia.