The burden of headache disorders among adults in Peru: national estimates and a health-care needs assessment from a population-based door-to-door survey.

backgroundWe have previously found that almost two thirds (64.6%) of adults in Peru have an active headache disorder. Here, using data from the same sample, we present attributed burden at individual and population levels. We use these data to assess need for headache-related health care among this population.

methodsWe used the standard methodology of the Global Campaign against Headache. Cluster-sampling from five geographical regions of Peru (Cajamarca, Lima, Piura, Puno, San Martín) generated a sample representative of the population aged 18-65 years. At unannounced visits to households, we interviewed one adult from each using the HARDSHIP questionnaire. We assessed symptom burden in terms of headache frequency and usual duration and intensity, and impaired participation in paid work, household work and social or leisure activities using the HALT index. To assess need for health care, we counted all those with headache on ≥ 15 days/month (H15+), those with migraine on ≥ 3 days/month, and those with migraine or tension-type headache meeting either of two criteria: a) proportion of time in ictal state (pTIS) > 3.3% and intensity ≥ 2 (moderate-to-severe); b) ≥ 3 lost days from paid and/or household work during the preceding 3 months. We derived population-level estimates by factoring in prevalences.

resultsThe sample size was N = 2,149. From individual data, we estimated population-level pTIS at 1.9-2.5%, this proportion of all time among adults in Peru being spent with headache, with migraine the greatest contributor (1.2%). At population level, headache was responsible for 0.5 days lost from paid work and 1.0 days from household work per person per 3 months, with migraine again the biggest contributor (0.2 and 0.5 days). However, at individual level, H15 + was associated with greatest burden (pTIS 14.9-24.9%; 2.3-4.5 lost workdays/3 months). A quarter of the sample (n = 590; 27.5%) fulfilled one or more of our health-care need criteria.

conclusionHeadache disorders are responsible for high levels of ill health and economic burden in Peru, with a substantial requirement for health care. Health and economic policies balancing health benefits against the cost of providing care should take account of the productivity losses that might be recovered, and the expected cost-offset.