Headache burdens and bearers.

All elements of headache burden, and those who bear them, need to be identified if headache is to secure its rightful place in the priority queue for scarce healthcare resources. This paper sets out to do this. Illness manifesting as headache imposes substantial burdens on individual people and on society. Whilst different diagnostic categories of headache vary quantitatively in their impact, the elements of burden are similar for all common headaches. Migraine, being the most studied, is a good model. The AASH/IHS Consensus Symposium on Improving Migraine Management, held in Washington DC on October 2nd 1998, argued that, world-wide, migraine is both under-diagnosed and under-treated. Whilst improved allocation of healthcare resources to migraine and other headache illnesses will mitigate these burdens, this will not happen unless the size and full nature of the problem are recognised. Using rhetoric, I answer two questions: what are the burdens of headache, and who bears them? Migraine has a peculiar tendency to extend its burdens beyond attacks and to others than the immediate sufferer. In many cases it should be characterised as a chronic rather than episodic illness. Other categories of headache impose qualitatively similar and heavy and widely-placed burdens. Healthcare resources expended on better treatment are likely to be repaid several-fold by savings elsewhere.