Steiner T J
Division of Neuroscience, Imperial College School of Medicine, Charing Cross Campus, St. Dunstan's Road, London W6 8RP, UK.
Funct Neurol. 2000;15 Suppl 3:219-23.
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.
如果要让头痛在稀缺医疗资源的优先队列中获得应有的地位，就需要明确头痛负担的所有要素以及承受这些负担的人群。本文旨在做到这一点。表现为头痛的疾病给个人和社会都带来了沉重负担。虽然不同诊断类别的头痛在影响程度上存在数量差异，但所有常见头痛的负担要素是相似的。偏头痛作为研究最多的一种，是一个很好的范例。1998年10月2日在华盛顿特区举行的美国头痛协会/国际头痛协会改善偏头痛管理共识研讨会指出，在全球范围内，偏头痛的诊断和治疗都不足。虽然增加对偏头痛和其他头痛疾病的医疗资源分配将减轻这些负担，但除非认识到问题的规模和全貌，否则这一切都不会发生。我用言辞回答两个问题：头痛的负担是什么，以及谁在承受这些负担？偏头痛有一种特殊的倾向，即其负担不仅会延伸到发作之外，还会波及直接患者以外的其他人。在许多情况下，它应被视为一种慢性疾病而非发作性疾病。其他类型的头痛也会造成性质相似、沉重且广泛的负担。在更好的治疗上投入的医疗资源很可能会在其他方面节省数倍的开支而得到回报。
