Leonardi Matilde, Steiner Timothy J, Scher Ann T, Lipton Richard B
Scientific Direction, Italian National Neurological Institute Carlo Besta, Via Celoria 11, I-20133, Milan, Italy.
J Headache Pain. 2005 Dec;6(6):429-40. doi: 10.1007/s10194-005-0252-4. Epub 2005 Dec 15.
This overview of the published epidemiological evidence of migraine helps to identify the size of the public-health problem that migraine represents. It also highlights the need for further epidemiological studies in many parts of the world to gain full understanding of the scale of clinical, economic and humanistic burdens attributable to it. This paper presents some of the work on migraine undertaken by the World Health Organization (WHO) in the Global Burden of Disease study conducted in 2000 and reported in the World Health Report 2001. Migraine was not included in the first Global Burden of Disease 1990. The paper also discussed the measurement of disability attributable to headache disorders using WHO ICF Classification. Using disability-adjusted life years (DALYs) as a summary measure of population health (which adds disability to mortality), WHO have shown that mental and neurological disorders collectively account for 30.8% of all years of healthy life lost to disability (YLDs) whilst migraine, one amongst these, alone accounts for 1.4% and is in the top 20 causes of disability worldwide. This information is combined with the increasingly widely accepted belief that disability and functioning are relevant parameters for monitoring the health of nations and that there is an increasing need to measure them. WHO's Classification of Functioning, Disability and Health (ICF) provides a model of human functioning and disability, as well as a classification system, that allows us to highlight and measure all dimensions of disability. ICF applied to headache disorders allows comparability with other health conditions as well as evaluation of the role of the environment as a cause of disability amongst people with headache. Migraine causes a large proportion of the non-fatal disease-related burden worldwide. Our knowledge of headache related burden is incomplete and it is necessary to add to it epidemiological studies in many parts of the world and to combine this with measurements of disability using both DALYs and WHO's ICF Classification. The work described here has been the base for the Global Campaign against Headache disorders: "Lifting the Burden", launched in 2004 jointly by WHO, IHS (International Headache Society), WHA (World Headache Alliance) and EHF (European Headache Federation).
这篇已发表的偏头痛流行病学证据综述有助于确定偏头痛所代表的公共卫生问题的规模。它还凸显了在世界许多地区开展进一步流行病学研究的必要性，以便全面了解偏头痛所致临床、经济和人文负担的程度。本文介绍了世界卫生组织（WHO）在2000年开展的全球疾病负担研究中有关偏头痛的部分工作，并在《2001年世界卫生报告》中予以报道。偏头痛未被纳入1990年首次全球疾病负担研究。本文还讨论了使用WHO国际功能、残疾和健康分类（ICF）对头痛障碍所致残疾进行的测量。使用残疾调整生命年（DALYs）作为人群健康的综合衡量指标（该指标将残疾与死亡率相加），WHO表明，精神和神经障碍合计占因残疾而损失的所有健康生命年（YLDs）的30.8%，而偏头痛作为其中之一，单独占1.4%，位列全球残疾的前20大原因。这些信息与日益被广泛接受的观念相结合，即残疾和功能是监测国家健康状况的相关参数，且对其进行测量的需求日益增加。WHO的《国际功能、残疾和健康分类》（ICF）提供了一个人类功能和残疾模型以及一个分类系统，使我们能够突出并测量残疾的各个维度。将ICF应用于头痛障碍，可实现与其他健康状况的可比性，以及评估环境在头痛患者残疾成因中的作用。偏头痛在全球非致命性疾病相关负担中占很大比例。我们对头痛相关负担的了解并不完整，有必要在世界许多地区增加流行病学研究，并将其与使用DALYs和WHO的ICF分类进行的残疾测量相结合。这里所描述的工作是2004年由WHO、国际头痛协会（IHS）、世界头痛联盟（WHA）和欧洲头痛联盟（EHF）联合发起的全球抗击头痛障碍运动：“减轻负担”的基础。
