Manandhar Kedar, Risal Ajay, Linde Mattias, Steiner Timothy J
Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, NO, 7489, Norway.
Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Dhulikhel, Nepal.
J Headache Pain. 2015;17:3. doi: 10.1186/s10194-016-0594-0. Epub 2016 Jan 25.
Headache disorders, particularly migraine and tension-type headache (TTH), are among the most prevalent global public-health problems. Medication-overuse headache (MOH) is a common sequela of mismanagement of these. Migraine and MOH are highly disabling. Formulation of responsive health policy requires reliable, locally-derived, population-based data describing both individual and societal impact of headache disorders. South-East Asia is the only one of WHO's six world regions in which no such national data have yet been gathered.
In a nationwide population-based cross-sectional study, a representative sample of Nepalese-speaking adults (18-65 years) were randomly selected by stratified multistage cluster sampling. Trained interviewers made unannounced door-to-door visits and enquired into headache and its attributable burden using a culturally-adapted and validated Nepalese translation of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire.
Among 2100 participants, 1794 (85.4 %) reported headache during the preceding year (male: 689 [38.4 %], female 1105 [61.6 %]; mean age 36.1 ± 12.6 years). Mean headache frequency was 3.8 ± 6.2 days/month, mean headache intensity 2.1 ± 0.7 on a 0-3 scale, and mean attack duration 41.9 ± 108.5 h. All aspects of symptom burden (frequency, intensity and duration) were greater among females (p < 0.001). Participants with headache had poorer quality of life (QoL) than those without (p < 0.001); QoL was worst among those with probable MOH (pMOH). Mean proportions of total available time spent in the ictal state were 5.4 % among participants with migraine, 3.9 % among those with TTH and 44.7 % among those with pMOH, with headache-related disabilities of 2.4, 0.15 and 9.7 % respectively. At population level, these disorders were responsible for reduced functional capacities of 0.81, 0.06 and 0.20 %. Total lost productive time due to headache was 6.8 % for the 85 % of the population with headache. Males lost more paid worktime than females (p < 0.001); the reverse was so for household worktime (p < 0.001).
Headache disorders, very common in Nepal, are also highly burdensome at both individual and population levels. There is a substantial penalty in lost production. The remedy lies in better health care for headache; structured headache-care services are urgently needed in the country, and likely to be cost-saving.
头痛性疾病，尤其是偏头痛和紧张型头痛（TTH），是全球最普遍的公共卫生问题之一。药物过量使用性头痛（MOH）是这些疾病管理不当的常见后遗症。偏头痛和MOH具有高度致残性。制定有效的卫生政策需要可靠的、源自当地的、基于人群的数据，以描述头痛性疾病对个人和社会的影响。东南亚是世界卫生组织六个世界区域中唯一尚未收集此类国家数据的地区。
在一项全国性的基于人群的横断面研究中，通过分层多阶段整群抽样随机选取了具有代表性的尼泊尔语成年人群体（18 - 65岁）。经过培训的访谈员进行不事先通知的挨家挨户访问，并使用经过文化调适和验证的尼泊尔语翻译版《头痛所致限制、残疾、社会障碍及参与受限问卷》（HARDSHIP问卷）询问头痛及其相关负担情况。
在2100名参与者中，1794名（85.4%）报告在前一年有头痛症状（男性：689名[38.4%]，女性1105名[61.6%]；平均年龄36.1±12.6岁）。平均头痛频率为3.8±6.2天/月，平均头痛强度在0 - 3级量表上为2.1±0.7，平均发作持续时间为41.9±108.5小时。女性在症状负担的各个方面（频率、强度和持续时间）都更严重（p < 0.001）。有头痛症状的参与者的生活质量（QoL）比没有头痛症状的参与者差（p < 0.001）；在可能患有药物过量使用性头痛（pMOH）的参与者中，生活质量最差。在发作期花费的总可用时间的平均比例在偏头痛患者中为5.4%，在紧张型头痛患者中为3.9%，在可能患有药物过量使用性头痛的患者中为44.7%，与头痛相关的残疾率分别为2.4%、0.15%和9.7%。在人群层面，这些疾病导致功能能力下降0.81%、0.06%和0.20%。因头痛导致的总生产时间损失占85%有头痛症状人群的6.8%。男性损失的带薪工作时间比女性多（p < 0.001）；在家务工作时间方面则相反（p < 0.001）。
头痛性疾病在尼泊尔非常普遍，在个人和人群层面也负担沉重。生产损失巨大。补救措施在于改善头痛的医疗护理；该国迫切需要结构化的头痛护理服务，而且这可能会节省成本。
