GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
Institute of Medical Sciences, New Delhi, India.
J Headache Pain. 2024 Mar 19;25(1):41. doi: 10.1186/s10194-024-01746-x.
Knowledge of the prevalence and attributable burden of headache disorders in India is sparse, with only two recent population-based studies from South and East India. These produced conflicting results. A study in North India is needed. We report the methodology of such a study using, and validating, a Hindi translation of the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire developed by Lifting The Burden (LTB). Almost half of the Indian population speak Hindi or one of its dialects.
The study adopted LTB's standardized protocol for population-based studies in a cross-sectional survey using multistage random sampling conducted in urban Delhi and a surrounding rural area. Trained interviewers visited households unannounced, randomly selected one adult member from each and applied the Hindi version of HARDSHIP in face-to-face interviews. The most bothersome headache reported by participants was classified algorithmically into headache on ≥ 15 days/month (H15 +), migraine (including definite and probable) or tension-type headache (including definite and probable). These diagnoses were mutually exclusive. All participants diagnosed with H15 + and a 10% subsample of all others were additionally assessed by headache specialists and classified as above. We estimated the sensitivity and specificity of HARDSHIP diagnoses by comparison with the specialists' diagnoses.
From 3,040 eligible households, 2,066 participants were interviewed. The participating proportions were 98.3% in rural areas but 52.9% in urban Delhi. In the validation subsample of 291 participants (149 rural, 142 urban), 61 did not report any headache (seven of those assessed by HARDSHIP, eight by headache specialists and 46 by both) [kappa = 0.83; 95% CI: 0.74-0.91]. In the remaining 230 participants who reported headache in the preceding year, sensitivity, specificity and kappa with (95% CI) were 0.73 (0.65-0.79), 0.80 (0.67-0.90) and 0.43 (0.34-0.58) for migraine; 0.71 (0.56-0.83), 0.80 (0.730.85) and 0.43 (0.37-0.62) for TTH and 0.75 (0.47-0.94), 0.93 (0.89-0.96) and 0.46 (0.34-0.58) for H15 + respectively.
This study validates the Hindi version of HARDSHIP, finding its performance similar to those of other versions. It can be used to conduct population surveys in other Hindi-speaking regions of India.
印度的头痛障碍患病率和可归因负担的知识相对较少，仅有两项来自印度南部和东部的最近的基于人群的研究。这些研究结果相互矛盾。需要在印度北部进行研究。我们报告了使用 Lifting The Burden（LTB）开发的头痛归因的限制、残疾、社会障碍和受损参与（HARDSHIP）问卷的印地语翻译进行此类研究的方法。几乎一半的印度人口说印地语或其方言之一。
该研究采用 LTB 的标准化方案，在城市德里和周边农村地区进行横断面调查，采用多阶段随机抽样。经过培训的访谈员未经事先通知，随机从每个家庭中选择一名成年成员，并在面对面访谈中应用 HARDSHIP 的印地语版本。参与者报告的最困扰的头痛通过算法分类为每月头痛天数≥15 天（H15+）、偏头痛（包括确诊和可能）或紧张型头痛（包括确诊和可能）。这些诊断是相互排斥的。所有被诊断为 H15+的参与者和所有其他参与者的 10%的子样本都由头痛专家进行额外评估，并进行上述分类。我们通过与专家诊断的比较来估计 HARDSHIP 诊断的敏感性和特异性。
从 3040 个合格家庭中，有 2066 名参与者接受了采访。农村地区的参与率为 98.3%，但城市德里的参与率为 52.9%。在 291 名（149 名农村，142 名城市）验证子样本中，有 61 名参与者未报告任何头痛（其中 7 名接受了 HARDSHIP 评估，8 名接受了头痛专家评估，46 名同时接受了这两种评估）[kappa=0.83；95%CI：0.74-0.91]。在其余 230 名在前一年报告头痛的参与者中，敏感性、特异性和 Kappa 值（95%CI）分别为 0.73（0.65-0.79）、0.80（0.67-0.90）和 0.43（0.34-0.58）用于偏头痛；0.71（0.56-0.83）、0.80（0.730.85）和 0.43（0.37-0.62）用于 TTH；0.75（0.47-0.94）、0.93（0.89-0.96）和 0.46（0.34-0.58）用于 H15+。
本研究验证了 HARDSHIP 的印地语版本，发现其性能与其他版本相似。它可以用于在印度其他讲印地语的地区进行人群调查。
