Who Atlas Headache Disorders

7/29/2019 Who Atlas Headache Disorders

1/35

AtlAso headache disordersand resources in theworld 2011

A collaborative project of World Health Organization and

Lifting The Burden


2/35

4 AtlAs of heAdAche disorders And resources in the world 2011 5foreword

Foreword

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Lord Walton of Detchant,

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WHO Lirary Cataloguing-in-Pulication Data

a 2011.

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World Health Organization 2011

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3/35

6 AtlAs of heAdAche disorders And resources in the world 2011 7contents

AtlAs of heAdAche disorders And resources

in the world 2011

8

9

10

14

15

17

17

17

18

19

19

19

19

20

20

21

23

23

24

25

26

30

36

44

54

56

60

62

66

68

CoNteNts

Project teAm And PArtners

PrefAce

executive summAry

introduction

HeAdACHe disorders

epidemiology ANd burdeN

bArriers to CAre

purpose oF tHe AtlAs of H eAdAcHe disorder s

methods

QuestioNNAire developmeNt

ideNtiFiCAtioN oF respoNdeNts

dAtA ColleCtioN

dAtA mANAgemeNt ANd ANAlysis

results

dAtA QuAlity

rePresentativeness

liMitations

data orGanization and Presentation

tHemes

ePideMioloGy

iMPact on society, and national data

health-care utilization

diaGnosis and assessMent

treatMent

Proessional traininG

national Proessional orGanizations

issues

the wAy forwArd

references

list of resPondents


4/35

8 AtlAs of heAdAche disorders And resources in the world 2011 9PrefAce

d sk sx, d t d, d B s

d c M:

w h og, G, s

P tm s P l Jb s:ng u s tg, tm,

n, Liting The Burden, l, u Kgm

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tm, n

M u s:

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d n h:

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p g .

t g Atlas o Headac he Disorder s p

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m b .

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, gm g,

x, Atlas o Headache Disorders

m b .

Project teAm And PArtners

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sx d t d. d B s pg d c M g p.

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The Burden k mp Gb cmpg g

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h a w ng. P

s M G G, pp b ng

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b, q

mgm. d d d n h

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t m m ,

p b g, p , g

p p p m

mp b P s, M s M

G. t p

a.

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pj.

M a l p m pp pp

p m. a ppg

a pb m M e l

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m p

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1.3 % b . o , ,

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mp, kg

- ,

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. t b

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x m g

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.

t w h o g (wh o) Project Atlas

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m - .

w Project Atlas, m b

m m g

pb- p. tAtlas o Headac he Disorder s

mp . tAtlas o Headach e

Disorders p b

who b gm g,

Liting The Burden, m

Dr Shekhar Saxena

d, dpm M h sb ab,

w h og, G, s

Professor Timothy J Steiner

Gb cmpg d, Liting The Burden, l, uK;

P M (h Gb Pb h),

ng u s tg,

tm, n

preFACe


5/35

10 AtlAs of heAdAche disorders And resources in the world 2011 11executive summAry


in the world 2011

eXeCutive

summAry

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m m

p xp m mm

, m k b pb-

mp . i k , m,

m pp , -

mg .

t gb q m m

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q p g .

METHODS

t Atlas o Headach e Disorders p q b

who b Liting The Burden: Gb

cmpg g h. M m

q g, g

p p p m 101 ,

pm m ob 2006 M 2009.

epmg mp m pb

g m , ppm b

g pp-b k

Gb cmpg.

Key messAgespHeadache disorders are ubiquitous, prevalent and

disabling. Yet they are under-recognized, under-

diagnosed and under-treated worldwide:

aminorityofpeoplewithheadachedisordersareprofessionally diagnosed;

managementguidelinesareusedroutinelyin55%of

respondingcountries,butmuchlesscommonlyinlow-incomecountries;

despitetherebeingarangeofdrugswithefcacyagainstheadache,countriesinallincomecategories

identifynon-availabilityofappropriatemedicationas

abarriertobestmanagement;

worldwide,onlyfourhoursarecommittedtoheadachedisordersinformalundergraduatemedical

training, and lack of education is seen as the key

issueimpedinggoodmanagementofheadache;

illness that could be relieved is not, andburdens,both individual and societal, persist unnecessarily;

nancialcoststosocietythroughlostproductivityareenormous.

pAmongproposalsfor change:

better professional education ranks far above allothers;

athirdofrespondingcountriesalsorecommend

improvedorganizationanddeliveryofhealthcare

for headache.

pGiven the very high indirect costs of headache,greaterinvestmentinhealthcarethattreatsheadache

effectivelymaywellbecost-savingoverall.


6/35

12 AtlAs of heAdAche disorders And resources in the world 2011 13executive summAry


in the world 2011eXeCutive summAry

Education in headache

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10 p g.

p B p k b

pp g (75 % p),

k k mpg

g mgm .

National professional headache organizations

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( p g) x

p. t mk

b g- pp m-m (71 76 %)

-m (16 %).

t g m b m , p

m m

g x.

p o p g g

, -

g g mgm

.

t p g m

g.

p p g (20 %)

pp pg g

, 10 % pm

g .

KEY FINDINGS

The burden of headache

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t p m q

g 18 65

.

ag , 10 % mg,

1.7 4 % p p b

15 m m.

p im mp x

18 % p.

p h

pg m 12 % xp

7 % p.

Diagnosis of headache

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p g.

t mg -p

b 40 %; m- 10 %.

p sp i h s g

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p. ug a, e

M s-e a -

m g. l g

-m .

p ig , m g pp, g,

p g pp

g.

p im mp

24 % p,

m- -m .

CONCLUSIONS

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Management of headache

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p.

up 10 % b g, g

a s -e a .

t p , b

pm p , mg, -p

mb .

M- p

(1 10 %) m.

o p

(5 12 %) m.

p Mgm g 55 %

pg . ug m

mm -m .

p t m b g g

, g fg . t

q g, b m b m.

amg p -mg g, gm m

b p. t m

x, b m xp.

dg g mb

, p mbm

m p .

c m g -b

ppp m b b mgm.

t pbb m mbm .

p amg mpm p, p

p, p p p, bg p p

g m g.

Organization of headache services

p a pg mm, pp

g, mp g

.


7/35

14 AtlAs of heAdAche disorders And resources in the world 2011 15introduction


in the world 2011

iNtroduCtioN

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heAdAche disorders

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MIGRAINE

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g .

TENSION-TYPE HEADACHE

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MEDICATION-OvERUSE HEADACHE

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g, p , p ,fg m p . t

k m, m g. a

mm pbb k m g pm

m- p -mp

m, p

p q.


8/3516 AtlAs of heAdAche disorders And resources in the world 2011 17introduction


in the world 2011

BArriers to cAre

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m (19). i Jp,

mg b mg

b b (20). o 80 % d -

p

(21). i g k pp

b -p .

t b p b g , b

m b , p / m.

CLINICAL bARRIERS

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k b m p

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m.

SOCIAL bARRIERS

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m p,

g. i , m, m x pb.

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p b.

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qg m (20). t

p m m

m x. ag,

k b b m m.

POLITICAL / ECONOMIC bARRIER S

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m b . t

g g

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mg b m (.g. b g kg )

ppp.

PurPose of the AtlAs ofheAdAche disorders

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Disorders, pj mpm m pmg

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kg.

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h (22).

iNtroduCtioN

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pp.

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( 50), m

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.

ePidemiology And Burden

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i m p, m- -

g (8). t g

m 1 % m pp (9), m

m m, m .

o, gb p mg

(mpm ) 47 % (1).


9/3518 AtlAs of heAdAche disorders And resources in the world 2011 19methods


in the world 2011

metHods

t Atlas o Headache Disorders p q b

who b Liting The Burden: Gb

cmpg g h (22). M m

g pm m

ob 2006 M 2009. epmg mp m pb g m

pp-b pm p M 2006 (1)

ppm b g Gb

cmpg -- c (23), i

r (24). t b s . p

mg m

(1). t m Gb cmpg --

b (23, 24). t,

pmg p p: ..,

pp b p - pb ,

pb, g m b g q.

QuestionnAire develoPment

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, q , eg, b

gp who Liting The Burden xp. t q- m b mp:

q p -

g (g ), pm- p (GP

) p pp

( ). a g m q

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q m .

t q p who

g, g m .

identificAtion ofresPondents

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w h a -mmb g, i

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g ) p p

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Resources or Neurological Disorders Atlas o Epilepsy Care

in the World. a mb ggp gp m;

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t g mj

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dAtA collection

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b m .

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, m m mpb

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i -p p m, mp

q .

dAtA mAnAgement AndAnAlysis

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m p b g m

.

a ,

b ppg b g s (p )

8 .

a g p m p m s Pss 17

. v b

q b m

(m, m )

ppp. Gp g m b k b m , m ,

.

c gp x who g (a

rg [ar], rg am [aMr], e M-

rg [eMr], ep rg [eur], s-e

a r g [se ar] w P r g [w Pr])

w Bk m g g 2009 g

m (Gni) p p (-m: us$ 995 ;

m-m: us$ 996 3 945; pp m-m:

us$ 3 946 12 195; g- m: u s$ 12 196 m) (25).


10/3520 AtlAs of heAdAche disorders And resources in the world 2011 21results | dAtA QuAlity

Yes

No


in the world 2011

results

rePresentAtiveness

i mp , g q

m 101 ( 65 mp ),

GP q m 47 ( mp) q m 48 (16 mp).

a q b m 101

(g 1.1): 18 a rg (39 %

g), 19 am (54 %), 13

e M (62 %), 38 ep rg

(72 %), s-e a (46 %) g w

P (30 %) (g 1.2). t mb mg gg

50 % p m g, b

p 86 % pp: 71 %

pp a, 95 % am, 83 % e

M, 86 % ep, 82 % s-e a

93 % w P (g 1.3).

rp (.., p m)

g q f -m g:

g (77 %) m g-m ,

g g : pp m- (54 %),

m- (46 %) -m (38 %). rp GP q k p

m b g-p k

m.

FIG. 1.1 w mp bg yes no

dAtA QuAlity


11/3522 AtlAs of heAdAche disorders And resources in the world 2011 23results | dAtA QuAlity


in the world 2011

limitAtions

n b m 92 (48 %) 193 Mmb

s. ag pg p g

mj (86 %) pp, m b p b.P -m

k p; m b xp p-

p. i , m g

-p.

a m, x k p (b m

) m pm-

g . M p, p m g

, mp q

mg b g m

. h, m p mg

b p . M g-

p, m

b k k m.

h, xp p mg

b.

, q p pbb q

b. i m , m b b

mp ( xmp, -

), q

b b xp, b

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b p b k .

i p m, Atlas o Headache Disorde rs

m mp mp

mp.

dAtA orgAnizAtion AndPresentAtion

t m g g m

g b m g m. d p gp, mp x. B

p q, m m

ppp. B b m

k, m b p

m b.

i b pb p g m

. lm p m b kp

m pg .

imp g pm

gg m.

0

10

20

30

40

50

60

70

80

52

30

46

72

62

54

39

WORLDWPRSEAREUREMRAMRAFR

0

20

40

60

80

100

86

93

8286

83

95

71


FIG. 1.2 c-b p (% who g p

[ q ] mg p)

FIG. 1.3 Pp-b p (% pp who g p

[ q ] mg p)

AFR = a rgAMR = rg amEMR = e M rg

EUR = ep rgSEAR = s-e a rgWPR = w P rg

results

dAtA QuAlity


12/3524 AtlAs of heAdAche disorders And resources in the world 2011 25results | themes | ePidemiology

tHemes epidemiology


in the world 2011

results

tHemesepmg mp m m

pb (1) ppm b g

Gb cmpg -- c (23), i

r (24). o pmg

p p : .., gm b g q; xp m g

b ( M). t q

m b b b

, m

g-g 18 65 . ag, mm

b 2.1 m pp-b mp

q m, pb p

b g (26, 27). t m "1-

p" m pg pp pg

p mg g

g p 12 m.

SALIENT FINDINGS

p appxm q g 18 65

m g

xp a, m 1- p

22 %.

p Mg p, , m 10 %

g g, xp a e M.

p h 15 m m 1.7 4 %

pp, g . M

m b m- , b

kg m m g.

p i m , m g,

b g pmg .

imPlicAtions

p t g b 2.1 m ,g mg -p , mg m p mk.

p r ,

m p. t

g 18 65 ppp m pb-

pp p .

p w, mg 1.3 %

b (yld) (10). t b

b g g m

pb (1). h-p mk

b m b . y, m ,

x who g, gp kg

m - p. M g-q pm-

g q .

Arica Americas Eastern

Mediterranean

Europe South-East

Asia

Western Pacifc

All headache 21.6

(n = 2)

46.5

(n = 1)

78.8

(n = 2)

56.1

(n = 8)

63.9

(n = 1)

52.8

(n = 4)

Migraine 4.0

(n = 2)

10.6

(n = 1)

6.8

(n = 2)

14.9

(n = 9)

10.9

(n = 1)

10.4

(n = 6)

Tension-type

headache

nr 32.6

(n = 1)

nr 80*

(n = 2)

34.8

(n = 1)

19.7

(n = 3)

Medication-overuse

headache (MOH)

nr nr nr 1.0

(n = 3)

1.2

(n = 1)

nr

Headache on 15 days /

month (including MOH)

1.7

(n = 2)

4.0

(n = 1)

nr 3.3

(n = 3)

1.7

(n = 1)

2.1

(n = 3)

TAbLE 2.1 M 1- p (%) g 18 65 , mg, -p

m- m pp-b b who g

n = nmb who g bg p m.nr= n p. t k b .* t p b 80 % -p 56.1 % b m m m

. t g m g m g q -p (b g m), mm p; g mg k .


13/3526 AtlAs of heAdAche disorders And resources in the world 2011 27results | t hemes | imPAct on society, And nAtionAl dAtA

results

Yes

No


in the world 2011

societAl imPAct

rp k m b

mp , g m mp.

i . t p p

g 3.1 3.3.

SALIENT FINDINGS

p Gb, m mp

x : 18 %

p (g 3.2).

p rg mk: ep b m

m, b (32 %)

. g am (16 %),

w P (13 %), e M (8 %)

a (6 %), s -e a.

p a g x b g-m (

, 35 %) (6 10 %) (g 3.3).

FIG. 3.2 c m mp , b who g

(% p p mg pg)

FIG. 3.3 c m mp , b m g

(% p p mg pg)

tHemes impACt oN soCiety, ANd

NAtioNAl dAtA

FIG. 3.1 c m mp yes no no data


14/3528 AtlAs of heAdAche disorders And resources in the world 2011 29results | t hemes | imPAct on society, And nAtionAl dAtA


in the world 2011

FIG. 3.5 c g -pg m, b who g

(% p p mg pg)

results

tHemes impACt oN soCiety, ANd

NAtioNAl dAtA

nAtionAl heAlth rePorting

rp k

-pg m

xp . t p

g 3.4 3.5.

SALIENT FINDINGS

p w,

-pg m 12 %

p.

p t b g, b

pp g 18 %. t

b m.

p

w, xp : 7 % pg ,

g e M

(15 %), ep (11 %) am (5 %). n

-m .

imPlicAtions

p v - mp

, p q -

p p.

p Pp-b , m b -

b b, m g-

, g, b p -p

. i b pm mp mm bg .

M Gb cmpg

g h (22).

p i b g m p

m x

bb , g g p

b (28, 29). h, m

x .

Yes

No

FIG. 3.4 c g

-pg m yes no no data


15/3530 AtlAs of heAdAche disorders And resources in the world 2011 31results | themes | heAlth-cAre utilizAtion


in the world 2011

self-treAtment versusProfessionAl heAlth cAre

rp k m pg

pp pm -g g p (pm- p [PcP],

g, mpm m p

). t p mm g 4.1.

SALIENT FINDINGS

w, b 50 % pp m

b pm -g,

p. h, m 10 % p b

g, g , mg b xp, a s-e a.

consultAtion rAtes

ng pm- p k

pg g

. t p p g 4.2 4.3.

0

10

20

30

40

50

60

57

55687

101010101010

15

1010

5

20

15

10

5

20

3030

20

3028

20

50

43

50

40

30

50

58


OthersAlternativeNeurologistPCPSelf

FIG. 4.2 em pg p

(m p, j 100 %)

results

tHemes HeAltH-CAre utiliZAtioN

FIG. 4.1 em pg pp pm -g mg b p,

b who g (m p g)


16/35

32 AtlAs of heAdAche disorders And resources in the world 2011 33results | themes | heAlth-cAre utilizAtion


in the world 2011

NeurologistPrimary care

0

5

10

15

20

25

30

35

40

7854

22

32

22

7810

4

10

38

23

OTHERSOTHER SECONDARYMOHCLUSTER HEADACHEM + TTHTTHMIGRAINE


0

5

10

15

20

25

30

35

45

17

3

16

22

33

7

1010

3

14

2828



0

5

10

15

20

25

30

35

6

911

3

16

22

33

3

6

13

1

13

3232


FIG. 4.3 em pg m , pm p ,

b who g (m p g, j 100 %) (TTH: tension-type headache; M+TTH: combined

migraine and T TH; MOH: medicatio n-overuse head ache; Other seco ndary: othe r secondar y headache)

A. AFR ICAN RE GION

b. REGION OF THE AMERICAS

D. EUROPEAN REGION

C. EASTERN MEDITERRANEAN REGION

results



0

10

20

30

40

50

35

13

4

10

21

44

14

4

9

5

0

27

41


F. WESTERN PACIFIC REGION

E. SOUTH-EAST ASIA REGION


0

5

10

15

20

25

30

35

5

89

1

2222

33

2

11

68

21

2626



17/35

34 AtlAs of heAdAche disorders And resources in the world 2011 35results | themes | heAlth-cAre utilizAtion


in the world 2011

SALIENT FINDINGS

pGb, p ,

b pm p , mg, -

p mb . t-p

m p ( p 25),

b q mg -

p p f . Mg

g pbb (p p )

-p ,

m p pm . Pm-

p, m , m

-p , m f

g p. sp m

mg, pbb f (g

b).

prg, mg m q

pg am, ep,

s-e a w P. t

p ( p 25) g pbb f

b bb mg -

p . t-p m q

, b fg p, rg a e M.

pB m g, mg m

20 % -m

32 % g-m . c, fg

g b, -

p mk p 25 30 %

- m-m 18.5 20 %

pp m- g-m . a xp

pp g p ,

g pmg m a e

M rg m -p

g. c m p p . i ,

g g -p

, m g p

, p, g g .

h, m (

) b kp m.

p c 1 3.8 % p

. t

g m g. exp b

p mm m

, xp b xm

, mg m .

p M- p

m 1 % -m

10 % pp m- g-m .

p o p -

m g: 12 % -m , g 5 % g-m .

remediABle risK fActors

rp k b k

, , g mp

gg.

SALIENT FINDINGS

p Gb, g k g

mp: (20.8 %), g q , m

m ; m (15.8 %),

g p, p ;

g m (12.9 %), p m ;

(7.9 %), xmp b b

b.

p o m p mb k

- m-m g. t

g, p b, -

m mm -p .

dg m p k pp m-

g-m , g

m-.

imPlicAtions

p t pp pp m b -

g (b 50 %) xp, g m

-p m mg m

q / m k. n

b m p .

p t pp k g b

; q, pp b

b pb- mp. t p

m k m- .

p o , b 10 % pp

b g, g

pp (30). t pp b,

pp g g b g,

pm- p p, b

gp m -m mb

m. t q ppeople ,

b pp p patients . e

, g -b

gm xpg pm- mgm

(30).

p t pp pm g m

, b pm- p, g

m gp. w m

g mp -p , pm

mg -p

g m .

p c mp p b

. n mg p .

t , q

g m g.

p M b p p

m. B- m

k p , m m-

. t mp :

b pb q.

results



18/35

36 AtlAs of heAdAche disorders And resources in the world 2011 37results | themes | diAgnosis And Assessment


in the world 2011

0

10

20

30

40

50

60

10

57

2120

10

1

38

4545

25

55

40

23

40

33

60

40

60

40

10


Medication-overuse headacheTension-type headacheMigraine

0

10

20

30

40

50

30

1010

1

40

30

40

30

50

3835

13

HIGHUPPER MIDDLELOWER MIDDLELOW

Medication-overuse headacheTension-type headacheMigraine

FIG. 5.1 em pg pp p b p g,

b who g (m p)

FIG. 5.2 em pg pp p b p g,

b -m g (m p )

results

tHemes diAgNosis ANd AssessmeNt

diAgnostic rAtes

rp k m pg

p mg, -p m-

b g b

p. t p g 5.1 5.2.

SALIENT FINDINGS

p Gb, p g mg -

p b 40 % pp

, m- m

m (10 %) .

p t m g : pg

a rg, m b g b

b mb p.

p t b g

mg m g, m

m m- .

t -p .


19/35



in the world 2011

use of diAgnostic criteri A

ng p k xp

g , p ,

pp g p . t p

p g 5.3 5.5.

SALIENT FINDINGS

i p , xp g

pp g p 56 %

p. t , b,

i h s ( (26)

(27)). t m g ,

g m p

a , e M s -e a rg .

l-m m xp

g .

0

10

20

30

40

50

60

70

80

56

75

40

66

31

68

39


0

10

20

30

40

50

60

70

80

62

57

63

37


FIG. 5.4 c mkg p xp g pp g,

b who g (% p p mg pg)

FIG. 5.5 c mkg p xp g pp g,

b m g (% p p mg pg)

results


Yes

No

FIG. 5.3 c mkg p xp

g pp g yes no no data


20/35



in the world 2011

use of investigAtions

rp k m pg

p, g, g p g

p g m p

. t b 5.6. rp

k pp g

g.

SALIENT FINDINGS

p ig g g, m xp

b m q

g g m. t

p eeG.

p rg , p

( ) xm.

p Gb, m-p pmg g

p g (70 %). t m-

( 55 %) g m g-

. r p m mmb (20 %)

, q b g, m 10 %

a 40 % w P rg ,

x b m, m 20 % - m-

m 27.5 % pp m- g-

m . a g (10 %).

WHO region MRI (%) CT (%) Sinus

examination (%)

EEG (%) CSF (%) Reractory

errors (%)

N PC N PC N PC N PC N PC N PC

Arican (n = 17) 0 1 28 5 15 15 5 5 5 5 19 3

Americas (n = 19) 15 8 30 10 10 8 15 28 2 10 13

Eastern Mediterranean

(n = 12)

10 2 60 10 18 28 13 5 5 5 10 25

Europe (n = 34) 10 3 30 4 10 5 9 1 2 1 5 7

South-East Asia (n = 5) 5 1 30 2 45 8 5 1 5 1 50 3 5

Western Pacifc (n = 8) 23 20 20 64 10 30 13 55 1 15 8 13

World (n = 95) 10 3 30 5 10 10 10 5 3 1 10 8

TAbLE 5.6 em pg p p pm g p g

(m p)

MRI = mg mgg; CT = X- mp mgp; EEG = pgp;CSF = bp f xm; N = p (g) ; PC = pm ; n = mb bg

use of Assessmentinstruments

ng k m m,

-p g,

g q b pp .

t p g 5.7 5.9.

SALIENT FINDINGS

p Gb, m m

24 % p. t m-

m Midas q (31 33)

hit-6 (34, 35).

p rg . em

b mb p, b m

m pp b q

b pp a

s-e a rg.

p l- m-m

m (5 12.5 %) pp m- g-

m (29 43 %).

results


Yes

No

FIG. 5.7 c mkg p m

m q b pp yes no no data


21/35



in the world 2011

0

10

20

30

40

50

24

50

0

32

8

37

0


0

10

20

30

40

50

30

43

13

5


FIG. 5.8 c mkg p m m q b

pp , b who g (% p p mg pg)

FIG. 5.9 c mkg p m m q b

pp , b m g (% p p mg pg)

imPlicAtions

p t x g f q

, m m mpm

g. B p m

.

p l p g p q

p , m b f b

( m g) g

xp g . B m bg

, g ( pg p)

g -p mg -

p b pp m-

g-m . exp p. u-

g , b

b g mg g-m m b

b b p m, pp

p pm mpg.

i m g-m , mbm p

g mg -p

-g mg (, ,

k -p b m g).

p M- b pb

mb. a , p p ,

g b. i k

m . t g 10 %

mp m

q.

p P i h s g

g, b g

-m . l g

-m . t m , b

q p-pp. P pbm k b

mpx ichd-ii, bg 200

160 pg (27). t q

b mmm ,

mgm m pm : m-

b 15 g

(36).

p ig m b b ,

xp . t p

b , g.

p am mp

b p mgm. t p

m, m .

p exg m , b

g. t g p mpm gb,

p -p .

p t mp m pp p, b

ppp. Midas m m

(31 33), f b. a m -

pb halt x (37).

hit-6 mp m b, g p

q (34, 35). t p p

q-- m whoQl, m

b mgm pp

.

results



22/35

44 AtlAs of heAdAche disorders And resources in the world 2011 45results | themes | treAtment


in the world 2011

guidelines

ng p k g

mm mgm

p . t

p g 6.1 6.3.

SALIENT FINDINGS

p Gb, g mm

mgm m (55 %)

pg . n g 26

.

p rg mk: g mm

q

am , ep w P , m a

b e M s-ea r g.

p t pp b b -m

(g 6.3), m b xp. ab 40 %

pp -m .

results

tHemes treAtmeNt

0

10

20

30

40

50

60

70

80

55

75

0

76

3

74

22


0

10

20

30

40

50

60

70

80

68

6263

16


FIG. 6.2 c mkg mgm g mm p ,

b who g (% p p mg pg)

FIG. 6.3 c mkg mgm g mm p ,

b m g (% p p mg pg)

Yes

No

FIG. 6.1 c mkg mgm g

mm p yes no no data


23/35



in the world 2011

0

20

40

60

80

100

66

93

4744

21

45

22

96

ZolmitriptanSumatriptanRizatriptanNaratriptanFrovatriptanEletriptanAlmotri ptanErgotamine

FIG. 6.4 ab p -mg g (% p p mg pg)

AvAilABility of medicAtions

t m g

q: g, -m, p

-mg g pp m. rp-

k b b g

, mbm p.

t g g p m (m p),

p, - -fmm g (nsaid),

bb-g g mp, p / p

(g ) p -g

g mp.

t - m g mp

mpm, b pk (b g

g mpg) p ppp mg.

t p -m g g g (gm

gm) p (mp, p,

p, p, p, mp mp).

t pp g b-b k, f ,

mg, p, p (m p, p

px), p pm.

r g 6.4 6.9.

results

tHemes treAtmeNt

0

20

40

60

80

100292722262222134

555961

586560

79

73

16141716

1318

8

23


SPGPOTC

0

20

40

60

80

100


NoIn partYes

OTC = --; GP = GP pp ; SP = p pp

FIG. 6.5 rg p -mg g (% pg)

FIG. 6.6 rmbm p -mg g (% pg)


24/35



in the world 2011

SALIENT FINDINGS

Analge sics

p Pm p b

p, g m g. o

nsaid b (67 %). t g

m bb --.

p op / p b 65 % , bb-

g g mp mb (33 %).

t g m b p p .

p ag mb b

p, b g .

Anti -emeti cs

p Mpm b (100 %), mp

m (86 %). a pp , b

p -- pb b

.

p t g p b mb

.

Anti- migraine dr ugs

p t m b p -mg g

gm (96 % pg ),

b mp (93 %) (g 6.4). o p,

mp (66 %) m pg

. rp (47 %), p (45 %) p

(44 %) m b - b mp

(22 %) p (21 %) q

.

p a g pp- (GP p)

m , b gm, b, bb -

- m q (23 %) (g 6.5). t

mb p b ,

b b (g 6.6).

Prophylactic drugs

p t m b pp g b-bk

p (100 % pg ),

b m p (98 %) g

b pm (81 %), f (72 %), p (57 %)

mg (43 %) (g 6.7).

p a g pp- m (g

6.8). t mb, p, b

, b (g 6.9).

0

20

40

60

80

100

23

81

10098

57

43

72

100

OthersTopiramateTricyclic

antidepressants

Sodium

valproate

PizotifenMethysergideFlunarizineBeta-blockers

FIG. 6.7 ab pp g (% p p mg pg)

0

20

40

60

80

1003718252222105

54

75

636773

6876

971211

5

2219

TopiramateTricyclic

antidepressants

Sodium

valproate


SPGPOTC

0

20

40

60

80

100 39353428193231

222623

26

49

2627

403943

46

32

4241

TopiramateTricyclic

antidepressants

Sodium

valproate


NoIn partYes

OTC = --; GP = GP pp ; SP = p pp

FIG. 6.8 rg pp g (% pg)

FIG. 6.9 rmbm pp g (% pg)

results

tHemes treAtmeNt


25/35



in the world 2011

use of medicAtions

rp k p mg

g ( q , b

k b b).

SALIENT FINDINGS

Migraine

p m p mg, nsaid (

p) , , m p g (86 %

p). Pm (69 %) p

(52 %) . B g b who

m mg pbb g p

g g ( pp g ) g

m g (g 6.10).

pMpm p -m g

p mg (71 % ),

g xp s-e a.

p Gb, q-p p -mg g

gm (34 % p)

mp (33 %) (g 6.11). t mb

mk g , gm

p b ep w P,

mp ( - p ep).

p B-bk p mg pp g

(85 % ) g (g

6.12). t p (56 %) ,

g xp w P. sm p (40 %),

pm (34 %) f (34 %) ,

g .

Tension Type Headache

p m p -p ,

nsaid ( p) , , m p-

g (87 % p). Pm

(75 %) , b pbb g g g

g m g. ap (45.5 %) pp

b .

0

20

40

60

80

100

52

25

80

4546

53

61

6975

80

66

85

47

8386

100100

9085

74

83


Aspiri nParacetamol/acetaminophenOther NSAIDs

FIG. 6.10 M p g g m p mg, b who g

(m % p)

0

10

20

30

40

50

60

33

50

40

45

23

16

22

34

38

60

11

39

47

56


SumatriptanErgotamine

0

20

40

60

80

100

56

38

80

5054

6367

3438

20

39

54

37

6

40

63

20

47

23

3733 34

50

40

2923

53

22

8588

100

8792

7978


Tricyclic antidepressantsTopiramateSodium valporateFlunarizineBeta-blockers

FIG. 6.11 egm mp m p p -mg g who g

(m % p)

FIG. 6.12 M-p pp g mg, b who g (m % p)

results

tHemes treAtmeNt


26/35



in the world 2011

WHO region Acupuncture (%) Naturopathy (%) Physical therapy (%)

Arican (n = 18) 22 11 22

Americas (n = 19) 32 26 42

Eastern Mediterranean (n = 13) 31 15 23

Europe (n = 38) 50 32 68

South-East Asia (n = 5) 60 80 0

Western Pacifc (n = 8) 38 0 38

World (n = 101) 39 25 44

n = mb pg

TAbLE 6.13 t m q mpm p , b

who g (% p p mg pg )

AlternAtive orcomPlementAry therAPies

rp k m q

mpm p

. t p mm b 6.13.

SALIENT FINDINGS

p P p (44 % p), -

p (39 %) p (25 %) m q

b mg. a p

p g m g.

p o mpm p q

m bbk / x, b

pp, m, x g, p-

g p, g m m, -

, a, fxg mp.

imPlicAtions

p G, p p ppp

p, , xp

mp mgm m,

. M -m

g, g g mj -

pp mpm. h,

p g ( pp 58 59)

p , p, g

mm.

p i , , , pp

, mgm g

. i m, g -

p m b

m mp.

p t m b g, g fg

g q g. t ,

, g p mgm, g

g g g.

p w p mbm, b

p b mgm. G, b

g mb

(g p mbm m

g p ). G -

m g (

q- g (6, 12,

28, 29)), p mbm b b.

p t m p g m ppx

mg m b g ( > 96 %

pg ), b m

. a p xmp gm, m

m b p -mg g ,

p m m who m

2005 (38). egm - mp p ,

g mp

bm b g p, pp

p p g q

(39). m, -- b b

q x,

m p (39). tp, p

mp, b m b m

mm .

p tm -p , ,

m m . i k m

, m b : mpm

, m , m q.

p op / p b, b

p g mg -p .t . t p

, p p,

, bm k g

q p.

results

tHemes treAtmeNt


27/35

54 AtlAs of heAdAche disorders And resources in the world 2011 55results | themes | ProfessionAl trAining

FIG. 7.1 em mb g g m m

pg g p g, b who g (m p)


in the world 2011

undergrAduAte A ndPostgrAduAte medicAltrAiningP p k m mb

g m -

g m m. ng

k m p p-

g p g. t g mm

g 7.1 7.2.

rp k b g m

pm- p.

FIG. 7.2 em mb g g m m

pg g p g, b -m g (m p )

SALIENT FINDINGS

p w, j mm

m g m g, 10

p g. t p m

g , m mm am

ep. h, p b

g m g:

m 0 20 g m g m

0 720 p g. t m (4.8 -

g 37 p g) gg m

g k b . t pbb

f g pgmm

p; m f b

g ( xmp, m

p ).

imPlicAtions

p t k g g

g ( 4 6 ) mm,

g , p

g pp m p b pm

p g (40).

p a p g

mp,

mgm p m. B

m g mgm , pp j

m, -g ,

p.

p i, b mp g b -

m b m .

p i g

. B m b

pm , mp b g

g, m g m

g p p g.

results

tHemes proFessioNAl trAiNiNg


28/35

56 AtlAs of heAdAche disorders And resources in the world 2011 57results | themes | nAtionAl ProfessionAl orgAnizAtions

0

20

40

60

80

100

61

50

85

70

3630

18


0

20

40

60

80

100

61

50

40

84

31

79

28


0

10

20

30

40

50

60

70

80

70

7671

16



in the world 2011

ng p k

p g

. i , k

p x p g

( xmp, g). i , p

k b (mb mmb) g

p (m p-p ).

t p mb :

b m (g 8.1 8.6).

results

tHemes NAtioNAl proFessioNAl

orgANiZAtioNs

FIG. 8.2 c p g p g, b who g (% p p mg p g)

FIG. 8.3 c p g p g, b m g (% p p mg pg)

FIG. 8.4 s (mb mmb) p g p g, b who g (m p)

Yes

No

FIG. 8.1 c p g

p g yes no no data


29/35

58 AtlAs of heAdAche disorders And resources in the world 2011 59results | themes | nAtionAl ProfessionAl orgAnizAtions


in the world 2011

0 5 10 15 20 25 30 35 40

39

36

35

20

17

13

10Constructing curriculum in undergraduate training

Lobbying governments

Advising governments

Constructing curriculum in postgraduate training

Guidelines for management

Raising awareness

Organizing professional meetings

FIG. 8.6 a p g p

g (% p p mg pg)

results

tHemes NAtioNAl proFessioNAl

orgANiZAtioNs

SALIENT FINDINGS

p a p g ,

/ p g, x

(67 %) p.

p rg, g m mm ep(85 % ) am (79 %),

w P (50 %) s-e a (40 %)

mm e M (31 %) a (28 %).

p t mk b g-

m-m ( g 71 76 %) -

m (16 %).

p rg pp (mb

mmb) p g

p. Jg b m, g s-e

a (m 85). g ep (m 70),

w P (m 50), e M

(m 36), am (m 30) a (m 18).

lg am w P

b .

p s pp -m g:

(m 25 mmb), m (m 21), pp

m (m 50) g (m 113).

p o p g

p g mg (39 %),

- (36 %)

g g / mm

mgm (35 %). t p

g m g, g

. Mg ,

mg b xp, m- pm

49 % pg g-m , 38 % pp

m-m 21 % -

m .

p n m g pp

pg g (20 %),

pm g

(0 15 % b g, 10 % ).

p o 13 % bb gm -

(0 25 % b g, m mm w P

ep ). lbbg m-: m k (16 19 %)

g- pp m-m , (8 %)

m-m (5 %) -m .

p sg m g (17 %) gm

(0 32 % b g, m mm ep

w P).

imPlicAtions

p s p g ,

g g-g,

g pbb pm b

m , pg.

p n p g m k

g, mpg

g kg

. am g

mmb i h s,

p g mmbp

p kg 100 p .

p w p g -

pp b mm (xg p-

g ), g b k: p m

m g

x, m -p-

. i m k b 193

who Mmb s 101 pg -, pp g 35 %,

pbb . i , -

b p b g m g ,

p -m .

p B pm- . n

p g pp m

pmg m g b,

, p k g m

pm- p.

p lbbg g gm m ,

m-p pbb

.

0

20

40

60

80

100 95

36

2025


FIG. 8.5 s (mb mmb) p g p

g, b -m g (m p)


30/35

60 AtlAs of heAdAche disorders And resources in the world 2011 61results | themes | issues


in the world 2011

0 5 10 15 20 25 30 35

34

33

33

29

26

22

22

21

20

13

11

11

10

9

7

6

6

5Lack of awareness of indirect costs

National poverty and/or social infrastructure problems

General problems of health-care organization/delivery

Excessive demand

Lack of research/data

Lack of political awareness

Iatrogenic and medical mismanagement

Headache-specific problems of health-care organization/delivery

Low priority for headache disorders

General lack of health-care resources

Lack of or need for management aids/support

Inadequate reimbursement

Lack of controls/regulation (including medication overuse)

Lack of public awareness

Non-availability of appropriate medication

Patient-related problems including co-morbiditiesbut excluding medication overuse

Headache-specific lack of health-care resources

Lack of professional education

FIG. 9.1 Pbm b g pp

(% pg)

encountered ProBlems

ng p k p mj

pbm b p

pp g .

t -x p p 18 g , g 9.1.

SALIENT FINDINGS

p t p mj pbm : p

k p (34 % pg -

), p- pbm g -mb b

xg m (33 %), -p k

- (33 %), -b ppp

m (29 %) k pb (26 %).

p l- m-m m k

g, pp m- g-

m p k -p .

p a m g -b ppp

m. t pg g-m, g p

b b ( pp 46 49).

rp m f m mbm,

b p , mp -

b. a mb p p g

m. o mm k

pp g.

results

tHemes issues

suggested chAnges

ng GP p k p

mj g mp pp

. t p,

g, g 9.2.

SALIENT FINDINGS

p amg g mp pp

, p b g

(75 % p).

p nx, mm b m (49 %) pg -

, -g, fg -g

.

p ab mp b

(37 %) mp g

(34 %) .

p o gg g mgm

, mp mbm, pp p , , bbg,

pp gp b

g m.

0 10 20 30 40 50 60 70 80

75

49

37

34

21

18

16

15

12

10

5Control/regulation

Lay support (groups)

Advocacy/lobbyi ng

Professional societies

Research

Improved reimbursements

Management aids/improvements

Improved health-care organization/delivery

Improved health-care availability

Awareness-raising

Professional education

FIG. 9.2 cg gg b p mp pp

(% pg)

imPlicAtions

p M pbm b g

p f p g

-g mp. t

p g

Atlas o Headache Disorders .

p B k b pp

g, k k

mpg g mgm . t

b ( pp 54 55).

p i , b b b g

.


31/35

62 AtlAs of heAdAche disorders And resources in the world 2011 63the wAy forwArd


in the world 2011

tHe wAy ForwArd

h bq, p, bg

g b, b -g, -g

-. i b , b,

b , p.

g p m g

- xp .

t g m g, g g ,

mg m p .

PoliticAl will is needed

t g p g

pbm x, m m . t

Atlas o Headache Disorde rs .

Knowledge gAPs must Befilled

Kg m p mp. -

pmg , pg pp-b m b,

m , p -p .

heAlth cAre for heAdAchemust Be imProved

i b , , b 50 % pp

pm -g,

p: m -p m

mg m q / m k.

o , g f q

, k, m m

mpm g. a xmp, m-

g b, b pb

mb, b k m .

t g (10 %)

mp m q.

G g m pp b

mgm, p b -xp pm .

M x ; k m p -

m p b b

. t - pp b

mpm.

t g g p p g

xp, m q

g, g m. s b

pb, g.

a m mp p m gm, p m

m . exg m m

. t g - pp

mpm g g, p -

p .

dg k b mp g b

b , gb, p gg

ppp m b . i ,

m g x, b m g

k m b b mgm.

i p, p b m b,

p gm,

b x, m

p ( p 53).

rmbm , m pp, k b g. rmbm b mp, b

m b . G -

m g , p mbm

pp b m pp.

heAdAche services must BeorgAnized

t m pp - mg,

-p m- . i

pm g

m .

h b ,

qb g mb pp

b m m. og

g, pp g, mp

-ppp , b b m b

pm . t g mj pp

b mg. t pp 10 %

b p g: p

q b b m

m m.

a g -b gm x xpg

pm- mgm , p

- m , g,

g p pm .


32/35

64 AtlAs of heAdAche disorders And resources in the world 2011 65Key messAges


in the world 2011tHe wAy ForwArd

educAtion is centrAl toremediAl Action

a p m g

mp,

mgm p m. cg g m - ,

m p g.

e q mp . M mp, -

p b kg g

m mb pb-

mp. t b kg mp g

b m, p b m, g

.

B m b pm ,

mp b g g, m

, qg g g m.

s, b g m g

p.

w, b 50 % pp pm-g, p. t,

pp b

b pb-

mp. i b - p,

b m

q m- ,

g b.

nAtionAl ProfessionAlorgAnizAtions should BesuPPortedn p g,

x, pmg , pg- mgm , g g,

mpg kg g

k gp.

spp bm m

p g pp g .

greAter investment inheAdAche services issensiBleG g , g

m ,

g -g pp b

, m b -g .

Key messAgespHeadache disorders are ubiquitous, prevalent and

disabling. Yet they are under-recognized, under-

diagnosed and under-treated worldwide:

aminorityofpeoplewithheadachedisordersareprofessionally diagnosed;

managementguidelinesareusedroutinelyin55%of

respondingcountries,butmuchlesscommonlyinlow-incomecountries;

despitetherebeingarangeofdrugswithefcacyagainstheadache,countriesinallincomecategories

identifynon-availabilityofappropriatemedicationas

abarriertobestmanagement;

worldwide,onlyfourhoursarecommittedtoheadachedisordersinformalundergraduatemedical

training, and lack of education is seen as the key

issueimpedinggoodmanagementofheadache;

illness that could be relieved is not, andburdens,both individual and societal, persist unnecessarily;

nancialcoststosocietythroughlostproductivityareenormous.

pAmongproposalsfor change:

better professional education ranks far above allothers;

athirdofrespondingcountriesalsorecommend

improvedorganizationanddeliveryofhealthcare

for headache.

pGiven the very high indirect costs of headache,greaterinvestmentinhealthcarethattreatsheadache

effectivelymaywellbecost-savingoverall.


33/35

66 AtlAs of heAdAche disorders And resources in the world 2011 67references


in the world 2011reFereNCes

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g-m p.Journal o

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gb_b_/m_g//x.m.

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k

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M M, v d b ep h

Liting The Burden: Gb cmpg

g h. rmm

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mp (hit). Quality o Lie Research.

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mp: hit-6. Quality o Lie Research.

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pm g.Journal o the R oyal Colle ge o

Physicians o London. 1996; 30: 426 431.

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p uK g p. Cephalalgia. 1999; 19:328 329.

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pp u Kgm.Journal o

Neurology, Neurosurgery and Psychiatry. 1997; 63 spp 1:

s53 59.

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i h s. c m

mpg mg mgm. Headache. 1998; 38:

736.

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mg eg u s. Neurology.

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mg Jp: d . Headache. 2004;

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d pp . Journal o Epi demiology &

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. wg dc: w Bk, p

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mpg g. i: o J, .

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mg: ep . Brain 2000;

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34/35

68 AtlAs of heAdAche disorders And resources in the world 2011 69list of resPondents


in the world 2011list oF respoNdeNts

A

Afghani stanMs am

Alani aJ Kj, lm Gj

Algeri at Mm

Argenti nal Bm, c a,h Gmb

Austral iaB egg, r sk

Austri as ob

Azera ijana v M

b

bahraina a J

bangladeshakm a u, ab nr, a hq

baradoss Mq, a Mi, s Gk-B

belarush nm

belgiumM v, Jd, J r

benindm h, eam g, c p t sg

boliia (Plurinational State of)

J c d Q

botswanaJ Mk

brazilab vKmk, M PP, r cmp am v , r mG, w G

bulgariai v

burkina Fasoa Mg

C

Cameroona K njm

CanadaMk G, J vk,v s

Chilen B-ub

Chinasg-y y, y' G, Jl Jg, s w

China, Hong Kong Special

Admini strati e Regiont l, c Kk w, lP c

China (Proince of Taiwan)s-J wg, P-J wg

Colomia

M v Gm

Cte d'loiret s-d

Croatiav dm, J s,Mj

Cyprusc M

Czech RepulicJ Mk, Bm sk

D

Denmarkrgm J, Mg &hpg; Pd

Dominican Repulica rb

E

Ecuador a, a lv-P , Xm h g

EgyptMm s e-tm

El Saladorc a d M, lib r, M G

EstoniaMk Bk, Mktpp, t Jg

Ethiopiaabb Km, am Bk,G a, yb zt , r tk -hm

F

Finland

Mk kk, hkk K,Jkk aj

Franceemm d dg, nsp, M l-M,dmq v

G

Georgiaa dg, M Kk

Germanys e

Greececm Kgg,e G, asp

Guamrm a c

Guatemala

h B sk

H

Hondurastm em

Hungaryl v

I

IcelandM h

IndiaK rk, G Gj, Gr, G Kk, hm dP, sj c

Iran (Islamic Repulic of)am c, ng seb, am eb,hj sm

IrelandPk l

Israelam Mk

ItalyP M, cP, i

J

Jamaicaam a

Japanhk ig, hk og,y Km

K

KenyaMm M Q

L

Latial sk,d Jg

Lithuaniavm B

Luxemourgax B, K J

M

MadagascarM a

Malawit hkm-c

MalaysiaJ tk

Maltaa G db, nbv, J aq

Mauritiuslm t M dmq,y n mm

Mexicor K, l r P M,ag h o vq , c lp P, e M hc, c s

MoroccoB e, s Bbe a, z l

N

NepalJg P ag,a am, rmKm Mj

Netherlands dkk, r vag, G t , G sm

Nigeriaag a a, Bibm, o obk

Norwayl Jb s, ac P, l l

O

OmanM a-sb, Pc Jb,r a-z

P

Pakistanh a, Mmm w

Perue B

Polandam sp, nk P

PortugalJm c d s, JM P M

Q

Qatardk d

R

Repulic of KoreaKg-s l

Repulic of Moldoai M, s ob

Romaniaa-M r

Russian Federationa amk, npp, agk nk,i abg, v op,

S

Saudi AraiaM Mm, rmM, abm a t,Mmm a Jm

Senegal s d

Seriazk M,J z-tjk

Singaporec s,

SloeniaBj z

South AfricaK d rm, es, i d, iskmp

SpainMg Ja l

Sri Lankas sk, sjP

SwedenM lbg, e em,M em, K ekbm, Ml

Switzerlandh i, c a

Syrian Ara Repulicam a, s n,am K

T

Thailandrg ck, asp, a sb

Trinidad and ToagoK rm

Tunisiaam Mb, n amm, h, B ab,Mm lbb ck

TurkeyMm zg, n K,ak s , sb s p,M e, B Bk

U

Ugandae dmb, rg Mmnm Kmg, sp hakm

United Ara EmiratesJ s i, M tk,n s

United Kingdom of Great britain

and Northern IrelandPp ab, P d,tm s, a t

United Repulic of TanzaniaJ Mb, vm l,wm BP Mj

United States of Americaa i s, s w B,rbk

Uruguay

M d M

v

venezue la (bol iaria n

Repulic of)e P d P, vmm

viet N amng dg t, l d h,dg t t, P hgM

Y

Yemenab hkm smab , w q h ,hm a

Z

ZamiaB Kmg, l

cmmb lmb,Mp a

ZimaweJ Mk

w m g g , g

m b , bg m g bm

g m m q bg Atlas o Headache Disorders .


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