• Timothy J Steiner, Rigmor Jensen, Zaza Katsarava, Lars Jacob Stovner, Derya Uluduz, Latifa Adarmouch, Mohammed Al Jumah, Ali M Al Khathaami, Messoud Ashina, Mark Braschinsky, Susan Broner, Jon H Eliasson, Raquel Gil-Gouveia, Juan B Gómez-Galván, Larus S Gudmundsson, Akbar A Herekar, Nfwama Kawatu, Najib Kissani, Girish Baburao Kulkarni, Elena R Lebedeva, Matilde Leonardi, Mattias Linde, Otgonbayar Luvsannorov, Youssoufa Maiga, Ivan Milanov, Dimos D Mitsikostas, Teymur Musayev, Jes Olesen, Vera Osipova, Koen Paemeleire, PeresMario F PMFPInstitute of Psychiatry, University of São Paulo, Hospital Albert Einstein, São Paulo, Brazil., Guiovanna Quispe, Girish N Rao, Ajay Risal, Elena Ruiz de la Torre, Deanna Saylor, Mansoureh Togha, Sheng-Yuan Yu, Mehila Zebenigus, Yared Zenebe Zewde, Jasna Zidverc-Trajković, Michela Tinelli, and Lifting The Burden: the Global Campaign against Headache.
• Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway. t.steiner@imperial.ac.uk.
• J Headache Pain. 2021 Jul 21; 22 (1): 7878.

AbstractIn countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the "patient journey") with perplexing obstacles.High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary.The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded.It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.© 2021. The Author(s).

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