• Kia Vosoughi, Lars Jacob Stovner, Timothy J Steiner, Maziar Moradi-Lakeh, Seyed-Mohammad Fereshtehnejad, Farshad Farzadfar, Pouria Heydarpour, Reza Malekzadeh, Mohsen Naghavi, Mohammad Ali Sahraian, Sadaf G Sepanlou, Arash Tehrani-Banihashemi, Reza Majdzadeh, Valery L Feigin, Theo Vos, Ali H Mokdad, and MurrayChristopher J LCJLDepartment of Health Metrics Sciences, University of Washington, Seattle, WA, USA..
• Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
• J Headache Pain. 2019 Apr 25; 20 (1): 4040.

ObjectivesUsing the findings of the Global Burden of Disease Study (GBD), we report the burden of primary headache disorders in the Eastern Mediterranean Region (EMR) from 1990 to 2016.MethodsWe modelled headache disorders using DisMod-MR 2.1 Bayesian meta-regression tool to ensure consistency between prevalence, incidence, and remission. Years lived with disability (YLDs) were calculated by multiplying prevalence and disability weight (DW) of migraine and tension-type headache (TTH). We assumed primary headache disorders as non-fatal, so their YLD is equal to disability-adjusted life years (DALYs).ResultsMigraine and TTH were the second and twentieth leading causes of YLDs in EMR. Between 1990 and 2016, the absolute YLD numbers of migraine and TTH increased from 2.3 million (95% uncertainty interval (UI): 1.5-3.2) to 4.7 million (95%UI: 3-6.5) and from 383 thousand (95%UI: 240-562) to 816 thousand (95%UI: 516-1221), respectively. During the same period, age-standardised YLD rates of migraine and TTH in EMR increased by 0.7% and 2.5%, respectively, in comparison to a small decrease in the global rates (0.2% decrease in migraine and TTH). The bulk of burden due to headache occurred in the 30-49 year age group, with a peak at ages 35-44 years. The age-standardised YLD rates of both headache disorders were higher in women with female to male ratio of 1.69 for migraine and 1.38 for TTH. All countries of the EMR except for Somalia and Djibouti had higher age-standardised YLD rates for migraine and TTH in compare to the global rates. Libya and Saudi Arabia had the highest increase in age-standardised YLD rates of migraine and TTH, respectively.ConclusionThe findings of this study show that primary headache disorders are a major and a growing cause of disability in EMR. Since 1990, burden of primary headache disorders has constantly been higher in EMR compared to rest of the world, which indicates that health systems in EMR must focus further on developing and implementing preventive and management strategies to control headache.

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