On a cold January morning, looking through the frosted window of her apartment in Delhi, Janaki Bora (name changed) wonders, “When was the last time I did not have a headache?”
For the past two weeks, the 30-year-old has been waking up with a throbbing sensation or a dull ache on both sides of her head. As the day progresses, the pain worsens.
“It is unbearable. I am planning to visit a doctor soon after the Covid-19 restrictions are eased a bit,” she says. For the time being, she is self-medicating and taking paracetamol pills when she can no longer tolerate the pain.
Bora, who manages the social media of an advertising firm, is in no mood to attend to her office work but she can’t avoid it any further — she has already taken three days of “sick leave” and work is piling up.
“Because of regular headaches, my work is suffering a lot—both at the office and at home,” she says. “I remain irritated throughout the day. I hardly speak with my parents, who stay in Assam, and friends over phone. Thankfully, my roommate is doing all the cooking and cleaning without complaining. But this can’t continue for long.”
Bora’s situation is not unique as her pain is shared by almost half the world’s population. According to the World Health Organization (WHO), almost half of the adult population have had a headache at least once within the last year.
In fact, headache disorders—migraine, cluster headache, tension headache and medication-overuse headache—are among the most common disorders of the nervous system.
“Half to three quarters of adults aged 18–65 years in the world have had a headache in the last year and, among those individuals, 30 per cent or more have reported migraines,” says the WHO. “Headache on 15 or more days every month affects 1.7–4 per cent of the world’s adult population. Despite regional variations, headache disorders are a worldwide problem, affecting people of all ages, races, income levels and geographical areas.”
Not just a medical problem?
Miles away from Bora, retired couple Saurabh Kumar and Mitali Devi in Bengaluru say they both suffered from regular bouts of migraines throughout their teaching career. “In fact, Mitali took an early retirement as it was getting difficult to maintain a balance between work and home with a piercing pain from head to neck. I somehow managed to teach till my retirement,” says Kumar (66).
The husband-wife duo left their hometown Meerut, Uttar Pradesh, a few years ago. Now, they stay with their son in Bengaluru and see a doctor to keep migraine at bay.
“Sometimes I regret leaving my job before retirement, but I had no option,” says Devi (62). “People think, ‘Who leaves a job because of a headache?’ I did, as it was really painful, like I was hallucinating for days. Things are better now as I am on regular medication. We do yoga at least thrice a week, eat healthy food and sleep on time.”
Headache is one of the most common yet most neglected diseases. Experts say headache has been underestimated, under-recognized and under-treated throughout the world. Headache disorders are a public-health concern given the associated disability and financial costs to society.
Migraine in the workplace
A global study, ‘Impact of individual headache types on the work and work efficiency of headache sufferers’, published in 2020 said that headaches have not only medical but also great socio-economic significance, therefore, it is necessary to evaluate the overall impact of headaches on a patient’s life, including their work and work efficiency.
The study found that monthly absence from work was mostly represented by migraine sufferers (7.1 per cent), significantly more than those who suffer from tension-type headaches (2.23 per cent) and other headache types (2.15 per cent). Migraine sufferers (30.2 per cent) worked despite having a headache, which was more frequent than those having tension-type and other-type headaches (13.4 per cent).
On an average, headache sufferers reported work efficiency ranging from 66 per cent to 90 per cent, found the study done by a group of five scientists and available on PubMed. The study’s findings corroborated what patient have been saying for long. “Headaches at work, especially migraines, significantly affect work and the work efficiency of headache sufferers by reducing their productivity. Loss is greater due to reduced efficiency than due to absenteeism,” said the study.
Another study, ‘The burden attributable to headache disorders in India: estimates from a community-based study in Karnataka State’, in 2015 found that participants with headache lost 4.3 per cent of productive time; those with migraine lost 5.8 per cent (equating to 1.5 per cent from the adult population).
“Lost paid work time accounted for 40 per cent of this, probably detracting directly from the GDP,” said the study, which had scientists from the National Institute of Mental Health and Neurosciences (Nimhans), Bengaluru among the researchers. “We estimated population-level disability attributable to migraine. The mean disability per person with migraine is 1.8 per cent, reducing the functional capacity of the entire adult population by 0.46 per cent. Fewer than one quarter of participants with headache had engaged with health-care services for headache in the last year. Actual expenditure on headache care was greatest among those with headache on ≥15 days/month (especially probable medication-overuse headache), but otherwise not high. They expressed their willingness to pay for effective treatment for headache, signalling dissatisfaction with current treatments.”
Around 2,400 participants took part in the study. According to doctors at Nimhans, over 30 per cent of migraine patients are unaware that they suffer from the disease.
Treat the disease
Lack of proper awareness about headache disorders impacts treatment. “Many of those troubled by headache do not receive effective care,” says the WHO. “For example, in the United States of America and the United Kingdom, only half of those identified with migraine had seen a doctor for headache-related reasons in the previous 12 months, and only two-thirds had been correctly diagnosed. Most were solely reliant on over-the-counter medications.”
The WHO has stressed that appropriate treatment of headache disorders requires training of health professionals, accurate diagnosis and recognition of the conditions, appropriate treatment with cost-effective medications, simple lifestyle modifications, and patient education. The main classes of drugs to treat headache disorders include analgesics, anti-emetics, specific anti-migraine medications, and prophylactic medications.
