Skip to main content

Valuing headache care

Editors: Timothy Steiner and Michela Tinelli

This thematic series is set in a global context of prevalent and highly burdensome headache disorders that are under-recognized in society, under-prioritized in health policy, under-diagnosed in populations and undertreated in health-care systems. People with headache who would benefit from care find services unavailable, fragmentary or difficult to access. Where headache care is established, the focus is on specialist clinics, delivering high-end care at relatively high cost but with very limited capacity and overloaded with patients whose needs, although less, are unmet elsewhere. People with headache, dissatisfied with health care that is inadequate, fail to seek it and adhere poorly to it.

The thematic series responds, with a focus on Europe but relevance worldwide. It sets out detailed proposals, adaptable for different settings, for how structured headache services should be organized as the health-care solution to headache, along with evaluation based on robust empirical data. The content follows a narrative:

  • it explains the rationale behind the structured headache services model, describes its elements and demonstrates its adaptability;
  • it develops the methodology for economic evaluation of the model, including the introduction of an outcome measure equally applicable to different headache types, to treatments of different modalities, to care delivery systems and to cost-effectiveness analysis;
  • it looks into and provides a better understanding (underpinned by empirical evidence) of the complex relationship between headache-attributed disability and lost productivity – an unexplored but key factor in economic evaluation;
  • it applies the methodology to the model theoretically implemented in three European Region countries, finding and reporting clear evidence of its cost-effectiveness;
  • it comments on the policy priorities for headache in the current context of health-systems reforms, and on how we can ensure that policy is influenced by evidence built on robust research.
  1. Headache disorders are disabling, with major consequences for productivity, yet the literature is silent on the relationship between headache-attributed disability and lost productivity, often erroneously rega...

    Authors: Hallie Thomas, Simple Futarmal Kothari, Andreas Husøy, Rigmor Højland Jensen, Zaza Katsarava, Michela Tinelli and Timothy J. Steiner
    Citation: The Journal of Headache and Pain 2021 22:153
  2. Health economic evaluations support health-care decision-making by providing information on the costs and consequences of health interventions. No universally accepted methodology exists for modelling effectiv...

    Authors: Michela Tinelli, Matilde Leonardi, Koen Paemeleire, Dimos Mitsikostas, Elena Ruiz de la Torre and Timothy J. Steiner
    Citation: The Journal of Headache and Pain 2021 22:99
  3. There have been several calls for estimations of costs and consequences of headache interventions to inform European public-health policies. In a previous paper, in the absence of universally accepted methodol...

    Authors: Michela Tinelli, Matilde Leonardi, Koen Paemeleire, Alberto Raggi, Dimos Mitsikostas, Elena Ruiz de la Torre and Timothy J. Steiner
    Citation: The Journal of Headache and Pain 2021 22:90
  4. In 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 effi...

    Authors: 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…
    Citation: The Journal of Headache and Pain 2021 22:78
  5. Headache disorders are disabling and have a significant impact on productivity. The relationship between these two consequences is of considerable economic and political interest. We enquired into it through a...

    Authors: Simple Futarmal Kothari, Rigmor Hølland Jensen and Timothy J Steiner
    Citation: The Journal of Headache and Pain 2021 22:73
  6. The first manuscript in this series delineated a model of structured headache services, potentially cost-effective but requiring formal cost-effectiveness analysis (CEA). We envisaged a need for a new outcome ...

    Authors: Timothy J Steiner, Mattias Linde and Petra Schnell-Inderst
    Citation: The Journal of Headache and Pain 2021 22:63