An article from Norwegian SciTech News at NTNU
Asking the right questions about headaches
Headaches have long been a headache for science. Why are there worldwide differences in the prevalence? Researchers have now come up with questionnaire that may answer the question.
Gemini, NTNU Trondheim - Norwegian University of Science and Technology
Migraine alone is probably the seventh most common cause of disability, according to WHO.
In addition to causing severe pain for some sufferers, they represent an economic burden. Headaches can lead to reduced work capacity, work absenteeism, a reduced ability to study and a variety of other effects that have consequences for society.
However, there are huge differences in the prevalence of headaches worldwide.
“But we don’t know if this is due to genetic, cultural or economic differences,” says Lars Jacob Stovner, head of the Norwegian Advisory Unit on Headaches at St. Olavs Hospital and the Norwegian University of Science and Technology (NTNU) in Trondheim.
Need comparable results
Researchers need results that are as exact and comparable as possible to answer questions about the prevalence of headaches and their causes.
Research results about headaches have been collected from all over the world. But because the questions vary or they are asked in different ways, the results are not comparable. Also, the results must be interpreted in the context of each country.
Researchers have now addressed this issue with the publication of a new questionnaire in the Journal of Headache and Pain.
“The purpose of this project is to develop a standardized and better approach than what is currently used,” says Dr Timothy J. Steiner at Imperial College in London. He is also a professor at the Department of Neuroscience at NTNU.
Patients answer questions about their family situation, health, perception of the quality of life and a variety of other matters. The answers are designed so that researchers can compare results regardless of the countries surveyed.
Culturally neutral is impossible
Steiner says it is impossible to create a completely culturally neutral method for evaluating headache prevalence.
There is simply too much variation between the conditions in countries such as Norway and Ethiopia.
If you ask someone in Norway if they have been absent from work because of headaches, you will probably get far more yes answers than in Ethiopia.
“As one colleague put it: If you have to plow the fields, then you have to plow the fields,” says Steiner.
In Norway, you get paid sick leave if you are away from work, which means the threshold for staying at home may be relatively low. In Ethiopia, you go to work in the fields because you have to.
A question is not a question
The way a questions are asked is also crucia
For example, if you go canvassing and ask people directly how, you may get completely different results than if you phone them. In some countries it is impossible to contact people by knocking on doors. When you use the phone, you only get in touch with people with phones and those who are able to answer them.
Furthermore, if you ask someone if they have a headache on a Saturday morning, you may get very different answers than on a normal working day. A phone survey in the morning in some countries may give you answers from the mothers who are staying at home, but you will not contact the men who are at work.
There are many factors to consider. Thus, the new questionnaire has a series of recommended approaches to be used in the survey.
The questionnaire and the recommended approaches are the result of reviewing many other surveys and available literature.
The project is part of a global campaign against headaches, led by the non-profit foundation “Lifting the Burden”, which has an official connection to the World Health Organization (WHO).
“Representatives from all six regions of the World Health Organization have participated,” says Stovner.
Steiner and Stovner have worked together on the project for ten years. They have projects in 30 countries that will continue for three to four years.
The goal is for the questionnaire and the recommended approaches to be used throughout the world. The questionnaire has been translated from English into a number of different languages.
The answers will be useful for both specialists and epidemiologists, but most of all, for headache sufferers.
- Diagnosis, prevalence estimation and burden measurement in population surveys of headache: presenting the HARDSHIP questionnaire, The Journal of Headache and Pain.
- Highlights in headache research in 2013, The Lancet Neurology, 2014, Volume 13, Issue 1, Pages 5 - 7