Assessing Readiness for Headache Services in District of Kolar


One of the commonest symptoms that the clinicians encounter regularly in general OPD and Neurology is "Headache". In most cases headache is Primary symptom and a non fatal disorder,many a times it can be a secondary symptom of an underlying cause like intracranial neoplasms, epileptic seizures and intracranial infections. Migraine and tension type headache is the second leading cause of disability world wide(Ref:The Global Burden of Disease Study 2017). Though it is a very common disorder, there are no organized services for its cure.

It is being treated under general health care system which does not have a structured treatment procedure for headaches. Headache simply requires trained personnel who give appropriate medication and counsel the patients rather than the use of any sophisticated devices for diagnosis and treatment as it is for other neurological disorders. Structured headache services, especially in the primary care, along with educational initiatives are most efficient, equitable and cost effective solution. This places the responsibility of managing headache in the majority of affected people , upon the healthcare providers, who presebtly lack special expertise in headache management.

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Along with this, medical management of headache disorders requires only diagnostic and management skills that are usually available to all physicians and other heath care providers in primary care. Through out the world, there may be limited training in the application of these basic skills to headache diagnosis and treatment among the practitioners.

Readiness is the state of preparedness of persons, systems, or organizations to meet a situation and carry out a planned sequence of actions.

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Readiness is based on the planning, adequacy and training of the personnel, and supply and reserve of support services or systems. A readiness assessment identifies the potential challenges that might arise when implementing new procedures, structures, and processes within a current organizational context. Furthermore, through the identification of the gaps within the existing organization, the readiness assessment affords the opportunity to remedy these gaps either before, or as part of, the implementation plan.

Review of literature

Burden of primary headache

Of all GBD causes of disease, tension-type headache was the third most prevalent, and migraine the sixth. In terms of years of life lived with disability, migraine ranked second globally, and was among the ten most disabling disorders in each of the 21 GBD regions. Particularly burdensome among young and middle-aged women. Headache showed no clear relation to sociodemographic development, as measured by the Socio-demographic Index. No risk factors have yet been established in the GBD studies for headache disorders. Thus, primary headache disorders are an important health priority.

· In GBD 2000, migraine was included as the only headache subtype. Since then, TTH was added to the GBD study, and some of the limitations in the previous estimates were addressed by using more comprehensive and reliable epidemiologic data based on population-based surveys from countries without previous available data. Estimating the burden of headache is the first step to implement further measures to reduce its burden such as educating health care providers, developing primary care management, and allocating resources.Effective strategies to modify the course of headaches and alleviate pain exist, but many people affected by headache are not benefiting from this knowledge

Prevalence of headache

  • GBD 2016, provided more accurate estimations of prevalence and burden of headache by countries, regions, and super regions. Prevalence of headache disorders was variable across different geographic regions. Migraine was less frequent in African and Western Pacific WHO regions and TTH was less frequent in African region. The overall global all-age prevalence in 2016
  • Migraine: 14.1% (95% UI 13.5-14.8%
  • TTH: 25.6% (95% UI 23.1-28.4).
  • Prevalence of headache is an important epidemiologic measure, the burden of disability related to headache, as measured by YLD, is more informative for health policy making.
  • Migraine, with 45,121,909 YLDs (95% UI 29,045,835-62,826,9 04) - second leading cause of disability.
  • TTH, with 7,195,122 YLDs (95% UI 4,614,628-10,499,903) - 28 leading causes of disability.
  • In Karnataka: : The 1-year prevalence of headache was 63.9% (62.0% when adjusted for age, gender and habitation) and 1-day prevalence (headache on the day prior to the survey) was 5.9%. Prevalence was higher in the age groups of 18-45 years, among females (OR = 2.3; 95% con?dence interval: 1.9-2.7) and those in rural areas. Prevalence was higher in rural (71.2 [68.4-73.8]) than in urban areas (57.3 [54.5-60.1]) even after adjusting for gender. The proportion of days lost to headache from paid work was 1.1%, while overall productivity loss (from both paid and household work) was 2.8%.

Classification of headache

The International Classification of Headache Disorders (ICHD) is a detailed hierarchical classification of all headache-

Part one: primary headache

  1. Migraine
  2. Tension -type headache
  3. Trigeminal autonomic cephalaigias
  4. Other primary headache disorders

Part two: the secondary headaches

  1. Headache attributed to trauma or injury to the head and/or neck
  2. Headache attributed to cranial or cervical vascular disorders
  3. Headache attributed to non-vascular intracranial disorders
  4. Headache attributed to substance or its withdrawal
  5. Headache attributed to infection
  6. Headache attributed to disorder of homeostasis
  7. Headache or facial pain attributed to disorder of cranium, neck, eyes, ear ,nose ,Sinus , teeth ,mouth or other facial or cervical structure
  8. Headache attributed to psychiatric disorders

Part three: Painful cranial neuropathies ,other facial pain or other headache

  1. Painful cranial neuropathies and other facial pains
  2. Other headache disorders
  3. Diagnosis of headache
  • Primary headaches are not correlated with any other underlying medical condition or makes up around 90% of total headache cases. primary headaches are not life-threatening
  • Secondary headache is a sign of an underlying medical condition or makes up to the oth er 10% of total headache some cases underlying condition are life threatening

Some primary headaches can be triggered by lifestyle factors, including:

  • Alcohol, particularly red wine
  • Certain foods, such as processed meats that contain nitrates
  • Changes in sleep or lack of sleep
  • Poor posture
  • Skipped meals
  • Stress

Step 1: Exclude Secondary Headache:

Complete History and Examination

Assess Headache and Signs and Symptoms and look for atypical features Yes

Screen for Red Flags SNOOP Evaluate for Secondary

If headache frequency and severity are progressing, watch for and warn No Headache against risk for chronic migraine

Step 2: Identify primary headache symptoms: Yes

Identify primary headache syndrome Assess for Acute medication overuse

Episodic headache of Chronic headache of long duration long duration

Frequency < 15 days/month Frequency > 15 days/month

Lasting >4 hours lasting > 4 hours

Step 3: Diagnosis of specific headache disorder:

Migraine Chronic migraine

Migrainous Chronic tension type

Tension Type NDPH

Hemicrania continua

NDPH: New Daily Persistent Headache

Primary headache do not require sophisticated devices for simply require fully trained personnel who can give proper medication and counsel the patients.

The need for structured headache services:

Headache disorders, especially migraine and tension-type headache (TTH), are collectively cause substantial levels of public ill health and disability. Yet, throughout the world, they are under-recognized . This misperception is not easily explained, but it is now slowly changing. On the initiative of LTB and the Global Campaign against Headache , new studies are filling the gaps in our knowledge of the burdens attributable to headache disorders , which had embraced half the world These studies confirm, in all regions of the world, that these burdens weigh heavily not only on people with headache but also on their families, friends, work colleagues and, ultimately, society itself. The Atlas of Headache Disorders published by the World Health Organization (WHO) in collaboration with LTB, although not a population-based survey, collates corroborative evidence on the impact of headache from over 100 countries .

The recognizable consequences not only of public ill health but also of high socioeconomic cost . coupled with the large numbers of people affected by headache disorders, give rise to the need for organized, structured and adequately-resourced health services to alleviate them . Effective and cost-effective treatments exist for most people with headache ; however, they often fail to reach those who need them . Delivering these treatments is, from any sensible perspective, a public-health priority . The indirect costs of headache, arising mostly from lost productivity secondary to disability, vastly outweigh direct treatment costs ; consequently, from a societal perspective, headache-untreated costs a great deal more than headache-treated . Even if importance is not attached to the individual burdens attributable to headache , society should wish to mitigate the huge financial burden upon itself which headache imposes

Research Questions:

  1. What is the readiness of the system with respect to planning, training ,personnel and support services including availability of drugs in district of Kolar.
  2. What is the level of Knowledge, Attitude and Practice regarding Management of Primary headache disorders among Health personnel in district of Kolar.

Aim and Objectives:


Assessing readiness for headache services in district of Kolar.


  • To document the readiness for headache services in a district
  1. Review documents and identify plans for headache services
  2. Document drug availability for primary headache disorders in the district
  3. Review HRD training plans for management of primary headache disorders
  • To assess the levels of Knowledge, Attitude and Practice regarding Management of Primary headache disorders among Health personnel in district of Kolar.

Materials and Methods:

Study area /Setting: : the present study will conduct in district of Kolar, which is located 70km away from Bangalore. The Centre for Public Health NIMHANS has established a public health observatory in Kolar to strengthen public health aspect for control of Non Communicable diseases, mental health and neurological disorders.

Type of Service Service Provider

Identification ASHA, ANM

Diagnosis and Treatment PHC Medical Officer

Follow up Medical Officer, ANM

Study participants: Health personnel with in administrative limits of Kolar district

Inclusion criteria:

  • All health personnel who are working at least for one year

Exclusion criteria:

  • In case they are retiring in next two year
  • Not willing to provide informed consent
  • Study duration: 6 months
  • Study design: Mixed method
  • Sample size: 100% (around 82) of Medical Officers and 10% of remaining staff (Pharmacists, ANMs, Block Health Educators, ASHAs, etc.,)


Simple Random Sampling

10% of all stratified staff in each PHC are selected

  • Study instrument: Study instrument would contain the following sections
  • Section A: socio-demographic variables
  • Age
  • Gender
  • Education
  • Present cadre
  • Place of residence
  • Place of work
  • No. of year of work experience

Section B: Readiness of the system with respect to planning, training, personnel and support services including availability of drugs in district of kolar:

  • Focus group discussion and Key informative interview with the district health officer, Administrative medical officer of district hospital or medical superintendent , Administrative medical officer of taluka hospitals and NCD programme officer.

Section C: Knowledge, Attitude and Practice of health personnel regarding management of primary headaches assessed by case vignettes:

  • Five case vignettes pertaining to commonly observed primary headaches in primary care settings will be developed by a team of public health professional and Neurologist

Method of collection of data: Permission shall be taken from District Health Office. After prior appointment , informed consent shall be taken from health personnel and the questionnaire will be administered either individually or in groups

Statistical analysis

  • Test of normality (Shapiro- wilk test) will be performed before undertaking analytical statistics.
  • Non -parametric tests will apply when test for normality fails
  • Independent 't' test will be applied to test for differences in diagnosis and treatment scores for case vignettes

Ethical clearance

  • Scientific and ethical clearance will be applied for under the NIMHANS Ethics Committee.
  • Report of project will be submitted to all study stakeholders and district administration
  • A dissemination programme will be conducted to discuss findings and recommendations
Updated: May 21, 2021
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Assessing Readiness for Headache Services in District of Kolar. (2019, Dec 08). Retrieved from

Assessing Readiness for Headache Services in District of Kolar essay
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