The study is part of the Global Burden of Disease 2023 analysis and presents one of the most comprehensive assessments so far of the global burden caused by migraine, tension-type headache, and medication overuse headache. It was led by researchers from the Institute for Health Metrics and Evaluation and the Norwegian University of Science and Technology, and it evaluates how long people live with headache disorders, how the burden varies across age groups and sexes, and how the overall health loss has changed over time.

What is the scale of headache disorders around the world?

The findings highlight that headache disorders ranked sixth among all causes of disability globally in 2023. The age-standardised rate reached 541.9 years lived with disability per 100,000 population, and this burden has remained largely unchanged since 1990. Years lived with disability is a metric that captures the total time individuals spend living with symptoms that impair everyday functioning and quality of life.

The study also shows that headache disorders disproportionately affect women. Women experienced an age-standardised rate of 739.9 years lived with disability per 100,000 population, which is more than twice the rate reported for men at 346.1. Across all age groups, women not only had headaches more frequently but also experienced longer episodes of pain and disability.

According to co-author and research scientist Yvonne Xu from IHME, the analysis shows that headache disorders have remained unchanged for three decades. She adds that women experience significantly higher levels of headache-related disability because they have headaches more frequently and for longer durations than men.

What are the most common kinds of headaches?

One of the most significant insights from the study is that although tension-type headache is nearly twice as prevalent as migraine, migraine accounts for about 90 per cent of headache-attributed YLDs.

Migraine alone resulted in an estimated 40.9 million years lived with disability globally in 2023, with an age-standardised rate of 487.5 per 100,000. By comparison, tension-type headache contributed only 54.4 years lived with disability per 100,000, even though it is far more prevalent worldwide. This gap highlights the intensely disabling nature of migraine.

Medication-overuse headache, a chronic condition caused by excessive intake of medication used to treat acute headache symptoms, further amplifies global levels of disability. Although the number of people affected by this condition is relatively small, its impact on individual quality of life is extremely high, making it a significant contributor to population-level health loss.

For migraine, medication overuse accounted for 22.6 per cent of years lived with disability in men and 14.1 per cent in women. For tension-type headache, it contributed 58.9 per cent in men and 56.1 per cent in women. Overall, medication overuse was responsible for more than one-fifth of all disability from headache disorders around the world.

The study adds that “this underpins the need to raise awareness, among both people with headache and health-care providers, about the risks associated with the overuse of acute medication. The studies contributing to GBD make clear that medication overuse is a global problem, not restricted to high-income countries.”

What does it mean for India?

The Global Burden of Disease 2023 map of age-standardised years lived with disability due to headache disorders shows that India recorded between 500 and less than 550 years lived with disability per 100,000 population.

This places India lower than several other countries and regions, including Nepal, parts of Africa, and many European countries.  At first glance, this might suggest that India has a comparatively lower burden. However, this interpretation must be approached carefully. One important observation in India: fewer than one-quarter of those with headaches had consulted a physician for their headache in the preceding year.

Commenting on the global study, Dr Vinit Suri, Senior Consultant Neurologist at Indraprastha Apollo Hospitals in New Delhi, echoed this observation. He believes the actual burden in India is not lower, even though it may appear so in the data. “I do not think headaches are less in India. The prevalence would be almost similar to the rest of the world,” he said. A major reason the numbers seem lower is underreporting. With a large rural population and limited access to specialists, many individuals ignore symptoms or rely on local remedies. “Seventy per cent of people in villages do not report. That aspect goes unreported,” he added.

Dr Suri explained that migraine shows a clear sex difference, with women being affected far more than men. According to him, “migraine is two to three times more common in females” because of both genetic factors and hormonal influences. He said that fluctuations in oestrogen during menstruation, pregnancy, menopause, or with the use of oral contraceptives make women more vulnerable to migraine attacks.

A 2023 study conducted in the Jammu Division of Jammu and Kashmir assessed 3,148 participants and reported an overall headache prevalence of 53.84 per cent. The proportion of females reporting headaches was significantly higher at 38.18 per cent compared to 15.66 per cent for males. Migraine was found to be more prevalent at 33.25 per cent compared to tension-type headache at 20.58 per cent. The study noted that females suffering from migraine showed the highest prevalence at 25.28 per cent, in contrast to females suffering from tension-type headache at 12.89 per cent. Sociodemographic factors also played a significant role. Gender and marital status were both strongly associated with headache occurrence.

Another 2024 cross-sectional study conducted in both urban and rural areas of the National Capital Region, using the Global Campaign’s established methodology, assessed biologically unrelated Indian nationals aged 18 to 65 through multistage random sampling.  The study found that 1,918 participants, which is 92.8 per cent, reported ever having had any form of headache. The proportion was “significantly higher among females, 97.4 per cent, than males at 84.5 per cent.”

Dr Suri also noted that while most types of migraine are more common in women, cluster headache stands out as an exception. “Cluster headache is more common in males, almost eight to one,” he said, describing it as a trigeminal autonomic headache that behaves differently from typical migraines.

One pressing issue he highlights is medication-overuse headache. Many people assume headaches are normal and turn to painkillers frequently, which creates a harmful cycle. “People consider headaches as a normal thing and take painkillers every day,” he said. Such heavy reliance on acute medication without addressing the root cause leads to chronic daily headaches.

Dr Suri explained that preventive therapy is essential for patients who experience frequent attacks, but many skip it. “The mistake most people make is taking acute-attack drugs every day but not taking preventive therapy,” he said. Preventive treatment, he noted, can significantly reduce migraine frequency when used for two to six months in patients with more than four attacks a month.

He listed several common migraine triggers, particularly relevant in India. These include strong sunlight, sleep deprivation, prolonged fasting, delayed meals, strong odours such as perfume or petrol, long travel times, hormonal changes around menstruation, and the use of oral contraceptive pills. Stress and sudden interruptions in sleep can also trigger headaches. Screen time tends to cause tension-type headaches more often than migraine, though it may still contribute in some cases.

Dr Suri said that the most important step for patients is to understand their personal triggers. “Every individual has to find their own triggers,” he explained. Those sensitive to sunlight should use protective measures like sunglasses or umbrellas when outdoors. People whose headaches are linked to fasting or meal delays should maintain regular eating schedules. Individuals who react to specific foods, such as alcohol or chocolate, should avoid them.

He emphasised the need to separate acute treatment from prevention. Acute painkillers should be used during an attack, while preventive therapy is necessary for frequent or disabling episodes. This approach, he said, “reduces the burden and stops headaches from becoming chronic.”

Also read: Why are headaches rising among children and teenagers?