Europe-wide guidelines published by WHO's Lifting The Burden

GPs across Europe will bring better headache care to more people – without increasing health-care costs. This is the aim of new guidelines on headache management, published by the World Health Organization’s (WHO) Global Campaign to Reduce the Burden of Headache Worldwide (Lifting The Burden). The Global Campaign is WHO's partnership with International Headache Society, World Headache Alliance and European Headache Federation (EHF).

Developed by a working group supported by EHF, and entitled European Principles of Management of Common Headache Disorders in Primary Care, they bring together the key elements of national guidelines in Europe. Split into three sections and 12 user-friendly leaflets, they give guidance for GPs on diagnosis, management and referral.

Accompanying the principles is a range of management aids. These include the HALT (Headache-Attributed Lost Time) Index to assess the impact of headache on a patient prior to treatment. Modelled on the existing MIDAS Index, its purpose is to give GPs an immediate and clear insight into one major consequence of troublesome headache – lost days from work, school or social occasions.

The HART (Headache and Assessment of Response to Treatment) Index provides guidance on outcomes of treatment, with suggestions as to when, and how, changes to treatment are needed for individual patients.

In addition, GPs are provided with five easy-to-follow patient information leaflets, which between them cover the most common headache disorders. Handed out at the time of diagnosis, they offer patients a better understanding of their condition and the treatment they will receive. Better understanding helps them use their treatment to best effect, and to work with their doctors to achieve the best outcomes.

By promoting early correct diagnosis followed by optimal treatment, the guidelines and accompanying aids encourage efficient use of resources and avoidance of wastage as well as better outcomes. In this way, existing resources can meet the needs of more people with headache.

Translation into the major European languages is planned, and more aids will be added from time to time as part of Lifting The Burden ( The headache guidelines are just one element within a worldwide programme of activity undertaken by WHO and its partner charities to improve awareness of headache disorders as common and disabling and to implement practical solutions to the need, everywhere, for better diagnosis and management. With some 400,000 lost days from work or school each year per million of the population, migraine on its own is ranked 19th in WHO’s list of the top causes of disability worldwide.

The guidelines and management aids have been published in the Journal of Headache and Pain, the official journal of EHF. They are also available to download and print from the journal’s website,

Lifting The Burden chairman, Dr Timothy Steiner, said: “The statistics speak for themselves – headache is common and often disabling but under-recognised, under-treated and frequently mismanaged across the world. The consequence is a huge toll of avoidable pain, impaired lives and socioeconomic burden.

“The problem starts in medical schools, where headache disorders receive little emphasis in the teaching of trainee doctors despite that they cause so much disability and are amongst the most common reasons for consulting a doctor. It is not surprising that many GPs feel ill-equipped in headache management. We hope these aids, and others to follow, will address this. Then we can move on to the other obstacles that prevent people with headache everywhere in the world getting access to the care they need.”

For further information or an interview with Dr Steiner, please contact Becky Burch on 07825 405736 or email

Note to editors:

· Lifting The Burden was launched in 2004. It is a formal collaboration between WHO, World Headache Alliance (WHA), International Headache Society (IHS) and European Headache Federation (EHF).

Healthcare Republic does not have an editorial influence or input in to these press releases. The views expressed within these documents are not endorsed by Healthcare Republic or Haymarket Medical Publications Limited.

Enquiries should be directed to any contacts listed within the press releases.


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