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.