Introduction 1 2 3 http://www.eurolight-online.eu Economic impact of headache Headache may have considerable economic consequences, both for the patient and for the society as a whole. There are more studies about the societal costs than about the individual economic losses of the patients. Relation to socioeconomic status, education and employment 4 5 6 7 11 9 12 7 13 Absenteeism from work 14 15 16 9 17 9 9 18 16 13 8 19 Effectiveness when working with headache 20 21 Health economic studies 20 22 23 24 25 26 27 28 29 1 30 31 32 3 33 34 35 34 33 36 37 Non-economic impact 38 10 9 1 Disability 39 40 9 38 36 41 42 13 36 13 http://www.liftingtheburden.org/ 43 44 45 1 Studies using validated QoL-instruments 46 47 48 48 49 50 51 52 53 54 55 56 53 57 58 59 Family impact of migraine 9 60 Conclusions Health economic studies have documented that the costs of headache disorders are huge; the costs only for migraine amounting to €27 billion in the EU countries, and the cost for other headaches are probably as large. However, better population-based cost studies are needed to assess the cost involved with TTH. Headache sufferers tend to have lower income and education, and more of them may be unemployed, but it is still uncertain whether this is true for most European countries, and also whether it may be a cause of or an effect of headache. It is also amply documented that migraine confers a high degree of disability with more forced absence from work and leisure activities, and migraineurs also have a measurably reduced quality of life. In addition, there is a marked impact on family life, and headaches also put considerable strains on partners and children. A minority of headache sufferers chose to have fewer children than they would have had if they had not had headaches. 1 Table 1 The main domains that should be covered in headache burden studies Economic burden  Direct cost Medication, consultation, investigations, hospitalisations  Indirect costs Workdays lost Decreased effectiveness when working with headache Lost career and education opportunities Non-economic burden  Disability MIDAS or HALT Time with disability: Headache frequency x duration x intensity/disability  Impact outside attacks Residual disability and fear of next attack  Quality of Life SF 36, SF 12, WHOQual etc  Family impact Impact on the life of partner and/or children Impact on marriage and love life Impact on family planning and/or contraception  Psychiatric complaints Various scales to measure anxiety and/or depression as consequent or comorbid disorders (e.g. HADS)