The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image

Volume 15 Supplement 1

Abstracts from the 4th European Headache and Migraine Trust International Congress: EHMTIC 2014

Open Access

EHMTI-0332. Health care utilisation for primary headache disorders: insights from Karnataka, India

  • G Rao1,
  • G Gururaj1,
  • G Kulkarni2,
  • DK Subbukrishna3,
  • T Steiner4 and
  • L Stovner5
The Journal of Headache and Pain201415(Suppl 1):D48

Published: 18 September 2014


MigrainePrimary Care PhysicianCare UtilisationStructure QuestionnaireSecondary Care


Globally, primary headache disorders are neglected and inadequately treated. There is little information on management or health-care utilisation for headache disorders from the Indian sub-continent.


To fill this knowledge gap in Karnataka State, south India.


In a population-based survey, 2,329 randomly selected, biologically unrelated adults (18-65 years) (1,141 male, 1,188 female; 1,226 urban, 1,103 rural) were interviewed using a validated structured questionnaire. Ethics approval and informed consent from participants were obtained.


Headache was reported by 1,488 persons (crude annual 1-year prevalence 63.9%) with a mean age of 37±12 years, 58% females and 53% rural-dwelling. Only 24.7% (32.4% rural, 16.2% urban) had sought medical help. Of these, 80.6% had seen a primary-care doctor and 15.8% a specialist. Greater proportions of urban dwellers (38.6%) and females (17.7%) had consulted specialists. Consultation rates were higher for migraine (41.9% overall) but, even among those with high disability assessed as lost productive time by HALT questionnaire, did not exceed 50% (HALT grade 1: 27.3%; grade 2: 39.0%; grade 3: 45.7%; grade 4: 45.5%). Consultation rates were much higher for any headache occurring on ≥15 days/month (72.5%) and medication-overuse headache (78.6%).


Despite the high prevalence of primary headache disorders, health-care utilisation is poor. The primary care physician is consulted most often, which is where headache services should be built. Structured headache services require primary-care physicians trained in managing headache disorders, facilitated links to secondary care when needed, but also improved awareness among people with headache so that they use them.

No conflict of interest.

Authors’ Affiliations

Epidemiology Centre for Public Health, National Institute of Mental Health and Neurosciences, Bangalore, India
Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
Bio-statistics, National Institute of Mental Health and Neurosciences, Bangalore, India
Neuroscience, Imperial College, London, UK
Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway


© Rao et al; licensee Springer. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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