Insights Into Headache Disorders

Migraine and medication overuse continue to be leading causes of years lived with disability globally.

By Andreas Kattem Husøy, Yvonne Yiru Xu, and Timothy J. Steiner

Andreas Kattem Husøy, Yvonne Yiru Xu, and Timothy J. Steiner

The Global Burden of Disease (GBD) report, the most comprehensive study of death and health loss globally,¹ probably needs no introduction to most readers. New estimates for the entire series (from 1990 onward) are published every two years. The standardized method, including calculation of years lived with disability (YLD), allows for a comparison of the burden between disorders.¹

Migraine Most Burdensome

Nearly 3 billion people worldwide suffer from one or more headache disorders,² according to the GBD’s latest report, which was published Oct. 12, 2025. Migraine, tension-type headache (TTH) and medication-overuse headache (MOH) accounted for 4.6% of the world’s total YLD count, making them the sixth leading cause of health loss globally.² About 90% of this health loss was attributed to migraine, even though TTH was estimated to be nearly twice as prevalent.

All neurological disorders together accounted for 7% of total YLD,³ with two-thirds of this attributed to headache disorders. Migraine ranked first among all neurological disorders by a large margin.

That headache disorders, and in particular migraine, are among the most burdensome of neurological disorders is not news. But the GBD report again demonstrated that the age-standardized health loss attributed to headache disorders has remained unchanged since 1990.² The total global burden has increased in line with population expansion and fluctuations in age distribution. Whatever health services are in place for headache disorders, they are having no measurable effect. This is not for lack of effective treatments. Triptans, for example, have been available since 1991, and there are several preventative drugs with proven efficacy.

Increased Gender Gap

A new insight emerging from the GBD report, made possible through modeling refinements, is the gender gap in headache-attributed health loss is larger than previously estimated.² Females carry more than twice the burden of males, owing not only to a higher prevalence of migraine among females but also to females having higher frequency and longer duration headache episodes than their male counterparts.²

This insight came as the result of a meta-analysis of individual participant data from 41,653 people from 18 countries² gathered (mostly from unannounced visits to randomly selected households) in population-based studies carried out by the Global Campaign Against Headache.⁴ Although the overall estimate for the two genders combined did not change by much, the importance of this realization lies in the more precise depiction of the global headache burden and whom it affects.

Medication Overuse

A second insight emerging from the GBD report is of profound importance clinically to health policy and to public health education: More than one-fifth of the global health loss caused by headache disorders in 2023 was attributed to MOH, and therefore to mistreatment in the form of medication overuse. This finding is buried in the original data. Since the 2016 iteration, the GBD report has viewed MOH as a sequela either of migraine or TTH, and reattributed its burden in proportions to these disorders (almost three-quarters to migraine, in accordance with a meta-analysis of three studies).²

The profundity of this insight lies in the realization that a substantial portion of the global headache burden is treatable, or even preventable, by means that should not require investment in health services. Discouraging overuse of acute medication requires education rather than heath care. Governments with an interest in reducing health loss and the associated productivity losses should be the first to recognize this and promote public awareness. Physicians, whether in primary care or headache specialists, also need to be aware of this.

Andreas Kattem Husøy is a postdoctoral fellow in the Department of Neuromedicine and Movement Science at the Norwegian University of Science and Technology and a physician at the Norwegian Center for Headache Research (NorHead), both in Trondheim, Norway. Yvonne Yiru Xu is a researcher with the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. Timothy J. Steiner is an academic physician and specialist in headache medicine with NorHead, a professor in the Department of Neurology at the University of Copenhagen in Copenhagen, and a professor in the Division of Brain Sciences at Imperial College London.