Italian guidelines for primary headaches: 2012 revised version

The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105–190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version

Productivity impact of headache on a heavy-manufacturing workforce in Turkey

BACKGROUND: Headache disorders cause substantial productivity losses through absenteeism and impaired effectiveness at work (presenteeism). We measured productivity losses from both causes at a heavy-manufacturing company with a largely male workforce in north-western Turkey. METHODS: We used the HALT Index as the survey instrument. We first assessed productivity losses by surveying the entire workforce. Because we anticipated much non-participation, we also applied HALT at the annual health-checks provided to all employees by the company’s on-site health clinic. RESULTS: Mean age of the workforce (N = 7,200) was 31 yr. About two thirds (90% male) were manual workers rotating weekly through early, late and night shifts. One third (50% male) were clerical/managerial, working a standard 5-day week. In the first assessment, 3,939 questionnaires (54.7%) were returned with usable data. In the previous 3 months, absenteeism of ≥1 day was reported by 360 respondents (9.1%), of whom 4 (0.10%) recorded ≥45 days (average per worker: 0.92 days/yr). Presenteeism equivalent to ≥1 day’s absence was reported by 1,187 respondents (29.4%) (average per worker: 6.0 days/yr). We estimated that 23,519 days/yr were lost in total among respondents (2.3% of workforce capacity). In the first 6 months of annual health-checks, 2,691 employees (37.4%) attended (94.4% male). Absenteeism was reported by 40 (1.5%), with 74 days lost, presenteeism by 348 (12.9%), with 1,240 days lost. We estimated that, altogether, 41,771 man-days/yr were lost in the entire workforce (2.4% of capacity; 94% due to presenteeism), closely matching the earlier estimate. A small minority (5.7%) of those with headache, who were only 2.5% of the workforce, accounted for >45% of presenteeism-related lost productivity. CONCLUSION: The high productivity losses in a largely male workforce were surprising. Possible factors were the nature of the work – manual labour for two thirds, often heavy – and the recurring schedule disturbances of shift-work. There was a highly-disabled minority