Framing education on headache disorders into the Global Burden of Disease Study 2010. The European Headache Federation stands ready

Edvinsson, Lars

Jense, Rigmor H

Katsarava, Zaza

Lampl, Christian

Marteletti, Paolo

Mitsikostas, Dimos-Dimitrios

Osipova, Vera

Paemeleire, Koen

Siva, Aksel

Steiner, Timothy J

Valade, Dominique

English

PubMed

Martelletti, Paolo

Steiner, Timothy J.

Jensen, Rigmor H.

Lund University Publications

LUND UNIVERSITYPO Box 117221 00 Lund+46 46-222 00 00Framing education on headache disorders into the Global Burden of Disease Study2010. The European Headache Federation stands readyMartelletti, Paolo; Mitsikostas, Dimos-Dimitrios; Lampl, Christian; Katsarava, Zaza; Osipova,Vera; Paemeleire, Koen; Edvinsson, Lars; Siva, Aksel; Valade, Dominique; Steiner, TimothyJ.; Jensen, Rigmor H.Published in:Journal of Headache and PainDOI:10.1186/1129-2377-14-412013Link to publicationCitation for published version (APA):Martelletti, P., Mitsikostas, D-D., Lampl, C., Katsarava, Z., Osipova, V., Paemeleire, K., Edvinsson, L., Siva, A.,Valade, D., Steiner, T. J., & Jensen, R. H. (2013). Framing education on headache disorders into the GlobalBurden of Disease Study 2010. The European Headache Federation stands ready. Journal of Headache andPain, 14, [41]. https://doi.org/10.1186/1129-2377-14-41Total number of authors:11General rightsUnless other specific re-use rights are stated the following general rights apply:Copyright and moral rights for the publications made accessible in the public portal are retained by the authorsand/or other copyright owners and it is a condition of accessing publications that users recognise and abide by thelegal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private studyor research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portalRead more about Creative commons licenses: https://creativecommons.org/licenses/Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will removeaccess to the work immediately and investigate your claim.Martelletti et al. The Journal of Headache and Pain 2013, 14:41http://www.thejournalofheadacheandpain.com/content/14/1/41EDITORIAL Open AccessFraming education on headache disorders intothe Global Burden of Disease Study 2010. TheEuropean Headache Federation stands readyPaolo Martelletti1*, Dimos-Dimitrios Mitsikostas2, Christian Lampl3, Zaza Katsarava4, Vera Osipova5,Koen Paemeleire6, Lars Edvinsson7, Aksel Siva8, Dominique Valade9, Timothy J Steiner10 and Rigmor H Jensen11AbstractFraming education on headache disorders into the Global Burden of Disease Study 2010. The European HeadacheFederation stands ready.Start-up for a new education on headachedisorders after Global Burden of Disease Study2010The Global Burden of Disease Study 2010 (GBD 2010),recently published in The Lancet [1], has marked newstandards for all scientific societies, NGOs and patients’associations that gravitate towards headache disorders.These standards, dictated not only by the new migraineranking but also by the appearance of tension-type head-ache, confirm headache in the top ten causes of globaldisability, in the top three ranking of global prevalenceof disease and at the top of all neurological disorders ascauses of years lived with disability. All this has beenachieved despite the unjustified absence of medication-overuse headache from GBD 2010. The fundamentals ofthese results are built on the hard-working epidemio-logical activity of the Neurologic Disorders ExpertGroup in Headache for GBD 2010, and Lifting TheBurden (LTB) [2] which, on the basis of data carefullygathered (and featured in the Atlas of Headache Disor-ders and Resources in the World 2011 [3,4]), has thenoffered to GBD 2010 the headache-specific part of thiscultural giant of modern medicine.What is then the bond between the results therein in-cluded in this immense survey, correlated to the terms dis-ability, sequelae, disability states, years lived with disability,impairments, and the European Headache Federation* Correspondence: paolo.martelletti@uniroma1.it1Department of Clinical and Molecular Medicine, Sapienza University ofRome, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, ItalyFull list of author information is available at the end of the article© 2013 Martelletti et al.; licensee Springer. ThisAttribution License (http://creativecommons.orin any medium, provided the original work is p(EHF)? It is explicit in the message: “The principal findings,namely that mental health [impairments] ….. need urgentpolicy responses, are well established. Monitoring progressin reducing the effect of these, and other major contribu-tors to health loss, is as important for improving popula-tion health as monitoring progress against the leadingcauses of death.” In the strategy for achieving this in head-ache, physician education is a sine qua non [3,4], uponwhich quality of care and any multiplicity of structuresdedicated to the control of headache depend.European Headache Federation educationalresponseEHF takes pride from its long history of education onprimary headache disorders, integral to its mission,“Educate Europe about Headache”. This purpose hasbeen continuously pursued since its foundation over30 years ago, across both Central and Eastern Europe.Its educational activities have been conducted throughthe residential EHF Headache Schools, commenced in2002, and through the more recent distance-learningVideo Conference Courses, commenced in 2009. Wemust also mention the aids offered by EHF in conjunc-tion with LTB and WHO in the management of themost common types of primary headache, the Europeanprinciples of management of common headache disordersin primary care [5], specifically aimed at general practi-tioners. The efficient penetration of these guidelines hasbeen facilitated by their Italian, Portuguese and Russiantranslations freely available on the EHF website (www.ehf-org.org/).is an Open Access article distributed under the terms of the Creative Commonsg/licenses/by/2.0), which permits unrestricted use, distribution, and reproductionroperly cited.Martelletti et al. The Journal of Headache and Pain 2013, 14:41 Page 2 of 3http://www.thejournalofheadacheandpain.com/content/14/1/41EHF has also cared about the other, high-academicend of education in headache, through its collaborationwith Sapienza University of Rome. The Master in Head-ache Medicine course, held each year for ten years atSapienza University of Rome, has been endorsed by EHFsince the Academic Year 2005-2006, training a largenumber of specialists from various European countriesand many other geographical areas in the world (http://w3.uniroma1.it/headache) [6,7]. This initiative hasallowed the creation of a headache cultural chain follow-ing the consolidated train-the-trainer method as anachievable foundation for global education [8]. Oncetrained as headache specialists, physicians will becometrainers, offering education in this field to other health-care providers in their own countries. In this way theywill give life to the cultural chain, raising awarenesswherever they go of headache, its burden and its medicalcontrol [9].EHF has always strongly promoted educational collab-orations with other important European Societies, suchas European Federation of Neurological Societies (EFNS)and European Federation of Internal Medicine (EFIM).This last collaboration produced a Joint Symposiumdedicated to Emergency Headache, with its clinically evi-dent multidisciplinary characteristics and representing4% of all admissions to the emergency departments ofEurope [10]. Recently, the historical partnership betweenEHF and LTB has been enriched by an ad hoc partner-ship with the European Federation of IASP Chapters(EFIC), creating a Joint Task Force on Headache, whichis already active in educating pain physicians and head-ache experts in some particular headache models.A further educational product of EHF is the EHFHeadache Series, pertinent monographs owned by EHFand to be published by Springer, which will cover theemerging sectors of headache science and education.Cultural liberalism in headache education allows abetter future for headache patientsIt is therefore clear that GBD 2010 has found EHFoperatively efficient to conduct its educational role inEurope, ready to further the dissemination of fundamen-tal skills in this area of clinical medicine. This positionand readiness stand opposite to protectionist self-preservation fostered by an oligarchic culture, and bringnew hope to patients who are not yet adequately treatedor even yet diagnosed [11].These fundamental rules of cultural liberalism and col-laboration with like-minded neighbouring societies mustlead us to set EHF’s educational priorities. Such culturalopenness is neither a sign of captatio benevolentiae nora wish for colonization. Headache disorders are and al-ways will be in a multidisciplinary and transversal area,where only those who are capable of integration anddevelopment, as opposed to exclusion and disqualifica-tion, will achieve and produce positive effects for the im-mense civil society who need them – for migraine alone,a billion people affected worldwide.In fact, to produce new evidence in basic sciences andturn it into new molecules or devices for headache hasvery partial utility, if it does not reach most patients[12]. The use of triptans by only a small minority ofpeople with migraine is exemplary of such failure, andshould be a warning. Without better and larger struc-tures dedicated to headache health-care service delivery[13,14], and a concerted educational effort to train thelarge number of physicians these services require[13-15], few people will benefit, and not necessarilythose most in need; the majority will remain withoutdiagnosis and a proper treatment, carrying an impressivepersonal burden and contributing to that of society, andwith not much hope for change.We must all shrink from this, and reject the closed, ex-clusive cultural clubs that promise nothing else, obstin-ately pervaded by ancient self-referenced protectionism.Competing interestsThe authors declare that they have no competing interests related to thisEditorial.Authors’ contributionsPM, TJS, RHJ drafted the manuscript. All authors read and approved the finalmanuscript.AcknowledgmentsAll Authors (except TJS) are Trustees and Directors of the European HeadacheFederation (EHF). TJS is a founding member and past-President of EHF.The Authors declared no COI related to the contents of this Editorial.Author details1Department of Clinical and Molecular Medicine, Sapienza University ofRome, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.2Department of Neurology, Athens Naval Hospital, Athens, Greece.3Department of Neurology and Pain Medicine, Konventhospital BarmherzigeBrüder, Linz, Austria. 4Department of Neurology University of Duisburg-Essen,Essen and Department of Neurology, Evangelisches Krankenhaus Unna,Unna, Germany. 5Department of Neurology and Clinical Neurophysiology,First Sechenov Moscow State Medical University, Moscow, Russia.6Department of Neurology, Ghent University Hospital, Ghent, Belgium.7Department of Internal Medicine, University Hospital, Lund, Sweden.8Department of Neurology, Cerrahpasa School of Medicine, IstanbulUniversity, Istanbul, Turkey. 9Hôpital Lariboisière, Paris, France. 10Departmentof Neuroscience, Norwegian University of Science and Technology,Trondheim, Norway. 11Danish Headache Center, Department of Neurology,University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark.Received: 30 April 2013 Accepted: 4 May 2013Published: 10 May 2013References1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K,Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, AhnSY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, AtkinsonC, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, BasáñezMG, Baxter A, Bell ML, Benjamin EJ, Bennett D (2012) Years lived withdisability (YLD) for 1160 sequelae of 289 diseases and injuries 1990–2010: asystematic analysis for the Global Burden of Disease Study 2010.Lancet 380:2163–2196Martelletti et al. The Journal of Headache and Pain 2013, 14:41 Page 3 of 3http://www.thejournalofheadacheandpain.com/content/14/1/412. Steiner TJ, Stovner LJ, Birbeck GL (2013) Migraine: the seventh disabler.J Headache Pain 14:13. World Health Organization and Lifting The Burden (2011) Atlas ofheadache disorders and resources in the world 2011. World HealthOrganization, Genève. available at http://www.who.int/mental_health/management/atlas_headache_disorders/en/4. Martelletti P, Birbeck GL, Katsarava K, Jensen RH, Stovner LJ, Steiner TJ (2013)The Global Burden of Disease Survey 2010, Lifting The Burden and thinkingoutside-the-box on headache disorders. J Headache Pain 14:135. Steiner TJ, Paemeleire K, Jensen R, Valade D, Savi L, Lainez MJ, Diener HC,Martelletti P, Couturier EG, on behalf of European Headache Federation andLifting The Burden: The Global Campaign to Reduce the Burden ofHeadache Worldwide (2007) European principles of management ofcommon headache disorders in primary care. J Headache Pain8(Suppl 1):S3–S476. Martelletti P (2005) Academic specialist education in headache medicine.Next move for the headache community. J Headache Pain 6:103–1047. Martelletti P (2007) Headache medicine: academic teaching in Europe.The Sapienza university Master’s degree. Headache 47:1224–12258. Martelletti P, Haimanot RT, Láinez MJ, Rapoport AM, Ravishankar K, Sakai F,Silberstein SD, Vincent M, Steiner TJ (2005) The global campaign (GC) toreduce the burden of headache worldwide. The international team forspecialist education (ITSE). J Headache Pain 6:261–2639. Martelletti P, Steiner T (2010) Headache disorders: building specialisteducation. In: Olesen J, Ramadan N (ed) Headache care, research andeducation worldwide, 17th edition. Oxford University Press, Oxford,pp 173–17810. Licata G, Lindgren S, Diener HC, Martelletti P (2008) Headache andemergency medicine: sharing a language for a common project. InternEmerg Med 3(Suppl 1):S1–S211. Cevoli S, D’Amico D, Martelletti P, Valguarnera F, Del Bene E, De Simone R,Sarchielli P, Narbone M, Testa L, Genco S, Bussone G, Cortelli P (2009)Underdiagnosis and undertreatment of migraine in Italy: a survey ofpatients attending for the first time 10 headache centres. Cephalalgia29:1285–129312. Steiner TJ (2013) Headache in the world: public health and researchpriorities. Expert Rev Pharmacoecon Outcomes Res 13:51–5713. Steiner TJ, Antonaci F, Jensen R, Lainez MJ, Lanteri-Minet M, Valade D, onbehalf of European Headache Federation and Lifting The Burden: the GlobalCampaign against Headache (2011) Recommendations for headache serviceorganisation and delivery in Europe. J Headache Pain 12:419–42614. Antonaci F, Valade D, Lanteri-Minet M, Láinez JM, Jensen R, Steiner TJ, onbehalf of European Headache Federation and Lifting The Burden: the GlobalCampaign to Reduce the Burden of Headache Worldwide (2008) Proposalsfor the organisation of headache services in Europe. Intern Emerg Med3(Suppl 1):S25–S2815. Jensen R, Mitsikostas DD, Valade D, Antonaci F (2010) Guidelines for theorganization of headache education in Europe: the headache school II.J Headache Pain 11:161–165doi:10.1186/1129-2377-14-41Cite this article as: Martelletti et al.: Framing education on headachedisorders into the Global Burden of Disease Study 2010. The EuropeanHeadache Federation stands ready. The Journal of Headache and Pain2013 14:41.Submit your manuscript to a journal and benefi t from:7 Convenient online submission7 Rigorous peer review7 Immediate publication on acceptance7 Open access: articles freely available online7 High visibility within the fi eld7 Retaining the copyright to your article    Submit your next manuscript at 7 springeropen.com

Ghent University Academic Bibliography

Martelletti et al. The Journal of Headache and Pain 2013, 14:41http://www.thejournalofheadacheandpain.com/content/14/1/41EDITORIAL Open AccessFraming education on headache disorders intothe Global Burden of Disease Study 2010. TheEuropean Headache Federation stands readyPaolo Martelletti1*, Dimos-Dimitrios Mitsikostas2, Christian Lampl3, Zaza Katsarava4, Vera Osipova5,Koen Paemeleire6, Lars Edvinsson7, Aksel Siva8, Dominique Valade9, Timothy J Steiner10 and Rigmor H Jensen11AbstractFraming education on headache disorders into the Global Burden of Disease Study 2010. The European HeadacheFederation stands ready.Start-up for a new education on headachedisorders after Global Burden of Disease Study2010The Global Burden of Disease Study 2010 (GBD 2010),recently published in The Lancet [1], has marked newstandards for all scientific societies, NGOs and patients’associations that gravitate towards headache disorders.These standards, dictated not only by the new migraineranking but also by the appearance of tension-type head-ache, confirm headache in the top ten causes of globaldisability, in the top three ranking of global prevalenceof disease and at the top of all neurological disorders ascauses of years lived with disability. All this has beenachieved despite the unjustified absence of medication-overuse headache from GBD 2010. The fundamentals ofthese results are built on the hard-working epidemio-logical activity of the Neurologic Disorders ExpertGroup in Headache for GBD 2010, and Lifting TheBurden (LTB) [2] which, on the basis of data carefullygathered (and featured in the Atlas of Headache Disor-ders and Resources in the World 2011 [3,4]), has thenoffered to GBD 2010 the headache-specific part of thiscultural giant of modern medicine.What is then the bond between the results therein in-cluded in this immense survey, correlated to the terms dis-ability, sequelae, disability states, years lived with disability,impairments, and the European Headache Federation* Correspondence: paolo.martelletti@uniroma1.it1Department of Clinical and Molecular Medicine, Sapienza University ofRome, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, ItalyFull list of author information is available at the end of the article© 2013 Martelletti et al.; licensee Springer. ThisAttribution License (http://creativecommons.orin any medium, provided the original work is p(EHF)? It is explicit in the message: “The principal findings,namely that mental health [impairments] ….. need urgentpolicy responses, are well established. Monitoring progressin reducing the effect of these, and other major contribu-tors to health loss, is as important for improving popula-tion health as monitoring progress against the leadingcauses of death.” In the strategy for achieving this in head-ache, physician education is a sine qua non [3,4], uponwhich quality of care and any multiplicity of structuresdedicated to the control of headache depend.European Headache Federation educationalresponseEHF takes pride from its long history of education onprimary headache disorders, integral to its mission,“Educate Europe about Headache”. This purpose hasbeen continuously pursued since its foundation over30 years ago, across both Central and Eastern Europe.Its educational activities have been conducted throughthe residential EHF Headache Schools, commenced in2002, and through the more recent distance-learningVideo Conference Courses, commenced in 2009. Wemust also mention the aids offered by EHF in conjunc-tion with LTB and WHO in the management of themost common types of primary headache, the Europeanprinciples of management of common headache disordersin primary care [5], specifically aimed at general practi-tioners. The efficient penetration of these guidelines hasbeen facilitated by their Italian, Portuguese and Russiantranslations freely available on the EHF website (www.ehf-org.org/).is an Open Access article distributed under the terms of the Creative Commonsg/licenses/by/2.0), which permits unrestricted use, distribution, and reproductionroperly cited.Martelletti et al. The Journal of Headache and Pain 2013, 14:41 Page 2 of 3http://www.thejournalofheadacheandpain.com/content/14/1/41EHF has also cared about the other, high-academicend of education in headache, through its collaborationwith Sapienza University of Rome. The Master in Head-ache Medicine course, held each year for ten years atSapienza University of Rome, has been endorsed by EHFsince the Academic Year 2005-2006, training a largenumber of specialists from various European countriesand many other geographical areas in the world (http://w3.uniroma1.it/headache) [6,7]. This initiative hasallowed the creation of a headache cultural chain follow-ing the consolidated train-the-trainer method as anachievable foundation for global education [8]. Oncetrained as headache specialists, physicians will becometrainers, offering education in this field to other health-care providers in their own countries. In this way theywill give life to the cultural chain, raising awarenesswherever they go of headache, its burden and its medicalcontrol [9].EHF has always strongly promoted educational collab-orations with other important European Societies, suchas European Federation of Neurological Societies (EFNS)and European Federation of Internal Medicine (EFIM).This last collaboration produced a Joint Symposiumdedicated to Emergency Headache, with its clinically evi-dent multidisciplinary characteristics and representing4% of all admissions to the emergency departments ofEurope [10]. Recently, the historical partnership betweenEHF and LTB has been enriched by an ad hoc partner-ship with the European Federation of IASP Chapters(EFIC), creating a Joint Task Force on Headache, whichis already active in educating pain physicians and head-ache experts in some particular headache models.A further educational product of EHF is the EHFHeadache Series, pertinent monographs owned by EHFand to be published by Springer, which will cover theemerging sectors of headache science and education.Cultural liberalism in headache education allows abetter future for headache patientsIt is therefore clear that GBD 2010 has found EHFoperatively efficient to conduct its educational role inEurope, ready to further the dissemination of fundamen-tal skills in this area of clinical medicine. This positionand readiness stand opposite to protectionist self-preservation fostered by an oligarchic culture, and bringnew hope to patients who are not yet adequately treatedor even yet diagnosed [11].These fundamental rules of cultural liberalism and col-laboration with like-minded neighbouring societies mustlead us to set EHF’s educational priorities. Such culturalopenness is neither a sign of captatio benevolentiae nora wish for colonization. Headache disorders are and al-ways will be in a multidisciplinary and transversal area,where only those who are capable of integration anddevelopment, as opposed to exclusion and disqualifica-tion, will achieve and produce positive effects for the im-mense civil society who need them – for migraine alone,a billion people affected worldwide.In fact, to produce new evidence in basic sciences andturn it into new molecules or devices for headache hasvery partial utility, if it does not reach most patients[12]. The use of triptans by only a small minority ofpeople with migraine is exemplary of such failure, andshould be a warning. Without better and larger struc-tures dedicated to headache health-care service delivery[13,14], and a concerted educational effort to train thelarge number of physicians these services require[13-15], few people will benefit, and not necessarilythose most in need; the majority will remain withoutdiagnosis and a proper treatment, carrying an impressivepersonal burden and contributing to that of society, andwith not much hope for change.We must all shrink from this, and reject the closed, ex-clusive cultural clubs that promise nothing else, obstin-ately pervaded by ancient self-referenced protectionism.Competing interestsThe authors declare that they have no competing interests related to thisEditorial.Authors’ contributionsPM, TJS, RHJ drafted the manuscript. All authors read and approved the finalmanuscript.AcknowledgmentsAll Authors (except TJS) are Trustees and Directors of the European HeadacheFederation (EHF). TJS is a founding member and past-President of EHF.The Authors declared no COI related to the contents of this Editorial.Author details1Department of Clinical and Molecular Medicine, Sapienza University ofRome, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.2Department of Neurology, Athens Naval Hospital, Athens, Greece.3Department of Neurology and Pain Medicine, Konventhospital BarmherzigeBrüder, Linz, Austria. 4Department of Neurology University of Duisburg-Essen,Essen and Department of Neurology, Evangelisches Krankenhaus Unna,Unna, Germany. 5Department of Neurology and Clinical Neurophysiology,First Sechenov Moscow State Medical University, Moscow, Russia.6Department of Neurology, Ghent University Hospital, Ghent, Belgium.7Department of Internal Medicine, University Hospital, Lund, Sweden.8Department of Neurology, Cerrahpasa School of Medicine, IstanbulUniversity, Istanbul, Turkey. 9Hôpital Lariboisière, Paris, France. 10Departmentof Neuroscience, Norwegian University of Science and Technology,Trondheim, Norway. 11Danish Headache Center, Department of Neurology,University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark.Received: 30 April 2013 Accepted: 4 May 2013Published: 10 May 2013References1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K,Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, AhnSY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, AtkinsonC, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, BasáñezMG, Baxter A, Bell ML, Benjamin EJ, Bennett D (2012) Years lived withdisability (YLD) for 1160 sequelae of 289 diseases and injuries 1990–2010: asystematic analysis for the Global Burden of Disease Study 2010.Lancet 380:2163–2196Martelletti et al. The Journal of Headache and Pain 2013, 14:41 Page 3 of 3http://www.thejournalofheadacheandpain.com/content/14/1/412. Steiner TJ, Stovner LJ, Birbeck GL (2013) Migraine: the seventh disabler.J Headache Pain 14:13. World Health Organization and Lifting The Burden (2011) Atlas ofheadache disorders and resources in the world 2011. World HealthOrganization, Genève. available at http://www.who.int/mental_health/management/atlas_headache_disorders/en/4. Martelletti P, Birbeck GL, Katsarava K, Jensen RH, Stovner LJ, Steiner TJ (2013)The Global Burden of Disease Survey 2010, Lifting The Burden and thinkingoutside-the-box on headache disorders. J Headache Pain 14:135. Steiner TJ, Paemeleire K, Jensen R, Valade D, Savi L, Lainez MJ, Diener HC,Martelletti P, Couturier EG, on behalf of European Headache Federation andLifting The Burden: The Global Campaign to Reduce the Burden ofHeadache Worldwide (2007) European principles of management ofcommon headache disorders in primary care. J Headache Pain8(Suppl 1):S3–S476. Martelletti P (2005) Academic specialist education in headache medicine.Next move for the headache community. J Headache Pain 6:103–1047. Martelletti P (2007) Headache medicine: academic teaching in Europe.The Sapienza university Master’s degree. Headache 47:1224–12258. Martelletti P, Haimanot RT, Láinez MJ, Rapoport AM, Ravishankar K, Sakai F,Silberstein SD, Vincent M, Steiner TJ (2005) The global campaign (GC) toreduce the burden of headache worldwide. The international team forspecialist education (ITSE). J Headache Pain 6:261–2639. Martelletti P, Steiner T (2010) Headache disorders: building specialisteducation. In: Olesen J, Ramadan N (ed) Headache care, research andeducation worldwide, 17th edition. Oxford University Press, Oxford,pp 173–17810. Licata G, Lindgren S, Diener HC, Martelletti P (2008) Headache andemergency medicine: sharing a language for a common project. InternEmerg Med 3(Suppl 1):S1–S211. Cevoli S, D’Amico D, Martelletti P, Valguarnera F, Del Bene E, De Simone R,Sarchielli P, Narbone M, Testa L, Genco S, Bussone G, Cortelli P (2009)Underdiagnosis and undertreatment of migraine in Italy: a survey ofpatients attending for the first time 10 headache centres. Cephalalgia29:1285–129312. Steiner TJ (2013) Headache in the world: public health and researchpriorities. Expert Rev Pharmacoecon Outcomes Res 13:51–5713. Steiner TJ, Antonaci F, Jensen R, Lainez MJ, Lanteri-Minet M, Valade D, onbehalf of European Headache Federation and Lifting The Burden: the GlobalCampaign against Headache (2011) Recommendations for headache serviceorganisation and delivery in Europe. J Headache Pain 12:419–42614. Antonaci F, Valade D, Lanteri-Minet M, Láinez JM, Jensen R, Steiner TJ, onbehalf of European Headache Federation and Lifting The Burden: the GlobalCampaign to Reduce the Burden of Headache Worldwide (2008) Proposalsfor the organisation of headache services in Europe. Intern Emerg Med3(Suppl 1):S25–S2815. Jensen R, Mitsikostas DD, Valade D, Antonaci F (2010) Guidelines for theorganization of headache education in Europe: the headache school II.J Headache Pain 11:161–165doi:10.1186/1129-2377-14-41Cite this article as: Martelletti et al.: Framing education on headachedisorders into the Global Burden of Disease Study 2010. The EuropeanHeadache Federation stands ready. The Journal of Headache and Pain2013 14:41.Submit your manuscript to a journal and beneﬁ t from:7 Convenient online submission7 Rigorous peer review7 Immediate publication on acceptance7 Open access: articles freely available online7 High visibility within the ﬁ eld7 Retaining the copyright to your article    Submit your next manuscript at 7 springeropen.com

Framing education on headache disorders into the Global Burden of Disease Study 2010 : the European Headache Federation stands ready

Paolo Martelletti

Dimos-Dimitrios Mitsikostas

Christian Lampl

Zaza Katsarava

Vera Osipova

Koen Paemeleire

Lars Edvinsson

Aksel Siva

Dominique Valade

Timothy J Steiner

Rigmor H Jensen

Springer - Publisher Connector

Martelletti et al. The Journal of Headache and Pain 2013, 14:41
http://www.thejournalofheadacheandpain.com/content/14/1/41EDITORIAL Open AccessFraming education on headache disorders into
the Global Burden of Disease Study 2010. The
European Headache Federation stands ready
Paolo Martelletti1*, Dimos-Dimitrios Mitsikostas2, Christian Lampl3, Zaza Katsarava4, Vera Osipova5,
Koen Paemeleire6, Lars Edvinsson7, Aksel Siva8, Dominique Valade9, Timothy J Steiner10 and Rigmor H Jensen11Abstract
Framing education on headache disorders into the Global Burden of Disease Study 2010. The European Headache
Federation stands ready.Start-up for a new education on headache
disorders after Global Burden of Disease Study
2010
The Global Burden of Disease Study 2010 (GBD 2010),
recently published in The Lancet [1], has marked new
standards for all scientific societies, NGOs and patients’
associations that gravitate towards headache disorders.
These standards, dictated not only by the new migraine
ranking but also by the appearance of tension-type head-
ache, confirm headache in the top ten causes of global
disability, in the top three ranking of global prevalence
of disease and at the top of all neurological disorders as
causes of years lived with disability. All this has been
achieved despite the unjustified absence of medication-
overuse headache from GBD 2010. The fundamentals of
these results are built on the hard-working epidemio-
logical activity of the Neurologic Disorders Expert
Group in Headache for GBD 2010, and Lifting The
Burden (LTB) [2] which, on the basis of data carefully
gathered (and featured in the Atlas of Headache Disor-
ders and Resources in the World 2011 [3,4]), has then
offered to GBD 2010 the headache-specific part of this
cultural giant of modern medicine.
What is then the bond between the results therein in-
cluded in this immense survey, correlated to the terms dis-
ability, sequelae, disability states, years lived with disability,
impairments, and the European Headache Federation* Correspondence: paolo.martelletti@uniroma1.it
1Department of Clinical and Molecular Medicine, Sapienza University of
Rome, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
Full list of author information is available at the end of the article
© 2013 Martelletti et al.; licensee Springer. This
Attribution License (http://creativecommons.or
in any medium, provided the original work is p(EHF)? It is explicit in the message: “The principal findings,
namely that mental health [impairments] ….. need urgent
policy responses, are well established. Monitoring progress
in reducing the effect of these, and other major contribu-
tors to health loss, is as important for improving popula-
tion health as monitoring progress against the leading
causes of death.” In the strategy for achieving this in head-
ache, physician education is a sine qua non [3,4], upon
which quality of care and any multiplicity of structures
dedicated to the control of headache depend.European Headache Federation educational
response
EHF takes pride from its long history of education on
primary headache disorders, integral to its mission,
“Educate Europe about Headache”. This purpose has
been continuously pursued since its foundation over
30 years ago, across both Central and Eastern Europe.
Its educational activities have been conducted through
the residential EHF Headache Schools, commenced in
2002, and through the more recent distance-learning
Video Conference Courses, commenced in 2009. We
must also mention the aids offered by EHF in conjunc-
tion with LTB and WHO in the management of the
most common types of primary headache, the European
principles of management of common headache disorders
in primary care [5], specifically aimed at general practi-
tioners. The efficient penetration of these guidelines has
been facilitated by their Italian, Portuguese and Russian
translations freely available on the EHF website (www.
ehf-org.org/).is an Open Access article distributed under the terms of the Creative Commons
g/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction
roperly cited.
Martelletti et al. The Journal of Headache and Pain 2013, 14:41 Page 2 of 3
http://www.thejournalofheadacheandpain.com/content/14/1/41EHF has also cared about the other, high-academic
end of education in headache, through its collaboration
with Sapienza University of Rome. The Master in Head-
ache Medicine course, held each year for ten years at
Sapienza University of Rome, has been endorsed by EHF
since the Academic Year 2005-2006, training a large
number of specialists from various European countries
and many other geographical areas in the world (http://
w3.uniroma1.it/headache) [6,7]. This initiative has
allowed the creation of a headache cultural chain follow-
ing the consolidated train-the-trainer method as an
achievable foundation for global education [8]. Once
trained as headache specialists, physicians will become
trainers, offering education in this field to other health-
care providers in their own countries. In this way they
will give life to the cultural chain, raising awareness
wherever they go of headache, its burden and its medical
control [9].
EHF has always strongly promoted educational collab-
orations with other important European Societies, such
as European Federation of Neurological Societies (EFNS)
and European Federation of Internal Medicine (EFIM).
This last collaboration produced a Joint Symposium
dedicated to Emergency Headache, with its clinically evi-
dent multidisciplinary characteristics and representing
4% of all admissions to the emergency departments of
Europe [10]. Recently, the historical partnership between
EHF and LTB has been enriched by an ad hoc partner-
ship with the European Federation of IASP Chapters
(EFIC), creating a Joint Task Force on Headache, which
is already active in educating pain physicians and head-
ache experts in some particular headache models.
A further educational product of EHF is the EHF
Headache Series, pertinent monographs owned by EHF
and to be published by Springer, which will cover the
emerging sectors of headache science and education.
Cultural liberalism in headache education allows a
better future for headache patients
It is therefore clear that GBD 2010 has found EHF
operatively efficient to conduct its educational role in
Europe, ready to further the dissemination of fundamen-
tal skills in this area of clinical medicine. This position
and readiness stand opposite to protectionist self-
preservation fostered by an oligarchic culture, and bring
new hope to patients who are not yet adequately treated
or even yet diagnosed [11].
These fundamental rules of cultural liberalism and col-
laboration with like-minded neighbouring societies must
lead us to set EHF’s educational priorities. Such cultural
openness is neither a sign of captatio benevolentiae nor
a wish for colonization. Headache disorders are and al-
ways will be in a multidisciplinary and transversal area,
where only those who are capable of integration anddevelopment, as opposed to exclusion and disqualifica-
tion, will achieve and produce positive effects for the im-
mense civil society who need them – for migraine alone,
a billion people affected worldwide.
In fact, to produce new evidence in basic sciences and
turn it into new molecules or devices for headache has
very partial utility, if it does not reach most patients
[12]. The use of triptans by only a small minority of
people with migraine is exemplary of such failure, and
should be a warning. Without better and larger struc-
tures dedicated to headache health-care service delivery
[13,14], and a concerted educational effort to train the
large number of physicians these services require
[13-15], few people will benefit, and not necessarily
those most in need; the majority will remain without
diagnosis and a proper treatment, carrying an impressive
personal burden and contributing to that of society, and
with not much hope for change.
We must all shrink from this, and reject the closed, ex-
clusive cultural clubs that promise nothing else, obstin-
ately pervaded by ancient self-referenced protectionism.
Competing interests
The authors declare that they have no competing interests related to this
Editorial.
Authors’ contributions
PM, TJS, RHJ drafted the manuscript. All authors read and approved the final
manuscript.
Acknowledgments
All Authors (except TJS) are Trustees and Directors of the European Headache
Federation (EHF). TJS is a founding member and past-President of EHF.
The Authors declared no COI related to the contents of this Editorial.
Author details
1Department of Clinical and Molecular Medicine, Sapienza University of
Rome, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
2Department of Neurology, Athens Naval Hospital, Athens, Greece.
3Department of Neurology and Pain Medicine, Konventhospital Barmherzige
Brüder, Linz, Austria. 4Department of Neurology University of Duisburg-Essen,
Essen and Department of Neurology, Evangelisches Krankenhaus Unna,
Unna, Germany. 5Department of Neurology and Clinical Neurophysiology,
First Sechenov Moscow State Medical University, Moscow, Russia.
6Department of Neurology, Ghent University Hospital, Ghent, Belgium.
7Department of Internal Medicine, University Hospital, Lund, Sweden.
8Department of Neurology, Cerrahpasa School of Medicine, Istanbul
University, Istanbul, Turkey. 9Hôpital Lariboisière, Paris, France. 10Department
of Neuroscience, Norwegian University of Science and Technology,
Trondheim, Norway. 11Danish Headache Center, Department of Neurology,
University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark.
Received: 30 April 2013 Accepted: 4 May 2013
Published: 10 May 2013
References
1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K,
Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn
SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson
C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez
MG, Baxter A, Bell ML, Benjamin EJ, Bennett D (2012) Years lived with
disability (YLD) for 1160 sequelae of 289 diseases and injuries 1990–2010: a
systematic analysis for the Global Burden of Disease Study 2010.
Lancet 380:2163–2196
Martelletti et al. The Journal of Headache and Pain 2013, 14:41 Page 3 of 3
http://www.thejournalofheadacheandpain.com/content/14/1/412. Steiner TJ, Stovner LJ, Birbeck GL (2013) Migraine: the seventh disabler.
J Headache Pain 14:1
3. World Health Organization and Lifting The Burden (2011) Atlas of
headache disorders and resources in the world 2011. World Health
Organization, Genève. available at http://www.who.int/mental_health/
management/atlas_headache_disorders/en/
4. Martelletti P, Birbeck GL, Katsarava K, Jensen RH, Stovner LJ, Steiner TJ (2013)
The Global Burden of Disease Survey 2010, Lifting The Burden and thinking
outside-the-box on headache disorders. J Headache Pain 14:13
5. Steiner TJ, Paemeleire K, Jensen R, Valade D, Savi L, Lainez MJ, Diener HC,
Martelletti P, Couturier EG, on behalf of European Headache Federation and
Lifting The Burden: The Global Campaign to Reduce the Burden of
Headache Worldwide (2007) European principles of management of
common headache disorders in primary care. J Headache Pain
8(Suppl 1):S3–S47
6. Martelletti P (2005) Academic specialist education in headache medicine.
Next move for the headache community. J Headache Pain 6:103–104
7. Martelletti P (2007) Headache medicine: academic teaching in Europe.
The Sapienza university Master’s degree. Headache 47:1224–1225
8. Martelletti P, Haimanot RT, Láinez MJ, Rapoport AM, Ravishankar K, Sakai F,
Silberstein SD, Vincent M, Steiner TJ (2005) The global campaign (GC) to
reduce the burden of headache worldwide. The international team for
specialist education (ITSE). J Headache Pain 6:261–263
9. Martelletti P, Steiner T (2010) Headache disorders: building specialist
education. In: Olesen J, Ramadan N (ed) Headache care, research and
education worldwide, 17th edition. Oxford University Press, Oxford,
pp 173–178
10. Licata G, Lindgren S, Diener HC, Martelletti P (2008) Headache and
emergency medicine: sharing a language for a common project. Intern
Emerg Med 3(Suppl 1):S1–S2
11. Cevoli S, D’Amico D, Martelletti P, Valguarnera F, Del Bene E, De Simone R,
Sarchielli P, Narbone M, Testa L, Genco S, Bussone G, Cortelli P (2009)
Underdiagnosis and undertreatment of migraine in Italy: a survey of
patients attending for the first time 10 headache centres. Cephalalgia
29:1285–1293
12. Steiner TJ (2013) Headache in the world: public health and research
priorities. Expert Rev Pharmacoecon Outcomes Res 13:51–57
13. Steiner TJ, Antonaci F, Jensen R, Lainez MJ, Lanteri-Minet M, Valade D, on
behalf of European Headache Federation and Lifting The Burden: the Global
Campaign against Headache (2011) Recommendations for headache service
organisation and delivery in Europe. J Headache Pain 12:419–426
14. Antonaci F, Valade D, Lanteri-Minet M, Láinez JM, Jensen R, Steiner TJ, on
behalf of European Headache Federation and Lifting The Burden: the Global
Campaign to Reduce the Burden of Headache Worldwide (2008) Proposals
for the organisation of headache services in Europe. Intern Emerg Med
3(Suppl 1):S25–S28
15. Jensen R, Mitsikostas DD, Valade D, Antonaci F (2010) Guidelines for the
organization of headache education in Europe: the headache school II.
J Headache Pain 11:161–165
doi:10.1186/1129-2377-14-41
Cite this article as: Martelletti et al.: Framing education on headache
disorders into the Global Burden of Disease Study 2010. The European
Headache Federation stands ready. The Journal of Headache and Pain
2013 14:41.Submit your manuscript to a 
journal and beneﬁ t from:
7 Convenient online submission
7 Rigorous peer review
7 Immediate publication on acceptance
7 Open access: articles freely available online
7 High visibility within the ﬁ eld
7 Retaining the copyright to your article
    Submit your next manuscript at 7 springeropen.com


Jensen, Rigmor H

Copenhagen University Research Information System

file:///data/core-remote/dit/data/Springer-OA/pdf/b10/aHR0cDovL2xpbmsuc3ByaW5nZXIuY29tLzEwLjExODYvMTEyOS0yMzc3LTE0LTQxLnBkZg==.pdf

Framing education on headache disorders into the Global Burden of Disease Study 2010 : the European Headache Federation stands ready

Abstract

Similar works

Full text

Available Versions

Lund University Publications

Ghent University Academic Bibliography

Springer - Publisher Connector

Springer - Publisher Connector

Copenhagen University Research Information System