Risk factors associated to disability in primary headaches: a systematic review to inform future iterations of the Global Burden of Disease Study

Headache disorders are prevalent and disabling conditions. Despite the recent introduction of modern therapies, a large portion of patients are still sub-optimally treated, resulting in a minor or no decrease in health loss nor disability. The Global Burden of Disease (GBD) study classifies 88 risk factors which impact several conditions, thus enabling the estimation of the potential health gain due to addressing these risk factors, but such analysis is not available for headache disorders yet. To address which risk factors, as intended by the taxonomy of the GBD study, are associated to disability in primary headaches. Primary research studies addressing primary headache disorders and disability were searched in PubMed, Web of Science and SCOPUS, in the period between 2000 and 2025. The GBD taxonomy, which classifies risk factors into environmental and occupational, behavioural, and metabolic factors, was used. A descriptive analysis was employed to report the associations between disability measures and the presence/absence of specific risk factors, accounting for diagnoses and the age of patients. A total of 64 studies (97,846 patients) were included, and a total of 86 single associations were found. Metabolic risk factors (high BMI, high fasting plasma glucose, and LDL cholesterol), and behavioural risk factors (low physical activity, inadequate dietary habits, tobacco smoking, and alcohol consumption) were the most frequently reported. Our results suggest that it is possible to address headache-related disability by acting on a set of modifiable factors, with interventions tailored to the specific needs of patients or addressing the exposed populations as a whole. In particular, targeting dietary aspects and exercise is reasonably expected to promote weight loss, and might have an impact on the reduction in fasting plasma glucose and LDL cholesterol, ultimately improving patients’ overall health status and reducing headache-related disability.

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Publication Details

Journal
The Journal of Headache and Pain
Published
2025-12-23
DOI
https://doi.org/10.1186/s10194-025-02233-7
Citations
3
Primary Topic
Migraine and Headache Studies
Type
article
Field-Weighted Citation Impact
4.41

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article

Risk factors associated to disability in primary headaches: a systematic review to inform future iterations of the Global Burden of Disease Study

Francesca Puledda, Gabriele Sebastianelli, Andreas Kattem Husøy, Roberta Messina et al.
3 citations
The Journal of Headache and Pain
Migraine and Headache Studies
4.41
article

Risk factors associated to disability in primary headaches: a systematic review to inform future iterations of the Global Burden of Disease Study

Francesca Puledda, Gabriele Sebastianelli, Andreas Kattem Husøy, Roberta Messina, Sebastian Straube, Igor D. Petrušić, Matteo Castaldo, Lanfranco Pellesi, Bianca Raffaelli, Ellina Lytvyak, Damiana Scuteri, J J Wu, Ruth Ruscheweyh, Chia‐Chun Chiang, Yohannes W. Woldeamanuel, S Cho, Serkan Yener, Raffaele Ornello, Agnese Onofri, Adriana Della Pietra, Dilara Onan, Philip R. Holland, Wu Wang, Paolo Martelletti, Min Kyung Chu, Alejandro Labastida-Ramirez, Eloísa Rubio-Beltrán, Claudio Tana, Marta Waliszewska-Prosół, Alberto Raggi, Barbara Corso, Doga Vuralli, William Wells-Gatnik
article en
3 citations

Abstract

Headache disorders are prevalent and disabling conditions. Despite the recent introduction of modern therapies, a large portion of patients are still sub-optimally treated, resulting in a minor or no decrease in health loss nor disability. The Global Burden of Disease (GBD) study classifies 88 risk factors which impact several conditions, thus enabling the estimation of the potential health gain due to addressing these risk factors, but such analysis is not available for headache disorders yet. To address which risk factors, as intended by the taxonomy of the GBD study, are associated to disability in primary headaches. Primary research studies addressing primary headache disorders and disability were searched in PubMed, Web of Science and SCOPUS, in the period between 2000 and 2025. The GBD taxonomy, which classifies risk factors into environmental and occupational, behavioural, and metabolic factors, was used. A descriptive analysis was employed to report the associations between disability measures and the presence/absence of specific risk factors, accounting for diagnoses and the age of patients. A total of 64 studies (97,846 patients) were included, and a total of 86 single associations were found. Metabolic risk factors (high BMI, high fasting plasma glucose, and LDL cholesterol), and behavioural risk factors (low physical activity, inadequate dietary habits, tobacco smoking, and alcohol consumption) were the most frequently reported. Our results suggest that it is possible to address headache-related disability by acting on a set of modifiable factors, with interventions tailored to the specific needs of patients or addressing the exposed populations as a whole. In particular, targeting dietary aspects and exercise is reasonably expected to promote weight loss, and might have an impact on the reduction in fasting plasma glucose and LDL cholesterol, ultimately improving patients’ overall health status and reducing headache-related disability.

The Journal of Headache and PainVol. 27(1)
Texas Tech University (US), University of Parma (IT), University of Iowa (US), Mayo Clinic (US), Vita-Salute San Raffaele University (IT), University of Alberta (CA), University of Southern Denmark (DK), King's College London (GB), Yonsei University (KR), Norwegian University of Science and Technology (NO), University of L'Aquila (IT), Yozgat Bozok Üniversitesi (TR), Manchester Academic Health Science Centre (GB), Sir Run Run Shaw Hospital (CN), Taipei Veterans General Hospital (TW), University of Manchester (GB), LMU Klinikum (DE), Myer Foundation (AU), National Institute for Health and Care Research (GB), Magna Graecia University (IT), Wroclaw Medical University (PL), Humboldt-Universität zu Berlin (DE), University of Belgrade (RS), Neurobehavioral Systems (US), St Olav's University Hospital (NO), Neuroscience Institute (IT), Monash Health (AU), Martje Venter Hospital (ZA), Mayo Clinic in Arizona (US), Mayo Clinic Hospital (US), Datta Meghe Institute of Higher Education and Research (IN), Unitelma Sapienza University (IT), Hallym University Dongtan Sacred Heart Hospital (KR), Istituti di Ricovero e Cura a Carattere Scientifico (IT), National Research Council (IT), Fate Therapeutics (United States) (US), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), Ethiopian Institute of Agricultural Research (ET), Freie Universität Berlin (DE), Zhejiang University (CN), Charité - Universitätsmedizin Berlin (DE), Ludwig-Maximilians-Universität München (DE), Sapienza University of Rome (IT), Texas Tech University Health Sciences Center (US), Gazi University (TR)
Eli Lilly and Company, Pfizer, Biogen, Teva Pharmaceutical Industries, University of Ontario Institute of Technology, Government of Alberta, Deutsche Forschungsgemeinschaft, Else Kröner-Fresenius-Stiftung, Ministero della Salute, Alberta Medical Association, H. Lundbeck A/S, National Institutes of Health, Allergan
Good health and well-being
Openalex Percentile: Top 5%
Migraine and Headache Studies
4.41
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