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Volume 16 Supplement 1

1st Joint ANIRCEF-SISC Congress

  • Invited speaker presentation
  • Open Access

Disability, ICF biopsychosocial model and burden of migraine

  • 1Email author,
  • 1,
  • 2 and
  • 2
The Journal of Headache and Pain201516 (Suppl 1) :A2

  • Published:


  • Migraine
  • Health Care Facility
  • Global Effort
  • Headache Disorder
  • Work Capacity

When defining the burden of migraine it is important to consider patients’ disability and clinical and public health perspectives. Migraine sufferers often have severe under recognized and underdiagnosed health burden and reductions in social activities and work capacity. Health professionals focus on diagnosis as a key element to effective treatments, however the majority of clinicians still tend to perceive migraine, and headache disorders in general, as minor complaints. Ten years ago a possible way to increase awareness and diminish the burden was described[1]. However epidemiological data of headache disorders, despite the international Lifting the Burden Campaign, is still scarce in many parts of the world and inconsistent because of the sampling frames and of how prevalence rates are defined and the physical, emotional, social and economic burdens of headaches are still poorly acknowledged.

Uncertainty about the prevalence distribution reflects that there is still need of instruments for classifying migraine in a comparable manner across populations and that more studies must be undertaken to classify the disability due to the disorder using reliable outcome measures[2]. Estimation of needs for health services, their costs and effectiveness require indicators that go beyond measures of death rates or of diagnosis alone, and include the “functioning” of people. The biopsychosocial model of the WHO Classification of Functioning, Disability and Health (ICF) provides the model, as well as the classification system, that allows to measure all dimensions of functioning and disability[3]. More than ten years of research with ICF in migraine sufferers shows that it allows data comparability and the evaluation of the role of environment. According to ICF construct any health condition, in an unfavourable environment, can cause disability. Environmental barriers for migraine sufferers are lack of health care facilities, of accurate diagnosis, of drugs, but also difficulty in being taken seriously. Steiner[4] drew attention to the high number of people with disability due to headache who do not receive health care. The barriers responsible for this might vary throughout the world, but poor awareness of headache in a context of limited resources generally was still constantly among them. Describing and accounting the burden of migraine worldwide is not enough anymore, we need to change our paradigm again and to move towards new pathways. The opportunity is provided by the biopsychosocial approach of the ICF. To reduce the burden of millions of migraine and headache sufferers once we cannot change the disease, we should change the environment and global efforts should focus on the new development of drugs but mainly on improving the response of health care systems.

Conflict of interests

The authors certify that there is no actual or potential conflict of interest in relation to this article.

Authors’ Affiliations

SOSD Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
UO Neuroalgologia e Centro Cefalee, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy


  1. Leonardi M, Steiner TJ, Scher AT, Lipton RB: The global burden of migraine: measuring disability in headache disorders with WHO's Classification of Functioning, Disability and Health (ICF). J Headache Pain. 2005, 6 (6): 429-40. 10.1007/s10194-005-0252-4.PubMed CentralView ArticlePubMedGoogle Scholar
  2. D'Amico D, Grazzi L, Usai S, et al: Disability in Chronic Daily Headache: state of the art and future directions. Neurol Sci. 2011, 32: S71-6. 10.1007/s10072-011-0552-1.View ArticlePubMedGoogle Scholar
  3. World Health Organization: ICF- International Classification of Functioning Disability and Health. WHO. 2001, Geneva. SwitzerlandGoogle Scholar
  4. Steiner TJ, Stovner LJ, Birbeck GL: Migraine: the seventh disabler. J Headache Pain. 2013, 14: 1-10.1186/1129-2377-14-1.PubMed CentralView ArticlePubMedGoogle Scholar


© Leonardi et al. 2015

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. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.


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