In this world of scarce resources and competing priorities, there will be no remedy to the problem of headache unless its scope and scale are first made known to, and understood by, those who have power and influence to make change happen. As a starting point, the full burden attributable to headache must therefore be measured, so that its enormity is demonstrated objectively. Then the evidence of this must be thrust, in such a way that it cannot be ignored, in front of governments and those in control of health-service policy.

The three stages in which Lifting The Burden is conceived are identified accordingly. They can be summarized as:

• acquiring knowledge for action
• using knowledge to raise awareness and
• exploiting awareness to promote change.

They have been set out in detail elsewhere, and reduced to their seven component steps¹.

These steps are briefly described here.

The first step is to acknowledge the problem. This means recognising, in advance of precise knowledge, that headache disorders are heavily burdensome and under-treated worldwide.

The second is to build networks and collaborations as tools for the task. Bringing together WHA, IHS and EHF and involving WHO for its global impact on public health, which have been done, create only the first linkage in these - albeit by far the most important.

Step 3 is to gather information: all of the existing worldwide evidence of the burden attributable to headache. This means translating prevalence and incidence data into disability quanta. It also means gathering information, by region and country, on the allocation of health-care resources to headache disorders, not only showing the gaps between need and delivery but also discovering their causes. And it means establishing what other resources, including key people, are available in each community to be built upon.
It means, further, identifying the large holes in the evidence base and, in

Step 4, setting up or commissioning studies to fill them. So that proposed solutions reflect their needs - and not only those perceived by the developed world - direct support must be provided for studies to understand headache burdens and health-care gaps in developing countries.

Step 5 is to persuade agents of change of the problem and its priority. This will be achieved by arguing the strengths of the humanitarian and socioeconomic drivers of change, exploiting the data gathered from Steps 3 and 4. WHO will be given the sound evidence it needs to engage in dialogue with governments and other health-service policy-makers, convincing them that headache disorders should be high amongst their priorities for health care.

Step 6 will tackle these problems with practical local solutions, in each community building upon resources identified as present in Step 3. The aim will be to bridge the gaps between headache-related health-care need and delivery whilst removing or at least alleviating their causes. Programmes of education, key to effective solutions, will use, expand and supplement those provided by IHS, EHF and their member national societies for health-care providers and by WHA for people affected by headache and the general population.

Finally, and crucially, Step 7 will prove the case. Region-based demonstrational projects will be established in collaboration with WHO's Regional Offices. They will convene country policy-makers and other key stakeholders to plan headache-related health-care services appropriate to local systems and local needs, justified through the arguments above and set up using action-research methodology. They will evaluate outcomes in terms of measurable reductions in population burden attributable to headache disorders, using indices to be developed as one of the Campaign objectives.

Reference

^{1. Steiner TJ. Lifting the burden: the global campaign against headache. Lancet Neurol 2004; 3: 204-205.}

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