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Analysis of the management and costs of headache disorders in Spain during the period 2011–2016: a retrospective multicentre observational study
  1. Josep Darbà1,
  2. Alicia Marsà2
  1. 1 Department of Economics, Universitat de Barcelona, Barcelona, Spain
  2. 2 Department of Health Economics, BCN Health Economics & Outcomes Research SL, Barcelona, Spain
  1. Correspondence to Dr Josep Darbà; darba{at}


Objectives To investigate the number and characteristics of the Spanish population affected by headache disorders and the direct medical cost that these patients represent for the healthcare system.

Design A retrospective multicentre observational study.

Setting Records from all patients admitted with headache in primary and secondary care centres in Spain between 2011 and 2016 that were registered in a Spanish claims database were included in the analysis. Direct medical costs were calculated using the standardised average expenses of medical procedures determined by the Spanish Ministry of Health.

Results Data extraction claimed primary care records from 636 722 patients and secondary care records from 30 077 patients. Women represented 63% and 65% of all patients with headache in primary and secondary care respectively, with the exception of cluster headaches, a group with 60% of male patients. No large shifts were observed over time in patients’ profile; contrarily, the number of cases per 10 000 patients attended in primary care increased 2-folds between 2011 and 2016 for migraine and 1.85-folds for other headaches. Migraine was the cause for 28% of primary care consultations and 50% of secondary care admissions, and it was responsible for the largest portion of healthcare costs in 2016, a total amount of € 7 302 718. The estimated annual direct medical cost of headache disorders was € 10 716 086.

Conclusions Migraine was responsible for half of the secondary care admissions linked to headache disorders. The raise detected in the number of cases registered in primary care is likely to impact the direct medical costs associated to these disorders causing an increase in the total burden they represent for the Spanish National Healthcare System.

  • neurology
  • migraine
  • health economics

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  • Contributors JD contributed to the investigation by analysing and interpreting the economic situation of headache disorders in Spain and was a major contribution in the intellectual content revision. AM analysed patient descriptive and disease management data over the study period and was a major contributor in writing the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Parameters such as health centres and medical history identifiers were recoded prior to extraction to maintain records anonymised, with no access to identifying information, in accordance with the principles of Good Clinical Practice and the Declaration of Helsinki. In such cases the Spanish legislation does not require patient consent and ethics committee approval (Law 14/2007, 3 July, on biomedical research, Spain).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. The data that support the findings of this study is available from the Spanish Ministry of Health via the Unit of Health Care Information and Statistics (Spanish Institute of Health Information) for researchers who meet the criteria for access to confidential data at

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