The long drought: the dearth of public funding for headache research.

Headache disorders are the most prevalent of neurological conditions, and migraine is the most prevalent disabling neurological condition (1). Migraine affects 12% and chronic daily headache 4% of Europeans and Americans (2, 3); these disorders also predominantly afflict women during their peak years of productivity. Headache disorders account for ~9% of total lost labour productivity (>r20 billion) (4, 5) and ~1% of total disability (6) in the United States annually. Severe migraine attacks are classified by the World Health Organization as among the most disabling illnesses, comparable to dementia, quadriplegia and active psychosis (7). Given the high global prevalence, enormous societal costs and substantial disability and suffering, one might assume that the alleviation of migraine and other headache disorders would be a major priority for the public research agencies of developed nations. Unfortunately, nothing could be further from the truth. In this issue of Cephalalgia, Olesen and coworkers (8) quantify for the first time the neglect of migraine among European public research funding agencies. Their data are stark: migraine is the least publicly funded of all neurological illnesses relative to its economic impact. Moreover, these authors found that anxiety and affective disorders, two of the most prevalent categories of disorders comorbid with migraine, rank nearly as low as migraine in European public research funding priorities relative to economic impact. The cumulative effect of these funding decisions is to deny migraineurs the promise of research developments to change the courses of their illnesses. The lack of public research support for migraine is not limited to European grant-giving agencies. The problem is equally profound in the USA. Although the precise dollar amounts of migrainerelated National Institutes of Health (NIH) research grants have not been reported, the Computer Retrieval of Information on Scientific Projects (CRISP) database of US federally funded biomedical research projects can be used to infer abysmal funding levels. CRISP includes a document for every year of every federally funded (mostly NIH) biomedical research grant. Analysis of the relative number of CRISP documents for prevalent chronic disorders provides an approximation of the relative weight of US federal funding for each disorder. The results are striking (Figure 1 and Table 1). A comparison of the number of CRISP documents (9) with actual NIH funding levels (10) for several disorders leads to an estimate of the mean annual federal funding for migraine research at ~r13M. This sum comprises <0.05% of the total current NIH budget of ~r28B. By comparison, ~21 times more NIH research funding is devoted to