Editorial NexoScience
The pills sitting in your medicine cabinet for headaches might be quietly manufacturing more of them. That is not a fringe theory. It is one of the central findings of the largest and most detailed count of headache disorders ever assembled.
Published in The Lancet Neurology as part of the Global Burden of Disease Study, the analysis estimates that 2.9 billion people, more than a third of everyone on the planet, were living with a headache disorder in 2023. That works out to a global age-standardised prevalence of 34.6%. Funded by the Gates Foundation, the study pulls together decades of population data on migraine, tension-type headache, and a condition far less talked about: medication-overuse headache, the kind caused by the treatment itself.
Migraine is rarer than you would think, but far more disabling. Tension-type headache is actually the more common of the two, affecting 24.9% of people globally versus 14.1% for migraine. But migraine hits so much harder that it accounts for 90% of all the disability caused by headache disorders. Researchers measure this with a disability weight, a score of how much a condition erodes daily functioning, and migraine’s score (0.441) is more than ten times higher than tension-type headache’s (0.037). Taken together, headache disorders now rank as the sixth leading cause of health loss worldwide, responsible for 45.5 million years lived with disability in 2023 alone.
Women carry more than double the burden. Across every age group studied, women spent more of their lives with an active headache than men did. Migraine itself is far more common among women (17.6%) than men (10.5%), and among people 50 and older, women with migraine reported being symptomatic 12.8% of the time compared to 8.7% for men of the same age. Add it all up and the overall disability rate from headache disorders is 739.9 years lived with disability per 100,000 women, versus 346.1 for men, more than double.
The twist is what people do about the pain. Medication-overuse headache is diagnosed when someone has a headache on 15 or more days a month and has been regularly overusing acute painkillers, including over-the-counter ones, for more than three months. It turns out to be a bigger driver of suffering than its low prevalence suggests: it accounts for only about 1% of tension-type headache cases but contributes more than 56% of the disability that condition causes, and it adds another 14 to 23% on top of migraine’s disability toll. Across all headache types combined, the researchers calculate that over a fifth of the global burden traces back to medication overuse.
It is worth being precise about what that means. The medication-overuse numbers come from population surveys that link heavy painkiller use with high headache frequency, not from controlled trials proving that one causes the other, a limitation the study’s own authors acknowledge openly. Still, the association is consistent across regions and large enough in scale that headache specialists treat it as one of the field’s most actionable warnings: treating pain with more of the same pain relief can end up feeding the cycle it was meant to break.
The numbers have barely moved in three decades. Age-standardised prevalence and disability rates for both migraine and tension-type headache in 2023 look almost identical to where they stood in 1990, suggesting whatever underlies these disorders has not shifted much. The researchers caution that their most recent literature review dates to 2017, so the analysis cannot capture any effect from the COVID-19 pandemic or from newer migraine drugs such as CGRP inhibitors, which in any case remain unavailable or unaffordable across much of the world.
The authors argue the fix is not simply more medication, but better organised care: primary care services trained to guide the small minority of patients who need specialists toward them, while teaching everyone else how to use acute treatments correctly instead of relying on them daily. In their view, closing that educational gap, more than any new drug, is what would finally bend these numbers after 30 years of standing still.
About this article
This piece is based on the peer reviewed study “Global, regional, and national burden of headache disorders, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023,” published by the GBD 2023 Headache Collaborators in 2025 in The Lancet Neurology, open access under a CC BY license. DOI: 10.1016/S1474-4422(25)00402-8.
