Migraine is the most disabling neurological disease among children and adolescents, and second after stroke among adults: A call to action.

The Global Burden of Disease (GBD) study is pivotal in shaping health policies by providing comprehensive data on mortality and disability. An updated GBD2021 analysis, published in Lancet Neurology on 14 March 2024, expands the scope of neurological disorders to include 37 conditions, revealing their significant impact on global health. Neurological disorders affect 3.4 billion people, or 43.1% of the global population, making them the leading cause of disability-adjusted life years (DALYs) in 2021, with an 18.2% increase since 1990. The top three causes of DALYs in this category are stroke, neonatal encephalopathy and migraine. Migraine, affecting 1.16 billion people, ranks first among children and adolescents and second among adults aged under 60 years. Despite its substantial impact, migraine often lacks proper attention because of its non-fatal nature, invisibility and historical neglect of neurological disorders. The International Headache Society calls for recognizing migraine as a serious medical condition, promoting research and integrating migraine management into public health strategies. Effective interventions include raising awareness, improving access to treatment, adding migraine to the epidemiological surveillance agenda and exploring new treatment strategies. A coordinated effort among stakeholders is essential to alleviate the burden of migraine on individuals and society.

Sex Differences in Long-Term Mortality After Stroke in the INSTRUCT (INternational STRoke oUtComes sTudy): A Meta-Analysis of Individual Participant Data.

BACKGROUND: Women are reported to have greater mortality after stroke than men, but the reasons are uncertain. We examined sex differences in mortality at 1 and 5 years after stroke and identified factors contributing to these differences. METHODS AND RESULTS: Individual participant data for incident strokes were obtained from 13 population-based incidence studies conducted in Europe, Australasia, South America, and the Caribbean between 1987 and 2013. Data on sociodemographics, stroke-related factors, prestroke health, and 1- and 5-year survival were obtained. Poisson modeling was used to estimate the mortality rate ratio (MRR) for women compared with men at 1 year (13 studies) and 5 years (8 studies) after stroke. Study-specific adjusted MRRs were pooled to create a summary estimate using random-effects meta-analysis. Overall, 16 957 participants with first-ever stroke followed up at 1 year and 13 216 followed up to 5 years were included. Crude pooled mortality was greater for women than men at 1 year (MRR 1.35; 95% confidence interval, 1.24-1.47) and 5 years (MRR 1.24; 95% confidence interval, 1.12-1.38). However, these pooled sex differences were reversed after adjustment for confounding factors (1 year MRR, 0.81; 95% confidence interval, 0.72-0.92 and 5-year MRR, 0.76; 95% confidence interval, 0.65-0.89). Confounding factors included age, prestroke functional limitations, stroke severity, and history of atrial fibrillation. CONCLUSIONS: Greater mortality in women is mostly because of age but also stroke severity, atrial fibrillation, and prestroke functional limitations. Lower survival after stroke among the elderly is inevitable, but there may be opportunities for intervention, including better access to evidence-based care for cardiovascular and general health.