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Headache disorders are experienced by many people around the world. In current clinical practice, the follow-up and diagnosis of headache disorder patients only happens intermittently, based on subjective data self-reported by the patient. The mBrain system tries to make this process more continuous, autonomous and objective by additionally collecting contextual and physiological data via a wearable, mobile app and machine learning algorithms. To support the monitoring of headache symptoms during attacks for headache classification and the detection of headache triggers, much knowledge and contextual data is available from heterogeneous sources, which can be consolidated with semantics. This paper presents a demonstrator of knowledge-driven services that perform these tasks using Semantic Web technologies. These services are deployed in a distributed cascading architecture that includes DIVIDE to derive and manage the RDF stream processing queries that perform the contextually relevant filtering in an intelligent and efficient way.

Migraine affects around 18% of the population and is considered one of the most disabling conditions with a great socio-economic impact. Many therapeutic decisions in the management of migraine patients are almost entirely dependent on the patient’s accurate recollection of headache events and associated circumstances that have occurred between visits. Therefore, today’s solutions to improve the traditional interview at each physician visit exist of self-reporting systems, either paper-based or using one of the available smartphone apps. This way, patients manually record clinical and related events on the day they occur, such that possible headache triggers in the lifestyle of the patient can be discussed. However, self-reporting all lifestyle events is cumbersome and subjective. To overcome these issues, we have developed mBrain, a migraine app that automatically records activities, sleeping behavior and stress. mBrain also allows patients to record their personal feelings, migraine attacks and medication intake on a day-to-day basis. This way, mBrain enables a shift from sporadic self-reporting towards continuous and objective monitoring. To further optimize the migraine management, we also designed a dashboard for clinicians that uses semantic reasoning. The dashboard visualizes the optimal information to treat the patient without requiring any configuration. This allows physicians to have a more detailed and objective view on the patient, relevant clinical events, and the patient’s response to the treatment, thus aiding physicians with posing pertinent questions. The time physicians used to spend on uncovering the relevant history from the memory of the patients can now be used to diagnose the patients more quickly and optimize their treatments, paving the path towards improved migraine management and personalized migraine therapies.

Additional file 1. General-data-collection-statistics. General statistics of the first and second data collection wave of the mBrain study. These statistics are complementary to Table 8 of the main manuscript: the same statistics are shown, complemented by spread measures where appropriate, in two separate tables (one per wave). The statistics include data collection statistics, timeline activity & interaction statistics, and daily record statistics.

Additional file 3. Key words per diagnosis for migraine and cluster headache) with absolute value of the chi-squared statistical test.

Additional file 1. Information for the participant and question asked to each participants (original in Dutch, English translated version added).

Additional file 2. List of classification labels and class-related words that were removed from the attack description corpus during pre-processing.

Additional file 1: Appendix 1. Baseline vs sensitivity analyses: Luxembourg. Appendix 2. Baseline vs sensitivity analyses: Russia. Appendix 3. Baseline vs sensitivity analyses: Spain. Appendix 4. Luxembourg: economic results of changing from current to target care (population estimates). Appendix 5. Russia: economic results of changing from current to target care (population estimates). Appendix 6. Spain: economic results of changing from current to target care (population estimates). Appendix 7. Differences in outcomes when changing from current to target care (cohorts of 1000 patients per type of headache in Luxembourg). Appendix 8. Differences in outcomes when changing from current to target care (cohorts of 1000 patients per type of headache in Russia). Appendix 9. Differences in outcomes when changing from current to target care (cohorts of 1000 patients per type of headache in Spain).

In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the “patient journey”) with perplexing obstacles. High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary. The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded. It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.

Background Health economic evaluations support health-care decision-making by providing information on the costs and consequences of health interventions. No universally accepted methodology exists for modelling effectiveness and cost-effectiveness of interventions designed to close treatment gaps for headache disorders in countries of Europe (or elsewhere). Our aim here, within the European Brain Council's Value-of-Treatment project, was to develop headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Methods We developed three headache-type-specific decision-analytical models using the WHO-CHOICE framework and adapted these for three European Region country settings (Luxembourg, Russia and Spain), diverse in geographical location, population size, income level and health-care systems and for which we had population-based data. Each model compared current (suboptimal) care vs target care (delivered in accordance with the structured headache services model). Epidemiological and economic data were drawn from studies conducted by the Global Campaign against Headache; data on efficacy of treatments were taken from published randomized controlled trials; assumptions on uptake of treatments, and those made for Healthy Life Year (HLY) calculations and target-care benefits, were agreed with experts. We made annual and 5-year cost estimates from health-care provider (main analyses) and societal (secondary analyses) perspectives (2020 figures, euros). Results The analytical models were successfully developed and applied to each country setting. Headache-related costs (including use of health-care resources and lost productivity) and health outcomes (HLYs) were mapped across populations. The same calculations were repeated for each alternative (current vs target care). Analyses of the differences in costs and health outcomes between alternatives and the incremental cost-effectiveness ratios are presented elsewhere. Conclusions This study presents the first headache-type-specific analytical models to evaluate effectiveness and cost-effectiveness of implementing structured headache services in countries in the European Region. The models are robust, and can assist policy makers in allocating health budgets between interventions to maximize the health of populations.

In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the “patient journey”) with perplexing obstacles. High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary. The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded. It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses. CA extern

Background There have been several calls for estimations of costs and consequences of headache interventions to inform European public-health policies. In a previous paper, in the absence of universally accepted methodology, we developed headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Here we apply this methodology and present the findings. Methods Data sources were published evidence and expert opinions, including those from an earlier economic evaluation framework using the WHO-CHOICE model. We used three headache-type-specific analytical models, for migraine, tension-type-headache (TTH) and medication-overuse-headache (MOH). We considered three European Region case studies, from Luxembourg, Russia and Spain to include a range of health-care systems, comparing current (suboptimal) care versus target care (structured services implemented, with provider-training and consumer-education). We made annual and 5-year cost estimates from health-care provider and societal perspectives (2020 figures, euros). We expressed effectiveness as healthy life years (HLYs) gained, and cost-effectiveness as incremental cost-effectiveness-ratios (ICERs; cost to be invested/HLY gained). We applied WHO thresholds for cost-effectiveness. Results The models demonstrated increased effectiveness, and cost-effectiveness (migraine) or cost saving (TTH, MOH) from the provider perspective over one and 5 years and consistently across the health-care systems and settings. From the societal perspective, we found structured headache services would be economically successful, not only delivering increased effectiveness but also cost saving across headache types and over time. The predicted magnitude of cost saving correlated positively with country wage levels. Lost productivity had a major impact on these estimates, but sensitivity analyses showed the intervention remained cost-effective across all models when we assumed that remedying disability would recover only 20% of lost productivity. Conclusions This is the first study to propose a health-care solution for headache, in the form of structured headache services, and evaluate it economically in multiple settings. Despite numerous challenges, we demonstrated that economic evaluation of headache services, in terms of outcomes and costs, is feasible as well as necessary. Furthermore, it is strongly supportive of the proposed intervention, while its framework is general enough to be easily adapted and implemented across Europe.