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The capstone papers on the Global Burden of Disease study 2019 (GBD2019), delayed by a diversion of resources to mapping covid-19, appeared in Lancet on October 17th. The accompanying announcement by the Institute for Health Metrics and Evaluation (IHME) described GBD2019 as “the largest and most comprehensive effort to quantify health loss across places and over time”, including “more than 3.5 billion estimates of ... 369 diseases and injuries ... in 204 countries and territories” [1]. IHME had previously announced its move to a 3-year cycle of major model updates for most non-fatal causes and risk factors (but not causes of death) [2]. Each future GBD round will include a subset of these “in rotation”, while still producing results each year for all causes of death and all non-fatal outcomes. The focus among the capstone papers was therefore on disability-adjusted life years (DALYs) [3], without the usual separately reported estimates of years lived with disability (YLDs). From a policy perspective (GBD’s main purpose is to inform health policy), this makes complete sense: years of healthy life lost to early mortality are clearly no less important than those lost to disability. But the approach takes away the spotlight from disabling diseases that do not cause early death – such as headache disorders. Nevertheless, headache disorders in 2019 ranked 14th among global causes of DALYs (all ages, both genders) [3]. Seven non-communicable disorders were ranked higher: ischaemic heart disease, stroke, chronic obstructive pulmonary disease, diabetes, low back pain, congenital defects and depressive disorders [3]. Among females, headache disorders were tenth, below gynaecological diseases (ninth) but above depressive disorders (11th). Among young adult females (15–49 years), they were second only to gynaecological diseases (note that this was of DALYs, not YLDs). Among young adult men they were tenth, with road injuries, self-harm, interpersonal violence and cirrhosis – all causes of premature mortality – each responsible for more DALYs. What about YLDs? In separate on-line estimates, headache disorders were the cause in 2019 of 46.6 million YLDs globally, 5.4% of total YLDs, with 88.2% of these attributable to migraine [4]. In terms of lost healthy life, that equates to 46.6 million people dying one year early. In the ranked causes of YLDs (all ages, both genders), headache disorders (602.5 per 100, 000 person/years) were third, below low back pain (823.0) and, by a tiny margin, depressive orders (605.7) (Table 1). Among females, gynaecological diseases (second: 764.0) overtook both headache (third: 751.0) and depressive disorders (fourth: 743.7) (Table 1) despite their clearly evident association with female gender. Also clearly evident was the association of headache disorders with age – specifically, with young adulthood. Among females aged 15–49 years, headache disorders (1016.1) were second only to gynaecological diseases (1230.5), with depressive disorders third (890.4). But in all young adults, with gynaecological diseases a factor among only half, headache disorders (813.4) were top cause of YLDs (Table 1). There were variations according to World Bank region and country income level. Headache disorders were third cause of YLDs in East Asia & Pacific and in Middle East

Migraine remains second among the world’s causes of disability, and first among young women: findings from GBD2019