Measuring the effect of interventions is methodologically challenging but necessary, ideally done in terms of outcomes (reductions in population burden attributable to headache). The final step in any intervention, if evaluation indicates this to be necessary, is to revise and re-apply the modified interventions in plan-do-study-act cycles using standard management-of-change methodology.

Capacity-building of doctors, especially in primary care, is a necessary part of most interventional projects and requires integrated educational initiatives.

We are collaboratively involved in projects in Georgia, setting up a headache service in a country where none has existed (and there is little infrastructure to build upon), in Russia (in Sverdlovsk Oblast, centred in Yekaterinburg), implementing a 3-level service delivery model, and China, integrating headache services within the ongoing healthcare reform, with service provision mainly in primary care but supported by 31 specialist headache centres throughout China.

With local collaborators we are discussing interventions in Bulgaria and in India (where 80% of care is paid for out-of-pocket by a largely poor population).

Collaborators:

• M Djibuti, School of Public Health, Tbilisi State Medical University, and "Partnership in Research and Action for Health", Tbilisi, Georgia
• A Dzagnidze, Tbilisi Medical University, Tbilisi, Georgia
• G Gururaj, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
• M Janelidze, Tbilisi Medical University, Tbilisi, Georgia
• Z Katsarava, University of Duisburg-Essen, Essen, Germany
• L Kirov, Bulgarian Association of General Practitioners, Sofia, Bulgaria
• M Kukava, Tbilisi Medical University, Tbilisi, Georgia
• G Kulkarni, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
• E Lebedeva, Urals State Medical University, Yekaterinburg, Russia
• IG Milanov, Institute of Neurology, Psychiatry and Neurosurgery, Sofia, Bulgaria
• E Mirvelashvili, School of Public Health, Tbilisi State Medical University, Tbilisi, Georgia
• J Olesen, University of Copenhagen, Copenhagen, Denmark
• V Osipova, Sechenov Moscow Medical Academy, Moscow, Russia
• GN Rao, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
• G Tabeeva, Sechenov Moscow Medical Academy, Moscow, Russia
• S-Yu, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China