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Semin Neurol 2022; 42(04): 449-458
DOI: 10.1055/a-1942-6823
Review Article

The Epidemiology of Primary Headache Disorders

David Kopel
1   Division of Headache Medicine, Department of Neurology, Yale University, New Haven, Connecticut
,
Christopher Gottschalk 
2   Division of Headache Medicine, Department of Neurology, Yale University, New Haven, Connecticut
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Abstract

Defining the epidemiology of headache disorders is challenging given the prevalence of stigma and other harmful misconceptions about these diseases. Understanding the widespread impact of these disorders is essential when considering social and policy interventions to mitigate that impact. Tension-type headache is still widely considered the most common primary headache disorder, but population-based estimates of its prevalence vary widely. Migraine remains the most common headache disorder in patients who present for clinical care. Prevalence estimates have remained fairly stable over the last two decades (1-year period prevalence, United States: 18% of women and 6% of men). Recent studies indicate that people who identify as American Indian/Alaskan Native (AI/AN) have the highest migraine prevalence of any ethnic group surveyed, particularly among AI/AN men (15% vs. <10%). Studies in the United States also show an inverse relationship between income level and migraine incidence and prevalence, particularly for chronic migraine; factors mediating this relationship are difficult to define. There are many diseases comorbid with migraine, more so with migraine with aura. The burden of migraine is enormous: the Global Burden of Disease study indicates migraine is the number 1 cause of disability in women younger than 50 years and the number 2 or 3 cause of disability worldwide. Further study is needed into underdiagnosis, undertreatment, and persistent stigma associated with headache disorders, especially in underserved communities. Stakeholders including patients, providers, and governing bodies are affected by the results of epidemiologic studies and should all have a role in crafting and evaluating thoughtful and relevant questions and hypotheses in this field.

Keywords

migraine prevalence - disease burden - quality of life - healthcare disparities - comorbidities


Publication History

Accepted Manuscript online:
14 September 2022

Article published online:
02 November 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA 1998; 279 (05) 381-383
    CrossrefPubMedGoogle Scholar
  • 2 Russell MB, Levi N, Saltyte-Benth J, Fenger K. Tension-type headache in adolescents and adults: a population based study of 33,764 twins. Eur J Epidemiol 2006; 21 (02) 153-160
    CrossrefPubMedGoogle Scholar
  • 3 Evans RW, Seifert T, Kailasam J, Mathew NT. The use of questions to determine the presence of photophobia and phonophobia during migraine. Headache 2008; 48 (03) 395-397
    CrossrefPubMedGoogle Scholar
  • 4 Lipton RB, Stewart WF, Cady R. et al. 2000 Wolfe Award. Sumatriptan for the range of headaches in migraine sufferers: results of the Spectrum Study. Headache 2000; 40 (10) 783-791
    CrossrefPubMedGoogle Scholar
  • 5 Robbins MS, Lipton RB. The epidemiology of primary headache disorders. Semin Neurol 2010; 30 (02) 107-119
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Tepper SJ, Dahlöf CG, Dowson A. et al. Prevalence and diagnosis of migraine in patients consulting their physician with a complaint of headache: data from the Landmark Study. Headache 2004; 44 (09) 856-864
    CrossrefPubMedGoogle Scholar
  • 7 Burch RC, Buse DC, Lipton RB. Migraine: epidemiology, burden, and comorbidity. Neurol Clin 2019; 37 (04) 631-649
    CrossrefPubMedGoogle Scholar
  • 8 Zhang L, Losin EAR, Ashar YK, Koban L, Wager TD. Gender biases in estimation of others' pain. J Pain 2021; 22 (09) 1048-1059
    CrossrefPubMedGoogle Scholar
  • 9 Lipton RB, Nicholson RA, Reed ML. et al. Diagnosis, consultation, treatment, and impact of migraine in the US: results of the OVERCOME (US) study. Headache 2022; 62 (02) 122-140
    CrossrefPubMedGoogle Scholar
  • 10 Lyngberg AC, Rasmussen BK, Jørgensen T, Jensen R. Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey. Eur J Epidemiol 2005; 20 (03) 243-249
    CrossrefPubMedGoogle Scholar
  • 11 Stewart WF, Wood C, Reed ML, Roy J, Lipton RB. AMPP Advisory Group. Cumulative lifetime migraine incidence in women and men. Cephalalgia 2008; 28 (11) 1170-1178
    CrossrefPubMedGoogle Scholar
  • 12 Bernstein C, O'Neal MA. Migraine and menopause - a narrative review. Menopause 2020; 28 (01) 96-101
    CrossrefPubMedGoogle Scholar
  • 13 Hranilovich JA, Kaiser EA, Pace A, Barber M, Ziplow J. Headache in transgender and gender-diverse patients: a narrative review. Headache 2021; 61 (07) 1040-1050
    CrossrefPubMedGoogle Scholar
  • 14 Yalinay Dikmen P, Ertas M, Kosak S. et al. Primary headaches among gender dysphoric female-to-male individuals: a cross-sectional survey on gender transition experience. Headache 2021; 61 (08) 1194-1206
    CrossrefPubMedGoogle Scholar
  • 15 Burch R, Rizzoli P, Loder E. The prevalence and impact of migraine and severe headache in the United States: updated age, sex, and socioeconomic-specific estimates from government health surveys. Headache 2021; 61 (01) 60-68
    CrossrefPubMedGoogle Scholar
  • 16 Loder S, Sheikh HU, Loder E. The prevalence, burden, and treatment of severe, frequent, and migraine headaches in US minority populations: statistics from National Survey studies. Headache 2015; 55 (02) 214-228
    CrossrefPubMedGoogle Scholar
  • 17 Rhee H. Prevalence and predictors of headaches in US adolescents. Headache 2000; 40 (07) 528-538
    CrossrefPubMedGoogle Scholar
  • 18 Tao F. Migraine Prevalence and its Differences among Races and Ethnicities in the United States (2010–2015). eScholarship: UC Irvine; 2017
    Google Scholar
  • 19 Harris M, Brantley T, Hammond D, Kalamchi S. Demographic features of patients with concomitant facial fractures and closed head injuries in Maricopa, Arizona. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125 (06) 520-525
    CrossrefPubMedGoogle Scholar
  • 20 Stewart WF, Roy J, Lipton RB. Migraine prevalence, socioeconomic status, and social causation. Neurology 2013; 81 (11) 948-955
    CrossrefPubMedGoogle Scholar
  • 21 VanderPluym JH, Charleston IV L, Stitzer ME, Flippen II CC, Armand CE, Kiarashi J. A review of underserved and vulnerable populations in headache medicine in the United States: challenges and opportunities. Curr Pain Headache Rep 2022; 26 (06) 415-422
    CrossrefPubMedGoogle Scholar
  • 22 Charleston IV L. Headache disparities in African-Americans in the United States: a narrative review. J Natl Med Assoc 2021; 113 (02) 223-229
    PubMedGoogle Scholar
  • 23 Fischera M, Marziniak M, Gralow I, Evers S. The incidence and prevalence of cluster headache: a meta-analysis of population-based studies. Cephalalgia 2008; 28 (06) 614-618
    CrossrefPubMedGoogle Scholar
  • 24 Allena M, De Icco R, Sances G. et al. Gender differences in the clinical presentation of cluster headache: a role for sexual hormones?. Front Neurol 2019; 10: 1220
    CrossrefPubMedGoogle Scholar
  • 25 Grande RB, Aaseth K, Lundqvist C, Russell MB. Prevalence of new daily persistent headache in the general population. The Akershus study of chronic headache. Cephalalgia 2009; 29 (11) 1149-1155
    CrossrefPubMedGoogle Scholar
  • 26 Bigal ME, Lipton RB, Tepper SJ, Rapoport AM, Sheftell FD. Primary chronic daily headache and its subtypes in adolescents and adults. Neurology 2004; 63 (05) 843-847
    CrossrefPubMedGoogle Scholar
  • 27 Lipton RB, Fanning KM, Buse DC. et al. Identifying natural subgroups of migraine based on comorbidity and concomitant condition profiles: results of the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache 2018; 58 (07) 933-947
    CrossrefPubMedGoogle Scholar
  • 28 Buse DC, Reed ML, Fanning KM. et al. Comorbid and co-occurring conditions in migraine and associated risk of increasing headache pain intensity and headache frequency: results of the migraine in America symptoms and treatment (MAST) study. J Headache Pain 2020; 21 (01) 23
    CrossrefPubMedGoogle Scholar
  • 29 Scher AI, Bigal ME, Lipton RB. Comorbidity of migraine. Curr Opin Neurol 2005; 18 (03) 305-310
    CrossrefPubMedGoogle Scholar
  • 30 Breslau N, Lipton RB, Stewart WF, Schultz LR, Welch KM. Comorbidity of migraine and depression: investigating potential etiology and prognosis. Neurology 2003; 60 (08) 1308-1312
    CrossrefPubMedGoogle Scholar
  • 31 Penzien DB, Irby MB, Smitherman TA, Rains JC, Houle TT. Well-established and empirically supported behavioral treatments for migraine. Curr Pain Headache Rep 2015; 19 (07) 34
    CrossrefPubMedGoogle Scholar
  • 32 Wells RE, Seng EK, Edwards RR. et al. Mindfulness in migraine: a narrative review. Expert Rev Neurother 2020; 20 (03) 207-225
    CrossrefPubMedGoogle Scholar
  • 33 Koo BB, Bayoumi A, Albanna A. et al. Demoralization predicts suicidality in patients with cluster headache. J Headache Pain 2021; 22 (01) 28
    CrossrefPubMedGoogle Scholar
  • 34 Karimi L, Hoppe D, Burdick C, Buultjens M, Wijeratne T, Crewther SG. Recent evidence regarding the association between migraine and suicidal behaviors: a systematic review. Front Neurol 2020; 11: 490
    CrossrefPubMedGoogle Scholar
  • 35 Whealy M, Nanda S, Vincent A, Mandrekar J, Cutrer FM. Fibromyalgia in migraine: a retrospective cohort study. J Headache Pain 2018; 19 (01) 61
    CrossrefPubMedGoogle Scholar
  • 36 Chelimsky G, Heller E, Buffington CA, Rackley R, Zhang D, Chelimsky T. Co-morbidities of interstitial cystitis. Front Neurosci 2012; 6: 114
    CrossrefPubMedGoogle Scholar
  • 37 Peterlin BL, Rosso AL, Nair S, Young WB, Schwartzman RJ. Migraine may be a risk factor for the development of complex regional pain syndrome. Cephalalgia 2010; 30 (02) 214-223
    CrossrefPubMedGoogle Scholar
  • 38 Kurth T, Rist PM, Ridker PM, Kotler G, Bubes V, Buring JE. Association of migraine with aura and other risk factors with incident cardiovascular disease in women. JAMA 2020; 323 (22) 2281-2289
    CrossrefPubMedGoogle Scholar
  • 39 Androulakis XM, Kodumuri N, Giamberardino LD. et al. Ischemic stroke subtypes and migraine with visual aura in the ARIC study. Neurology 2016; 87 (24) 2527-2532
    CrossrefPubMedGoogle Scholar
  • 40 Chiang CC, Chhabra N, Chao CJ. et al. Migraine with aura associates with a higher artificial intelligence: ECG atrial fibrillation prediction model output compared to migraine without aura in both women and men. Headache 2022; 62 (08) 939-951
    CrossrefPubMedGoogle Scholar
  • 41 Eikermann-Haerter K, Lee JH, Yalcin N. et al. Migraine prophylaxis, ischemic depolarizations, and stroke outcomes in mice. Stroke 2015; 46 (01) 229-236
    CrossrefPubMedGoogle Scholar
  • 42 Ahmed Z, Sommer RJ. Reassessing the PFO-migraine trials: Are we closer to closure?. J Am Coll Cardiol 2021; 77 (06) 677-679
    CrossrefPubMedGoogle Scholar
  • 43 GORE® CARDIOFORM Septal Occluder Migraine Clinical Study: A Study to Evaluate the Safety and Efficacy of Transcatheter Closure of Patent Foramen Ovale for Relief of Migraine Headaches. NCT04100135, Accessed 14 September, 2022 at clinicaltrials.gov
    PubMedGoogle Scholar
  • 44 Rogawski MA. Common pathophysiologic mechanisms in migraine and epilepsy. Arch Neurol 2008; 65 (06) 709-714
    CrossrefPubMedGoogle Scholar
  • 45 Islamoska S, Hansen AM, Wang HX. et al. Mid- to late-life migraine diagnoses and risk of dementia: a national register-based follow-up study. J Headache Pain 2020; 21 (01) 98
    CrossrefPubMedGoogle Scholar
  • 46 Rains JC. Sleep and migraine: assessment and treatment of comorbid sleep disorders. Headache 2018; 58 (07) 1074-1091
    CrossrefPubMedGoogle Scholar
  • 47 Tiseo C, Vacca A, Felbush A. et al; European Headache Federation School of Advanced Studies (EHF-SAS). Migraine and sleep disorders: a systematic review. J Headache Pain 2020; 21 (01) 126
    CrossrefPubMedGoogle Scholar
  • 48 Chabi A, Zhang Y, Jackson S. et al. Randomized controlled trial of the orexin receptor antagonist filorexant for migraine prophylaxis. Cephalalgia 2015; 35 (05) 379-388
    CrossrefPubMedGoogle Scholar
  • 49 Barloese M. Current understanding of the chronobiology of cluster headache and the role of sleep in its management. Nat Sci Sleep 2021; 13: 153-162
    CrossrefPubMedGoogle Scholar
  • 50 Ishii R, Schwedt TJ, Dumkrieger G. et al. Chronic versus episodic migraine: the 15-day threshold does not adequately reflect substantial differences in disability across the full spectrum of headache frequency. Headache 2021; 61 (07) 992-1003
    CrossrefPubMedGoogle Scholar
  • 51 Buse DC, Manack AN, Fanning KM. et al. Chronic migraine prevalence, disability, and sociodemographic factors: results from the American Migraine Prevalence and Prevention Study. Headache 2012; 52 (10) 1456-1470
    CrossrefPubMedGoogle Scholar
  • 52 Adams AM, Serrano D, Buse DC. et al. The impact of chronic migraine: the Chronic Migraine Epidemiology and Outcomes (CaMEO) study methods and baseline results. Cephalalgia 2015; 35 (07) 563-578
    CrossrefPubMedGoogle Scholar
  • 53 Bigal ME, Lipton RB. Modifiable risk factors for migraine progression. Headache 2006; 46 (09) 1334-1343
    CrossrefPubMedGoogle Scholar
  • 54 Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache 2008; 48 (08) 1157-1168
    CrossrefPubMedGoogle Scholar
  • 55 Brandes JL, Klise S, Krege JH. et al. Interim results of a prospective, randomized, open-label, Phase 3 study of the long-term safety and efficacy of lasmiditan for acute treatment of migraine (the GLADIATOR study). Cephalalgia 2019; 39 (11) 1343-1357
    CrossrefPubMedGoogle Scholar
  • 56 Croop R, Lipton RB, Kudrow D. et al. Oral rimegepant for preventive treatment of migraine: a phase 2/3, randomised, double-blind, placebo-controlled trial. Lancet 2021; 397 (10268): 51-60
    CrossrefPubMedGoogle Scholar
  • 57 Dodick DW, Goadsby PJ, Lucas C. et al. Phase 3 randomized, placebo-controlled study of galcanezumab in patients with chronic cluster headache: results from 3-month double-blind treatment. Cephalalgia 2020; 40 (09) 935-948
    CrossrefPubMedGoogle Scholar
  • 58 Bonafede M, Sapra S, Shah N, Tepper S, Cappell K, Desai P. Direct and indirect healthcare resource utilization and costs among migraine patients in the United States. Headache 2018; 58 (05) 700-714
    CrossrefPubMedGoogle Scholar
  • 59 Buse DC, Armand CE, Charleston IV L. et al. Barriers to care in episodic and chronic migraine: results from the Chronic Migraine Epidemiology and Outcomes Study. Headache 2021; 61 (04) 628-641
    CrossrefPubMedGoogle Scholar
  • 60 Shen MJ, Peterson EB, Costas-Muñiz R. et al. The effects of race and racial concordance on patient-physician communication: a systematic review of the literature. J Racial Ethn Health Disparities 2018; 5 (01) 117-140
    CrossrefPubMedGoogle Scholar
  • 61 Lipton RB, Hahn SR, Cady RK. et al. In-office discussions of migraine: results from the American Migraine Communication Study. J Gen Intern Med 2008; 23 (08) 1145-1151
    CrossrefPubMedGoogle Scholar