References for this Review were identified by searches of MEDLINE between 1988 and September, 2007, and from the extensive files of the authors. The search terms “migraine”, “cluster headache”, “tension-type headache”, “daily headaches”, “epidemiology”, “comorbidity”, “prognosis”, and “burden of headache” were used. Abstracts from meetings were also included. Only papers published in English were included. The final reference list was compiled on the basis of originality, quality, use of
ReviewEpidemiology and comorbidity of headache
Introduction
Headache is the most prevalent neurological symptom1 and is experienced by almost everyone. Headache can be a symptom of a serious life-threatening disease, such as a brain tumour, but in most cases it is a benign disorder that comprises a primary headache such as migraine or tension-type headache (TTH).2 Nevertheless, migraine and TTH can cause substantial levels of disability, not only to patients and their families but also to society as a whole owing to its high prevalence in the general population.3, 4, 5, 6, 7
Unfortunately, the scope and scale of the burden of headache is underestimated, and headache disorders are universally under-recognized and undertreated. An important initiative, Lifting the Burden: The Global Campaign to Reduce the Burden of Headache, focuses on these widespread aspects of headache and is a collaboration between multinational health-care organisations and professionals to raise awareness of headache disorders in general.8 Another initiative, Cost of the Brain Disorders in Europe, includes migraine as a separate neurological disorder that ranks as number nine on the list of the most costly neurological disorders in both sexes, and as number three in women.1, 6 TTH is the most common form of headache and is often thought of as a normal headache, in contrast to debilitating and characteristic migraine attacks or cluster headaches. Owing to its high prevalence, disability due to TTH is greater than that for migraine at the population level.3 Headache is among the ten most disabling disorders for both sexes and, if the burden of TTH is taken into account, among the five most disabling disorders for women, in accordance with the WHO's ranking of the most disabling disorders.3
The main objectives of this Review are to present the recent epidemiological knowledge about primary headache disorders, their comorbidities, costs, risk factors, and prognoses.
Section snippets
Prevalence
Although there are no biological markers for primary headaches such as migraine and TTH, their diagnosis is made with relatively high precision on the basis of the diagnostic criteria of the second edition of the International Classification of Headache Disorders (ICHD-II),9 which were published in 2004 and are now applied worldwide. There might, however, be problems with case definitions in epidemiological studies, particularly the definition of TTH, which can greatly influence the prevalence
Costs
The total economic burden of migraine has been estimated in the USA57 and Europe58 on the basis of population-based prevalence studies, which reported a prevalence of about 14% in both regions. The two studies used different types of data sources for the cost estimates, although the results of both clearly show that most of the cost of migraine can be attributed to indirect costs, such as absence from work or reduced efficiency when working with headache. The US study,57 which used cost data
Comorbidity
Comorbidity is defined as a medical condition that exists simultaneously but independently with another condition, although recent descriptions have questioned this and have implied causality between certain comorbid disorders.74
The study of the co-occurrence of highly prevalent disorders such as TTH and migraine with other disorders requires careful statistical analysis before any clear conclusions about causality can be made. Several headache disorders can occur within the same individual
Prognosis
The results of a 40-year follow-up of 73 children with pronounced migraine showed that before the age of 25, 23% of the patients did not have migraine, and women were significantly more likely to have migraine,91 but more than 50% still had migraine when they were around 50 years old.
In a 12-year longitudinal epidemiological study from Denmark, 549 people participated in the follow-up study. Of 64 migraineurs at baseline, 42% were in remission, 38% had low-frequency migraine, and 20% had a poor
Conclusions
In conclusion, headache disorders are among the most prevalent, burdensome, and costly diseases in the world, and there is an urgent need for acceptance, education, and scientific interest. Most of the severely affected patients also have profound comorbid disorders, which complicate their overall management and outcome. Thus, the burden of headache on the patient, their families, and on society is considerable. Limited knowledge of the underlying pathophysiology combined with a lack of
Search strategy and selection criteria
References (94)
Lifting the burden: the global campaign against headache
Lancet Neurol
(2004)- et al.
Epidemiology of headache in a general population--a prevalence study
J Clin Epidemiol
(1991) - et al.
Prevalence and description of chronic daily headache in the general population in France
Pain
(2003) - et al.
Validity of the Migraine Disability Assessment (MIDAS) score in comparison to a diary-based measure in a population sample of migraine sufferers
Pain
(2000) - et al.
Relation between migraine and stroke
Lancet Neurol
(2005) - et al.
Headache syndromes and psychiatric disorders: association and familial transmission
J Psychiatr Res
(1993) - et al.
Depression and anxiety associated with three pain conditions: results from a nationally representative sample
Pain
(2004) - et al.
Cost of disorders of the brain in Europe
Eur J Neurol
(2005) - et al.
Burden of headache
Expert Rev Pharmacoeconomics Outcomes Res
(2004) - et al.
The global burden of headache: a documentation of headache prevalence and disability worldwide
Cephalalgia
(2007)
Epidemiology of tension-type headache
JAMA
Epidemiology of headache in an English district
Cephalalgia
The burden of brain diseases in Europe
Eur J Neurol
Prevalence of migraine in Latin America
Headache
The International Classification of Headache Disorders: 2nd edition
Cephalalgia
Prevalence of migraine headache in Canada: a population-based survey
Int J Epidemiol
Lost workdays and decreased work effectiveness associated with headache in the workplace
J Occup Environ Med
Prevalence and burden of migraine in the United States: data from the American Migraine Study II
Headache
Migraine in the United States: epidemiology and patterns of health care use
Neurology
Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors
JAMA
Variation in migraine prevalence by race
Neurology
A population-based survey of the social and personal impact of headache
Headache
Migraine is more frequent in individuals with optimal and normal blood pressure: a population-based study
J Hypertens
Prevalence of migraine and headache in a high-altitude town of Peru: a population-based study
Headache
Prevalence of headache in Puerto Rico
Headache
Epidemiology of migraine headache in Santiago, Chile: a prevalence study
Cephalalgia
The prevalence and characteristics of migraine in a population-based cohort: the GEM study
Neurology
Prevalence of migraine and non-migrainous headache-head-HUNT, a large population-based study
Cephalalgia
One-year prevalence of migraine in Sweden: a population-based study in adults
Cephalalgia
The Zurich Study: XXIII. Epidemiology of headache syndromes in the Zurich cohort study of young adults
Eur Arch Psychiatry Clin Neurosci
The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity
Cephalalgia
Prevalence of migraine in Croatia: a population-based survey
Headache
Hungarian migraine epidemiology
Headache
Prevalence and clinical characteristics of headache in a rural community in oman
Headache
Migraine, chronic tension-type headache, and cluster headache in an Ethiopian rural community
Cephalalgia
Prevalence of migraine in a rural area in South Tanzania: a door-to-door survey
Cephalalgia
A community-based prevalence study on headache in Malaysia
Headache
Prevalence of migraine in Taipei, Taiwan: a population-based survey
Cephalalgia
Population-based door-to-door survey of migraine in Japan: the Daisen study
Headache
Epidemiologic and clinical characteristics of migraine and tension-type headache in Korea
Headache
Prevalence of migraine in Japan: a nationwide survey
Cephalalgia
One-year prevalence of migraine in Austria: a nation-wide survey
Cephalalgia
Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey
Eur J Epidemiol
The epidemiology of headache in Germany: a nationwide survey of a representative sample on the basis of the headache classification of the International Headache Society
Cephalalgia
Prevalence of migraine, tension-type headache, and other headaches in Hong Kong
Headache
Epidemiology of chronic daily headache
Eur J Med Res
Epidemiology of chronic daily headache
Curr Pain Headache Rep
Cited by (480)
Long-term exposure to air pollutants and new-onset migraine: A large prospective cohort study
2024, Ecotoxicology and Environmental SafetyNeck pain and headache: Pathophysiology, treatments and future directions
2023, Musculoskeletal Science and PracticeHeadache Improvement Following Endoscopic Resection of Pituitary Adenomas
2023, World NeurosurgeryThe effect of salt substitution on frequency and severity of headache: results from the SSaSS cluster-randomised controlled trial of 20,995 participants
2024, European Journal of Clinical Nutrition