Frequency of migraine among an unselected group of employees and variation of prevalence according to different diagnostic criteria

Migraine incidence in 5 years: a population-based prospective longitudinal study in Turkey

BACKGROUND

The incidence of migraine has been investigated only in a few studies worldwide and it is not known in our country. We, therefore, aimed to estimate the migraine incidence in a previously accomplished population-based prevalence study sample of 5323 individuals in the year 2008.

METHODS

The former Turkish headache prevalence study has been completed as a nationwide, randomized, home-based study of face-to-face examination by physicians trained for headache diagnosis by using ICHD criteria. Five years after this study an optimized survey including 50 questions was performed to estimate the migraine incidence in migraine-free individuals in the previous study, with a 56.4 % responder rate. Two validation studies for this survey were performed prior and after the study each in 100 subjects by comparing the gold standard of expert diagnosis of headache, showing high rate of reliability (Crohnbach alpha: 0.911 and 0.706, respectively).

RESULTS

Migraine incidence was estimated as 2.38 % (2.98 % in women and 1.93 % in men) per year in 2563 migraine-free individuals; if the population at risk is defined as the group without any headaches, the migraine incidence decreased to 1.99 %. The chronic migraine (CM) incidence [without medication overuse (MOH)] was 0.066 % and that of MOH was 0.259 %. We found a significant burden of the disease on the occupational functionality as well as on social and family life, even in the early years of the migraine. The family history of headaches especially in the fathers could be useful to predict new cases of migraine, besides the well-known risk factor, diagnosis of depression, whereas income and education did not seem to relate to migraine onset.

CONCLUSIONS

Our study with a large population-based nation-wide sample, using ICHD-II criteria, with structured headache interviews as well as blinded re-validation of the questionnaire diagnoses showed a 2.38 % incidence rate of migraine in Turkey, higher than most of the other previous reports; a finding which could be related to genetic factors and also to the methodological differences in the study designs. Moreover the incidence of CM was found to be 0.066 %.

Epidemiology of headache

Epidemiological studies conducted in the general population point to average headache prevalence rates of 46% for 1-year prevalence and of 64% for lifetime prevalence. For migraine, most studies conducted in the adult general population of western Europe and North America indicate rates between 5% and 9% in men, and between 12% and 25% in women. Non-western countries report lower figures. Migraine shows no gender differences in children, while in the elderly its frequency appears much reduced in both genders. About one-third of migraineurs suffer from migraine with aura. For tension-type headache, prevalence data reports in the literature are few and conflicting: rates range from 11% in Singapore to 20-40% in the USA and over 80% in Denmark. It is worth noting that the highest figures are found in studies where a personal interview has been employed. This probably indicates that the prevalence of this headache subtype is particularly sensitive to the method of data collection. Cluster headache occurs in 1-3 per thousand of the general population, with a gender (M:F) ratio of about 3:1. About 4% of the adult general population suffers from chronic daily headache.

Pharmaceutical Care for Migraine and Headache Patients: A Community-Based, Randomized Intervention

Background:

Despite the high prevalence of headache and migraine in the general population, many people do not receive adequate medical attention and treatment.

Objective:

To evaluate the effects of pharmaceutical care (defined as intensified structured counseling between patient and pharmacist, including the use of drug databases), for patients with headache or migraine, on both clinical and psychological endpoints.

Methods:

A prospective, randomized, controlled intervention study was conducted using pharmacies in Northern Germany. A total of 112 pharmacies (26% of all pharmacies in the study region) recruited 410 patients with headaches. Pharmacies were randomly assigned to an intervention or control group. Patients were interviewed by telephone prior to the intervention and again after 4 months. Primary endpoints were number of days with headache, number and severity of headaches, self-efficacy, and the patients' perceptions of their health-related quality of life.

Results:

Each pharmacy treated an average of 4.6 patients (total time effort 9 h). The intervention group consisted of 201 patients who received pharmaceutical care, whereas the control group comprised 209 patients who received standard counseling. In both groups, the number of headache attacks and intensity of pain in treated headache attacks did not change significantly between the first and second interviews. However, a statistically significant improvement in mental health and self-efficacy was shown in the intervention group. Intensity of pain in untreated headache attacks and the number of days with headache decreased in both groups. Most participants described this intervention as helpful and effective and 90% reported that they would recommend pharmaceutical care to other patients with headache.

Conclusions:

A short-term pharmaceutical care intervention improved patients' mental health and self-efficacy, although it did not significantly change the number and severity of headaches. The increase in self-efficacy and mental health associated with pharmaceutical care may be instrumental in improving long-term pharmacotherapy of patients with migraine and headache. To fully assess the effects of pharmaceutical care, a longer study may be required.

Prevalence and Characteristics of Migraine in Women of Reproductive Age in Istanbul, Turkey: A Population Based Survey

Migraine is more common in female and onset of migraine is most commonly seen in the second and third decades of life. In this study, we aimed to estimate the prevalence and characteristics of migraine among women of ages between 15 to 45 years in Turkey. This is the first study to target this age group. The women were interviewed on a door-to-door basis, from early morning to late evening. Once responded positively to headache, an in-depth interview was performed questioning for migraine features. Diagnosis was made from a questionnaire by eight neurologists. One thousand eight hundred thirty five (1,835) out of 96,000 women living in Maltepe which is a town of Istanbul participated in this study. The prevalence of migraine in females aged 15-45 (reproductive ages) was 15.8% (95% CI, 0.142-0.176). This study showed that migraine onset occurred at a mean age of 22.7, 33% having family history, and with migraine with and without aura having near equal frequencies. The prevalence of migraine in women of reproductive ages in Istanbul as found in our study is lower than that reported in United States and Europe countries, but higher than that in Middle and Far Eastern countries.

Epidemiological and clinical characteristics of migraine and tension type headache in 1146 females in Kayseri, Turkey

In a female population of Turkey (1146 adult females), some epidemiological and clinical characteristics of migraine and tension type headache and their subtypes were investigated. The relation of the headache severity to clinical characteristics were inquired. Migraine prevalence was found to be statistically higher in the 35-44 years age group (P < 0.01) and those who were university graduates (P < 0.001), married (P < 0.01) and living in urban areas (P < 0.01). Tension type headache was found to be higher in the 45-64 years age group (P < 0.05). Chronic tension type headache patients were found to be older than episodic type (P < 0.01) and frequently were in the lowest education level (P < 0.05). Presence of impact on daily activities because of the severity of headache was found to be related to aggravation by physical activities (P = 0.001) in tension type headache, with no clinical characteristics in migraine headache and on consideration of all headache patients with throbbing nature (P < 0.05), aggravation on physical activities (P = 0.001), nausea (P < 0.01), vomiting (P < 0.05) and phonophobia (P < 0.05).

Low socio-economic status is associated with increased risk of frequent headache: a prospective study of 22718 adults in Norway

Prevalence studies exploring the relation between socio-economic status (SES) and headache have shown conflicting results. This is the first prospective study analysing the relation between SES and risk of headache. A total of 22685 adults not likely to suffer from headache were classified by SES at baseline in 1984-1986, and responded to a headache questionnaire in a follow-up 11 years later (1995-1997). SES at baseline was defined by educational level, occupation, and income. The risk of frequent headache and chronic headache (>6, and > or =15 days/month, respectively) at follow-up was estimated in relation to SES. When defining SES by educational level or type of occupation, low status was associated with increased risk of frequent and chronic headache at follow-up. The risk of frequent and chronic headache decreased with increasing individual income, but only among men. We conclude that individuals with low SES had higher risk of frequent and chronic headache than people with high SES.

Migraine consultation patterns in primary care. Results from the PCAOM study 1994-96

In order to establish a basis for the planning of improved medical care of migraine in Germany, we report on the proportion of migraine patients under primary care and the continuity of consultations for migraine as determined by age, gender, and history of migraine and nonmigraine practice contact (Primary Care of Migraine, PCAOM Study). A primary-care-physician-based migraineurs' sample of 16,573 women and 4,636 men (MediPlus, IMS Health) was placed in relation to cases expected according to International Headache Society criteria in the base population, and was followed for up to 3 years for repeat consultations. Overall, no more than 51% and 37%, respectively, of female and male statutory health-insured migraine headache sufferers had a migraine diagnosis mentioned at least once a year in primary care. At younger ages, substantially less advantage was taken of available primary healthcare for migraine; 79% of the women and 74% of the men were estimated to present again to the same primary-care physician within 3 years because of migraine, the corresponding figures for patients with no history of migraine in the practice concerned being 41% and 31%, respectively. Following first migraine contacts, time to recontact and quarterly recontact prevalences for migraine did not differ, whether on the basis of an established nonmigraine primary care relationship or a first encounter with a medical practice. Trust evidenced by an existing nonmigraine doctor-patient relationship apparently did not carry over to migraine. Results indicate that one of the greatest challenges in relation to the care of migraine patients in Germany is to establish and maintain solid doctor-patient relationships.

The burden of migraine to the individual sufferer: a review

This review of the literature reveals that migraine is a common, chronic condition featuring episodic attacks which vary in severity and symptomatology. Throbbing, unilateral headache, which is aggravated by activity, is the most prominent feature, although a high proportion of sufferers also experience phonophobia, photophobia and nausea, which may lead to vomiting. Preceding aura is a less common feature of the attack. The frequency and duration of migraine attacks varies widely between individuals, though the median frequency is around 1 attack per month and median duration is roughly 24 h. Migraine attacks can have a profound effect on the day-to-day lives and well-being of the sufferer. In the long term, migraine may cause profound emotional changes and result in coping strategies that interfere with working, social and family life and many normal daily activities. These effects are apparent in quality of life studies on migraine patients. Thus, the impact of migraine on many quality of life parameters is similar to that of other chronic conditions such as osteoarthritis, diabetes and depression. Reduction in the personal burden of migraine can be facilitated by encouraging migraine sufferers to consult their doctor, through accurate diagnosis of migraine headaches and assessment of the disability suffered by the migraineurs, and through improved and well-executed treatment strategies. Copyright 1998 Lippincott Williams & Wilkins

Non-migrainous headache, neck or shoulder pain, and migraine--differences in association with background factors in a city population

OBJECTIVE

To study the pattern of association of background factors with reported migraine, non-migrainous headache, and neck or shoulder pain.

DESIGN

In a cross-sectional survey the population of the municipality of Tromsø between 20 and 56 years of age was screened for risk factors of different diseases. Everybody attending the screening was given a questionnaire on psychosocial, lifestyle, and health factors. The odds ratios of reporting migraine, non-migrainous headache, and neck or shoulder pain were estimated by logistic regression for several background factors.

SETTING

A population-based study conducted in the municipality of Tromsø, northern Norway.

PARTICIPANTS

In a survey of risk factors for diseases in 1987/86, all the subjects between 20 and 56 years of age in the municipality of Tromsø were invited. The attenders were given a questionnaire about lifestyle, health, and psychosocial factors. Of the 18105 people who were given a questionnaire, 8537 men and 9162 women (97.7%) answered the questions about "non-migrainous headache", 8533 men and 9117 women (97.5%) answered the questions about neck or shoulder pain, and 8024 men and 7690 women (86.8%) the questions about migraine.

MAIN RESULTS

"Self estimated health" had the strongest association with all three target conditions although the strength of the association between headache and neck or shoulder pain was far higher than that of migraine. The reporting of headache and neck or shoulder pain was associated with psychosocial factors, in contrast to migraine. The less educated women were prone to both headache and neck or shoulder pain, while there was no association between migraine and length of education. The explored lifestyle factors were not associated with any of the target conditions.

CONCLUSIONS

Our findings underscore that migraine is reported by people with psychosocial backgrounds other than those of people who report chronic headache and neck or shoulder pain.

Gender variations in clinical pain experience

This review is a critical summary of research examining gender variations in clinical pain experience. Gender-comparative pain research was identified through Medline and Psychlit searches and references obtained from bibliographies of pertinent papers and books. Review of this research demonstrates that women are more likely than men to experience a variety of recurrent pains. In addition, many women have moderate or severe pains from menstruation, pregnancy and childbirth. In most studies, women report more severe levels of pain, more frequent pain and pain of longer duration than do men. Women may be at greater risk for pain-related disability than men but women also respond more aggressively to pain through health related activities. Women may be more vulnerable than men to unwarranted psychogenic attributions by health care providers for pain. Underlying biological mechanisms of pain and the contribution of psychological and social factors as they contribute to the meaning of pain for women and men warrant greater attention in pain research.

[The clinical picture of the chronic pain patient-Analysis of a pain outpatient clinic using headache as an example.]

INTRODUCTION

Patients with chronic headache are seen in an interdisciplinary pain clinic after many years of treatment. Compared with other pain syndromes, the standards for diagnosis and treatment are widely accepted according to the guidelines of the International Headache Society. Nevertheless, many patients continue to suffer. Analysis of their special clinical features may help to clarify what kind of conditions potentially cause chronicity.

PATIENTS AND METHODS

A total of 193 patients were seen in 1992-1993 in our pain clinic. Epidemiological, medical and psychological data were analyzed retrospectively. Classification of headache syndromes and pain behavior was based on the criteria of the International Headache Society, taxonomy of the Multiaxial Pain Classification System for Somatic Dimensions (MASK-S) and "Stages of Chronicity". Important psychodynamic factors were taken from standardized psychological interviews.

RESULTS

The patients had a mean age of 46 years; 67 % of them were female. Fifty-three percent of the patients suffered from chronic tension headache; a high percentage was suspected to be caused by analgesic intake. Because of their pain behavior, 68 % were classified as being in an advanced chronic stage with a poor prognosis. The most important findings of the psychological diagnosis was that 40 % of patients had a depressive style of conflict solving.

CONCLUSIONS

The results are discussed with respect to their relevance in explaining development of chronic pain, as seen in selected headache patients in an interdisciplinary pain clinic.

Population variation in migraine prevalence: a meta-analysis

A meta-analysis of published studies was conducted to identify factors which explained variation in estimates of migraine prevalence. Twenty-four population based studies contributed a total of 168 gender and age specific estimates of migraine prevalence. In linear regression analysis, 70.6% of the variation in these prevalence estimates was explained by gender, age (AGE+AGE2), a binary variable for case definition, and an interaction term between age and the case definition. Initially, we identified five groups of case definitions among the 24 studies. Only the definition of Waters (any 2 of warning, nausea, or unilateral pain) was associated with statistically significant differences in prevalence estimates among studies; accordingly the other 4 groups were combined. Several other factors were examined as predictors of migraine prevalence including the method of selecting the study population, the source of the population, the response rate and whether diagnoses were confirmed by a clinical assessment. None of these factors substantially increased explained variance. We conclude that after taking sociodemographic factors and case definition into account, estimates of migraine prevalence are remarkably stable among studies.

Epidemiology of migraine

The introduction of operational diagnostic criteria for the primary headaches in 1988 has provided new opportunities for comprehensive epidemiologic headache research. In recent years, several studies on the epidemiology of migraine have emerged. This review deals with methodologic considerations and provides a snapshot of the main findings in these studies. The importance of epidemiologic studies in clarifying the natural history of migraine is elucidated.

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

This study presents the first account of the prevalence of headache syndromes, defined according to the International Headache Society criteria, in a large representative sample of the German population; 5000 persons representative of the total population were selected from 30,000 households. Subjects were requested to answer a questionnaire about headache occurrence during their lifetime. The completion rate was 81.2%. Seventy-one point four percent (n = 2902) reported a history of headache. Twenty-seven point five percent fulfilled the criteria for migraine. Thirty-eight point three percent (n = 1557) met the criteria for tension-type headache and 5.6% (n = 229) did not fulfil criteria for either migraine or tension-type headache. Significant correlations were found between the prevalence of the different headache syndromes and sociodemographic variables such as sex, age and place of residence. The prevalence of headache did not exhibit any significant differences between the various länder (states or regions) of Germany. When extrapolated to the total population these results reveal that 54 million people in Germany suffer from headache at least occasionally or persistently. These findings suggest that the magnitude of the neurological disorders, migraine and tension-type headache, is seriously underestimated and thus constitutes a major contemporary health problem.