Increased headache prevalence in female adolescents and adult women with early menarche. The Head‐HUNT Studies

Background: Age at menarche is associated with cardiovascular events and lifestyle factors such as body mass index (BMI), certain women’s diseases like breast cancer and endometriosis and with occurrence of certain physical symptoms during puberty. It is unclear whether age at menarche is an independent determinant of headache. Objectives: The aim of the study was to explore age of menarche in relation to headache prevalence in a large population‐based study of both adolescents and adult women (HUNT). Methods: In the Nord‐Trøndelag Health Study in Norway 1995–97 (HUNT 2), a total of 26 636 (57%) of 46 506 invited women responded to questions regarding menarche and headache (Head‐HUNT). In the youth part of HUNT 2, 3196 female students were interviewed about their headache complaints and 2766 (87%) responded to questions regarding menarche. All the final analyses were adjusted for age, use of oral contraceptives and BMI, and for adults also for educational level. Results: Headache was more prevalent amongst females with menarche ≤ 12 years, both amongst adolescents (OR = 1.3, 95% CI = 1.1–1.5) and adults (OR = 1.1, 95% CI = 1.1–1.2), evident for migraine and non‐migrainous headache. Conclusion: Headache, both migraine and non‐migrainous headache, was more prevalent amongst both adolescents and adult females with early menarche. Early menarche may increase headache susceptibility, or be a consequence of a common pathogenetic factor, e.g., sensitivity to estrogens.     

The co-occurrence of headache and musculoskeletal symptoms amongst 51 050 adults in Norway

We have evaluated the association between headache and musculoskeletal symptoms in a large cross‐sectional population‐based study. Between 1995 and 1997, all 92 566 adults in Nord‐Trøndelag County in Norway were invited to participate in a health survey. A total of 51 050 (55%) responded to questions concerning headache and musculoskeletal symptoms. Both migraine and non‐migrainous headache were strongly associated with musculoskeletal symptoms. However, frequency of headache had a higher impact than headache diagnosis on this association. Thus, the prevalence of chronic headache (headache >14 days/month) was more than four times higher (OR = 4.6; 95% CI 4.0–5.3) in the group of individuals with musculoskeletal symptoms than in those without. Individuals with neck pain were more likely to suffer from headache as compared with those with musculoskeletal symptoms in other restricted areas. In conclusion, there was a strong association between chronic headache and musculoskeletal symptoms, which may have implications for the choice of treatment.     

Headache,migraine and cardiovascular risk factors: The HUNT study

Background: Migraine with aura (MA) has been found to be a risk factor for cardiovascular disease including ischaemic stroke and myocardial infarction. Studies have also reported a higher prevalence of unfavourable cardiovascular risk factors amongst migraineurs, but results have been conflicting as to whether this is restricted to MA or also holds true for migraine without aura (MO). This study aims to examine the relation between headache and cardiovascular risk factors in a large cross‐sectional population‐based study. Methods: A total of 48 713 subjects (age ≥20 years) completed a headache questionnaire and were classified according to the headache status in the Nord‐Trøndelag Health Study in Norway 1995–1997 (HUNT 2). Framingham 10‐year risk for myocardial infarction and coronary death could be calculated for 44 098 (90.5%) of these. Parameters measured were blood pressure, body mass index, serum total and high‐density lipoprotein cholesterol. Results: Compared to controls, Framingham risk score was elevated in non‐migraine headache sufferers (OR 1.17, 95% CI 1.10–1.26), migraineurs without aura (OR 1.17, 95% CI 1.04–1.32) and most pronounced amongst migraineurs with aura (OR 1.54, 95% CI 1.21–1.95). Framingham risk score consistently increased with headache frequency. For non‐migrainous headache and MO, the increased risk was accounted for by the lifestyle factors smoking, high BMI and low physical activity, whilst such factors did not explain the elevated risk associated with MA. Conclusions: Both MA, MO and non‐migrainous headache are associated with an unfavourable cardiovascular risk profile, but different mechanisms seem to underlie the elevated risk in MA than in the other headache types.     

Low headache prevalence amongst women with high TSH values

The aim of this large cross‐sectional population‐based study was to examine a possible positive or negative association between thyroid dysfunction and headache. Between 1995 and 1997, all 92 566 adults in Nord‐Trøndelag County in Norway were invited to participate in a health survey. A total of 51 383 (56%) responded to a headache questionnaire, whereof thyroid‐stimulating hormone (TSH) was measured in 28 058 individuals. These included 15 465 women and 8019 men above 40 years of age, 1767 randomly selected individuals between 20 and 40 years of age, and 2807 (97%) with thyroid dysfunction. Associations between thyroid dysfunction and headache were assessed in multivariate analyses, estimating prevalence odds ratios (OR) with 95% confidence intervals (CIs). High TSH values were associated with low prevalence of headache. This was most evident amongst women with no history of thyroid dysfunction. Amongst these, headache was less probable (OR=0.5, 95% CI 0.3–0.7) if TSH ≥ 10 mU/l than in women with normal TSH (0.2–4 mU/l). In all age groups between 40 and 80 years, TSH was lower amongst headache sufferers, especially migraineurs, than in those without headache complaints.     

Depression in relation to age and gender in the general population: the Nord-Trøndelag Health Study (HUNT)

Objective: Previous sample studies of depression have shown a higher prevalence of depression in women, and an inconsistent relation to age has been found for both genders. The aim of the present study was to investigate depression in relation to gender and age in the general adult population. Method: Of the total population of 92 100 individuals aged 20–89 years and living in Nord‐Trøndelag county of Norway, 62 344 (67.7%) filled in valid ratings of depression on the Hospital Anxiety and Depression Scale (HADS). Results: Minimal gender difference was found in dimensional depression scores and in prevalence rates of depression. Both these measures were found to increase continuously with age in both genders. Conclusion: Our results of this population‐based study differ from most sample studies reported, and these discrepancies are discussed with focus on study design, self‐rating, and the concept of depression covered by HADS.     

No increase in headache after previous intracranial infections: a historical cohort study (HUNT)

Background and purpose: Despite the absence of robust scientific evidence, it is today generally accepted that the acute headache typical for intracranial infections can develop into permanent headache complaints. This widespread concept was explored in the first, large, longitudinal, population‐based study. Methods: Data on confirmed exposure to intracranial infections amongst all adult inhabitants in a geographical area during a 20‐year period were assembled from hospital records. Surviving individuals were later invited to the third Nord‐Trøndelag Health Survey (HUNT 3), where 39 690 (42%) of 94 194 invited inhabitants aged ≥20 years responded to a validated headache questionnaire. Using logistic regression, the 1‐year prevalence of headache and its subtypes according to the diagnostic criteria of the International Headache Society was assessed and compared between those with and without previous confirmed intracranial infection. Age and sex were used as covariates. Results: Overall, 43 participants were identified with earlier intracranial infection, whereof three had more than one infection: bacterial meningitis (n = 19), lymphocytic meningitis (n = 18), encephalitis (n = 9), and brain abscess (n = 1).The mean interval from infection to participation in HUNT 3 was 11.2 (range 1.5–19.7) years. There was no significant increase in the prevalence of headache (OR 1.10, 95% CI 0.58–2.07), its subtypes (migraine, or tension‐type headache), or chronic daily headache (OR 1.85, 95% CI 0.45–7.68) amongst participants with previous intracranial infection compared with the surrounding population. Conclusions: This study challenges the existence of chronic post‐bacterial meningitis headache and does not indicate the presence of other long‐term headaches induced by intracranial infection.     

No association of depression and anxiety with the metabolic syndrome: the Norwegian HUNT study

Objective: To examine the associations of depression and anxiety with the metabolic syndrome. Method: Cross‐sectional study of 9571 participants aged 20–89 years in the Nord‐Trøndelag Health Study (HUNT 2). We assessed anxiety and depression with the Hospital Anxiety and Depression Scale and the metabolic syndrome with the International Diabetes Federation criteria. Results: Despite generous statistical power and use of both continuous and categorical approaches, we found no association between anxiety or depression and the metabolic syndrome in models adjusted for age, gender, educational level, smoking, physical activity and pulse rate. When adjusted for age and gender only, we found a weak positive association for depression when a continuous measure was used, but not at the case level. The findings were similar across sexes, and robust for exclusion of cardiovascular disease and antidepressants. Conclusion: In this largest study to date we found no association of anxiety and depression with the metabolic syndrome.     

Outcomes in adulthood for children with foetal growth retardation. A linkage study from the Nord-Trøndelag Health Study (HUNT) and the Medical Birth Registry of Norway

Objective: The aims were to examine the long‐term functional outcome and risk of mood disorders in adulthood in individuals with foetal growth retardation. Method: In a prospective cohort study of 7806 individuals aged 20–30 years, using linked data from the Health Survey of Nord‐Trøndelag (HUNT‐2) and the Medical Birth Registry of Norway, we studied the long‐term effects of being born with a birth weight below the 10th percentile for gestational age (SGA). Results: SGA individuals had lower educational level (OR: 1.33), lower socioeconomic functioning level (OR: 1.77) and more frequent reported mood disorder in adulthood (OR: 1.26). Analyses of a substratum of infants born at term showed almost identical results. Conclusion: Foetal growth retardation measured as SGA shows a moderate risk for lower education and socioeconomic level and for anxiety and/or depression in young adulthood. Issues concerning interventions for children at risk should be considered.     

The prevalence of nausea in the community: psychological, social and somatic factors

Nausea is a commonly reported symptom with a point prevalence of about 12% in the community. Nausea is a prominent symptom in functional gastrointestinal disorders and patients with anxiety and depression frequently present gastrointestinal symptoms such as nausea and abdominal discomfort as their main problem when they consult a doctor. Functional gastrointestinal disorders are strongly related to anxiety and depressive disorders with a lifetime prevalence of 80--90% in samples from clinics of gastroenterology. This study examines the relationship between anxiety disorders, depressions and nausea in a large community sample. A questionnaire on physical and mental health and demographic and life-style factors was sent to all adults 20 years and above in Nord Tr?ndelag county in Norway. A total of 94,197 questionnaires were sent, with 62,651 persons returning the questionnaire, a response rate of 66.5%. The presence of nausea, heartburn, diarrhea and constipation during the last year was recorded. Anxiety disorders and depressions were based on self-rating of the Hospital Anxiety and Depression Scale (HADS). Forty-eight per cent reported one or several gastrointestinal complaints during the last year. 12.5% complained of nausea. 15.3% had an anxiety disorder and 10.4% a depression based on HADS ratings. Presence of anxiety disorders carried the highest risk for nausea (OR 3.42). Presence of depression also increased the risk, but less than anxiety disorders (OR 1.47). Demographic factors, life-style factors and extra-gastrointestinal conditions did not reduce the OR of anxiety disorders and depressions to any significant extent. We found that the presence of anxiety disorders was the strongest risk factor for nausea. Depression also carried a certain risk while demographic factors, life-style factors and other somatic conditions did not carry any substantial risk for nausea. Differential diagnoses of nausea should therefore include both anxiety and depressive conditions.     

Multiple sclerosis in Nord-Trøndelag County, Norway: a prevalence and incidence study

Objective – To calculate the prevalence and incidence of multiple sclerosis (MS) in Nord‐Trøndelag County, Norway. Material and methods – The study comprised everyone diagnosed with MS according to the Poser criteria. On 1 January 2000 a total of 208 were identified: 130 women (62.5%) and 78 men (37.5%). We calculated the crude and age‐adjusted annual incidence rates from 1974 to 1999. Results – The prevalence on 1 January 2000 was 163.6 of 100,000, 204.8 of 100,000 for women and 122.6 of 100,000 for men. The age‐adjusted annual incidence increased from 3.9 to 5.6 per 100,000 from 1974 to 1999; women from 4.6 to 6.3 and men from 2.2 to 4.4. After 1984, the incidence among women increased most, peaking at 10.2 per 100,000 in 1984–88. Conclusions – MS incidence is increasing in Nord‐Trøndelag County. The prevalence is among the highest ever in Norway.     

Screening for anxiety and depression in dialysis patients: comparison of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory

ObjectiveAlthough anxiety and depression are frequent comorbid disorders in dialysis patients, they remain underrecognized and often untreated. The aim of the study was to evaluate the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory (BDI) and a truncated version of the BDI, the Cognitive Depression Index (CDI), as screening tools for anxiety and depression in dialysis patients.MethodsA total of 109 participants (69.7% males), from four dialysis centers, completed the self-report symptom scales HADS and BDI. Depression and anxiety disorders were diagnosed with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive value, overall agreement, kappa and receiver operating characteristic (ROC) curves were assessed.ResultsDepressive disorders were found in 22% of the patients based on the SCID-I, while anxiety disorders occurred in 17%. The optimal screening cut-off score for depression was ≥7 for the HADS depression subscale (HADS-D), ≥14 for the HADS-total, ≥11 for the CDI and ≥17 for the BDI. The optimal screening cut-off for anxiety was ≥6 for the HADS anxiety subscale (HADS-A) and ≥14 for the HADS-total. At cut-offs commonly used in clinical practice for depression screening (HADS-D: 8; BDI: 16), the BDI performed slightly better than HADS-D.ConclusionThe BDI, CDI and HADS demonstrated acceptable performance as screening tools for depression, as did the HADS-A for anxiety, in our sample of dialysis patients. The recommended cut-off scores for each instrument were: ≥17 for BDI, ≥11 for CDI, ≥7 for HADS depression subscale, ≥6 for HADS anxiety subscale and ≥14 for HADS total. The CDI did not perform better than the BDI in our study. Lower cut-off for the HADS-A than recommended in medically ill patients may be considered when screening for anxiety in dialysis patients.     

Prevalence and effects of depressive and anxiety symptoms in internal medicine inpatients during the first year after hospital discharge

In a prospective follow-up study the German version of the Hospital Anxiety and Depression Scale (HADS) was used to determine the prevalence of anxiety and depressive symptoms in internal medicine inpatients. From a total cohort of 376 admitted study patients questionnaires were completed at admission and after one year follow-up. The data demonstrated that the mean HADS score on the anxiety subscale decreased significantly from 6.7 3.5 at study inclusion to 5.8 3.8 after one year (p < 0.0005) while the mean HADS score on the depression subscale was relatively stable (5.3 3.6 versus 5.4 4.3, p = n.s.). Odds ratios for the prediction of positive HADS results at follow-up were 4.1 (95%-CI 2.0-8.4) for anxiety symptoms and 8.2 (95%-CI 4.6-14.6) for depressive symptoms. Patients with abnormal HADS anxiety scores were significantly more frequently rehospitalized (Odds ratio 1.9; p = 0.028) and also more frequently reported pain symptoms (Odds ratio 2.0; p = 0.019). These results demonstrate the persistence of depressive symptoms and the frequent utilization of health care in internal medicine inpatients with psychiatric disorders in the first year after hospital discharge.     

Prevalence and associated factors of DSM-V insomnia in Norway: the Nord-Trøndelag Health Study (HUNT 3)

BackgroundMany studies have assessed the prevalence of insomnia, but the influence of non-participants has largely been ignored. The objective of the present study was to estimate the prevalence and associated factors of insomnia in a large adult population using DSM-V (diagnostic and statistical manual of mental disorders, 5th ed.) criteria, also taking non-participants into account.MethodsThis cross-sectional study used data from a questionnaire in The Nord-Trøndelag Health Study (HUNT 3) performed in 2006–2008, and a subsequent non-participant study. The total adult population (n = 93,860 aged ⩾20 years) of Nord-Trøndelag County, Norway, was invited. Of these, 40,535 responded to the insomnia questionnaire. Among 42,024 eligible non-participants, 6918 (17%) responded to two insomnia questions.ResultsInsomnia was diagnosed by applying modified DSM-V criteria. The age-adjusted insomnia prevalence was estimated using the age distribution of all adult inhabitants of Nord-Trøndelag. Supplementary prevalence data were estimated by extrapolating data from the non-participant study. Additionally, the association between insomnia and self-reported health was estimated, adjusting for known confounders. The total age-adjusted prevalence of insomnia was 7.1% (95% confidence interval [CI], 6.9–7.4) (8.6% for women, 5.5% for men). Adjusting for non-participants, the prevalence estimate changed to 7.9% (95% CI, 7.3–8.6) (9.4% for women, 6.4% for men). Insomnia was more than eight times more likely (OR, 8.3; 95% CI, 6.2–11.1) among individuals with very poor versus very good self-reported health, adjusting for age, gender, employment status, chronic musculoskeletal complaints, anxiety and depression.ConclusionsThe adjusted insomnia prevalence estimate in Nord-Trøndelag was 7.9%. Insomnia was strongly associated with poor self-reported health.     

Prevalence of headache and migraine in children and adolescents: a systematic review of population‐based studies

Aim The aim of this study was to review systematically the prevalence of headache and migraine in children and adolescents and to study the influence of sex, age, and region of residence on the epidemiology. Method We systematically searched the literature in electronic databases to cover the period between 1 January 1990 and 31 December 2007. We assessed and included population‐based studies on epidemiology of headache and migraine in children and adolescents if they fulfilled the following criteria: (1) reporting on unselected childhood population; (2) reliable methods of data collection using a questionnaire or face‐to‐face interviews; (3) using the International Headache Society’s (IHS) criteria (1988 or 2004) for the diagnosis of migraine; and (4) provision of sufficient and explicit data for analysis. We used Excel, Stata, and Confidence Interval Analysis software. Results We identified and analysed 50 population‐based studies reporting the prevalence of headache and/or migraine in children and adolescents (<20y). The estimated prevalence of headache over periods between 1 month and lifetime in children and adolescents is 58.4% (95% confidence interval [CI] 58.1–58.8). Females are more likely to have headache than males (odds ratio [OR] 1.53, 95% CI 1.48–1.6). The prevalence of migraine over periods between 6 months and lifetime is 7.7% (95% CI 7.6–7.8). Females are more likely than males to have migraine (OR 1.67, 95% CI 1.60–1.75). Regional differences in prevalence of migraine, though statistically significant, may not be of clinical significance. The change in the IHS’s criteria for the diagnosis of migraine was not associated with any significant change in the prevalence of migraine. Interpretation This study confirms the global high prevalence of headache and migraine in children and adolescents. Sex, age, and regional differences are evident.     

The association between age and depression in the general population: a multivariate examination

Objective: In a large general population study we found a close to linear rise with age in the mean score and prevalence of self‐reported symptoms of depression. The aim of this study was to examine if this linear relation prevailed when controlled for multiple variables and to examine factors that eventually explained the association. Method: Among individuals aged 20–89 years living in Nord‐Trøndelag County of Norway, 60 869 filled in valid ratings of the Hospital Anxiety and Depression Scale as well as many other variables. Covariates were grouped into a multivariate model with six blocks. Logistic regression was used to model the blocks and variables with caseness of depression as the dependent variable. Results: The model explains a considerable part of the age‐related pattern on depression. The pattern became less distinct in the age groups above 50 years. Variables within the blocks of somatic diagnoses and symptoms, as well as impairment, had most explanatory power. Conclusion: Because of our large sample we were able to control for more relevant variables than earlier studies. In contrast to most other studies, we found that an age‐related increase of the prevalence of depression persisted after control for multiple variables.     

Positive correlation between anxiety severity and plasma levels of dehydroepiandrosterone sulfate in medication-free patients experiencing a major episode of depression

Although numerous studies have identified a correlation between dehydroepiandrosterone sulfate (DHEAS) levels and anxiety or depression, those findings remain controversial. The purpose of the present study was to determine whether a correlation exists between depression severity and anxiety severity and serum DHEAS concentrations in medication-free patients experiencing a major depressive episode. Twenty-eight medication-free major depressive outpatients (Hamilton Rating Scale for Depression 17 [HAM-D 17] score >or=17) were enrolled consecutively. Plasma DHEAS levels of all subjects were measured. Blood from subjects was drawn at 0900-1100 h Depression severity was assessed with the HAM-D 17 and the Hospital Anxiety and Depression Scale (HADS) depression subscale. Anxiety was assessed using the HADS anxiety subscale. Serum concentrations of DHEAS were measured immediately following the HAM-D 17 and HADS assessments. A significant, positive correlation was identified between HADS anxiety subscale total score and morning serum DHEAS concentration (P = 0.013) after controlling for age, gender and body mass index (BMI). No statistically significant correlations were found between depression ratings and morning serum DHEAS concentrations. This preliminary study provides pilot data indicating that morning serum DHEAS concentrations were positively correlated with HADS anxiety subscale score (anxiety severity) after controlling for age, gender and BMI in medication-free outpatients experiencing a major depressive episode. It is not known if morning serum DHEAS levels would show similar or dissimilar changes in non-depressed subjects. The present result needs subsequent replication.