Lifetime prevalence and characteristics of recurrent primary headaches in a population-based sample of Swedish twins

OBJECTIVE: To examine the lifetime prevalence and other characteristics of recurrent primary headaches in twins. BACKGROUND: The twin model may provide insights into the role of genetic and environmental influences in headache disorders. However, assumptions as to whether twins are representative of the general population, and whether monozygotic and dizygotic twins are similar have rarely been addressed. METHODS: The study population consisted of a random sample of 17- to 82-year-old twins from the Swedish Twin Registry (n = 1329). Structured interviews on the telephone by lay personnel and the International Headache Society criteria were used for assessment and diagnosis of recurrent primary headaches. Prevalence data of the general population for migraine and tension-type headache was obtained from various published reports. RESULTS: A total of 372 subjects (29%) had ever had recurrent headaches. In total, 241 recurrent headache sufferers fulfilled the criteria for migraine or tension-type headache, and the lifetime prevalence was 7.1% for migraine without aura, 1.4% for migraine always with aura, 1.9% for migraine occasionally with aura, 9.4% for episodic tension-type headache, and 1.3% for chronic tension-type headache. The lifetime prevalence of all migraine and all tension-type headache, including another 84 subjects fulfilling all but one of the criteria for migraine or tension-type headache, was 13.8% and 13.5%, respectively. The corresponding prevalence risk for women was 2.4 (95% confidence interval [CI] 1.7, 3.4) and 1.5 (95% CI 1.1, 2.1), respectively. Zygosity was not a significant predictor for migraine. In tension-type headache, the prevalence risk for dizygotic twins and unlike-sexed twins as compared with monozygotic twins was 1.9 (95% CI: 1.2, 3.1) and 1.8 (95% CI: 1.1, 2.9), respectively. CONCLUSION: There is no twin-singleton or monozygotic-dizygotic difference for the risk of migraine. In tension-type headache, twins seem to have a lower risk than singletons, and this is especially true for monozygotic twins.     

Childhood Maltreatment and Migraine (Part II). Emotional Abuse as a Risk Factor for Headache Chronification

(Headache 2010;50:32‐41) Objectives.— To assess in a headache clinic population the relationship of childhood abuse and neglect with migraine characteristics, including type, frequency, disability, allodynia, and age of migraine onset. Background.— Childhood maltreatment is highly prevalent and has been associated with recurrent headache. Maltreatment is associated with many of the same risk factors for migraine chronification, including depression and anxiety, female sex, substance abuse, and obesity. Methods.— Electronic surveys were completed by patients seeking treatment in headache clinics at 11 centers across the United States and Canada. Physician‐determined data for all participants included the primary headache diagnoses based on the International Classification of Headache Disorders‐2 criteria, average monthly headache frequency, whether headaches transformed from episodic to chronic, and if headaches were continuous. Analysis includes all persons with migraine with aura, and migraine without aura. Questionnaire collected information on demographics, social history, age at onset of headaches, migraine‐associated allodynic symptoms, headache‐related disability (The Headache Impact Test‐6), current depression (The Patient Health Questionnaire‐9), and current anxiety (The Beck Anxiety Inventory). History and severity of childhood (<18 years) abuse (sexual, emotional, and physical) and neglect (emotional and physical) was gathered using the Childhood Trauma Questionnaire. Results.— A total of 1348 migraineurs (88% women) were included (mean age 41 years). Diagnosis of migraine with aura was recorded in 40% and chronic headache (≥15 days/month) was reported by 34%. Transformation from episodic to chronic was reported by 26%. Prevalence of current depression was 28% and anxiety was 56%. Childhood maltreatment was reported as follows: physical abuse 21%, sexual abuse 25%, emotional abuse 38%, physical neglect 22%, and emotional neglect 38%. In univariate analyses, physical abuse and emotional abuse and neglect were significantly associated with chronic migraine and transformed migraine. Emotional abuse was also associated with continuous daily headache, severe headache‐related disability, and migraine‐associated allodynia. After adjusting for sociodemographic factors and current depression and anxiety, there remained an association between emotional abuse in childhood and both chronic (odds ratio [OR] = 1.77, 95% confidence intervals [CI]: 1.19‐2.62) and transformed migraine (OR = 1.89, 95% CI: 1.25‐2.85). Childhood emotional abuse was also associated with younger median age of headache onset (16 years vs 19 years, P = .0002). Conclusion.— Our findings suggest that physical abuse, emotional abuse, and emotional neglect may be risk factors for development of chronic headache, including transformed migraine. The association of maltreatment and headache frequency appears to be independent of depression and anxiety, which are related to both childhood abuse and chronic daily headache. The finding that emotional abuse was associated with an earlier age of migraine onset may have implications for the role of stress responses in migraine pathophysiology.     

Prevalences of migraine and tension-type headache in adolescent girls of Shiraz (southern Iran)

OBJECTIVE: To determine the prevalences of migraine and tension-type headache in teenaged girls attending schools in Shiraz (southern Iran). BACKGROUND: Studies of headache prevalence are numerous, and findings have varied according to the specific population and region involved. No data are available regarding headache prevalence among Iranian teenagers. METHODS: A random sample of 1868 teenaged girls (aged 11 to 18 years) was evaluated, and 507 subjects reported headache. The headache disorders were classified on the basis of a clinical interview, general physical and neurologic examinations, and the diagnostic criteria of the International Headache Society. Logistic regression was used for data analysis. RESULTS: Overall prevalence rate for migraine was 6.1% (95% CI, 5.0 to 7.2) and for tension-type headache, 12.1% (95% CI, 10.6 to 13.6). Migraine and tension-type headache were significantly associated. CONCLUSIONS: It is concluded that exposition of subjects to sunlight, type of food, and a family history of headache had most significant effects on occurrence of migraine and tension-type headaches.     

Chronic Migraine Prevalence,Disability, and Sociodemographic Factors: Results From the American Migraine Prevalence and Prevention Study

Objectives.— To estimate the prevalence and distribution of chronic migraine (CM) in the US population and compare the age‐ and sex‐specific profiles of headache‐related disability in persons with CM and episodic migraine. Background.— Global estimates of CM prevalence using various definitions typically range from 1.4% to 2.2%, but the influence of sociodemographic factors has not been completely characterized. Methods.— The American Migraine Prevalence and Prevention Study mailed surveys to a sample of 120,000 US households selected to represent the US population. Data on headache frequency, symptoms, sociodemographics, and headache‐related disability (using the Migraine Disability Assessment Scale) were obtained. Modified Silberstein–Lipton criteria were used to classify CM (meeting International Classification of Headache Disorders, second edition, criteria for migraine with a headache frequency of ≥15 days over the preceding 3 months). Results.— Surveys were returned by 162,756 individuals aged ≥12 years; 19,189 individuals (11.79%) met International Classification of Headache Disorders, second edition, criteria for migraine (17.27% of females; 5.72% of males), and 0.91% met criteria for CM (1.29% of females; 0.48% of males). Relative to 12 to 17 year olds, the age‐ and sex‐specific prevalence for CM peaked in the 40s at 1.89% (prevalence ratio 4.57; 95% confidence interval 3.13‐6.67) for females and 0.79% (prevalence ratio 3.35; 95% confidence interval 1.99‐5.63) for males. In univariate and adjusted models, CM prevalence was inversely related to annual household income. Lower income groups had higher rates of CM. Individuals with CM had greater headache‐related disability than those with episodic migraine and were more likely to be in the highest Migraine Disability Assessment Scale grade (37.96% vs 9.50%, respectively). Headache‐related disability was highest among females with CM compared with males. CM represented 7.68% of migraine cases overall, and the proportion generally increased with age. Conclusions.— In the US population, the prevalence of CM was nearly 1%. In adjusted models, CM prevalence was highest among females, in mid‐life, and in households with the lowest annual income. Severe headache‐related disability was more common among persons with CM and most common among females with CM.     

Lifetime prevalence of migraine and other headaches lasting 4 or more hours: the Atherosclerosis Risk in Communities (ARIC) study

OBJECTIVES: To evaluate the lifetime prevalence of migraine and other headaches lasting 4 or more hours in a population-based study of older adults. BACKGROUND: Migraine and other headaches not fulfilling migraine criteria are common afflictions. Yet the health and social effects of these conditions have not been fully appreciated, particularly among older adults. METHODS: The study included 12 750 participants in the Atherosclerosis Risk in Communities (ARIC) Study from 4 US communities. Prevalence estimates of a lifetime history of migraine and other headaches lasting 4 or more hours were obtained for race and gender groups. A cross-sectional analysis was done to assess the relationship between headache type, by aura status, and various sociodemographic and health-related indices. RESULTS: Compared to education beyond high school, having completed less than 12 years of education was significantly associated with an increased occurrence of migraine with aura (prevalence odds ratio [POR], 1.47; 95% confidence interval [CI], 1.08 to 2.01). Family income less than $16 000, compared to family income of $75 000 or greater, was significantly associated with migraine with aura (POR, 1.68; 95% CI, 1.07 to 2.64), migraine without aura (POR, 1.56; 95% CI, 1.14 to 2.14), and other headaches with aura (POR, 1.89; 95% CI, 1.14 to 3.13). The prevalence odds ratio was higher in each headache category, particularly for those with an aura, for those with hypertension versus normotension and for those who perceived their general health as poor compared to those whose perception was excellent. CONCLUSIONS: A lifetime history of migraine with aura and other headaches with aura was more common among whites, women, and younger participants. Further investigation of headaches lasting 4 or more hours, particularly by aura status, is warranted.     

One-year prevalence and the impact of migraine and tension-type headache in Turkey: a nationwide home-based study in adults

Several studies have shown that the prevalence of migraine and tension-type headache (TTH) varied between different geographical regions. Therefore, there is a need of a nationwide prevalence study for headache in our country, located between Asia and Europe. This nationwide study was designed to estimate the 1-year prevalence of migraine and TTH and analyse the clinical features, the impact as well as the demographic and socio-economic characteristics of the participant households in Turkey. We planned to investigate 6,000 representative households in 21 cities of Turkey; and a total of 5,323 households (response rate of 89%) aged between 18 and 65 years were examined for headache by 33 trained physicians at home on the basis of the diagnostic criteria of the second edition of the International Classification of Headache Disorders (ICHD-II). The electronically registered questionnaire was based on the headache features, the associated symptoms, demographic and socio-economic situation and history. Of 5,323 participants (48.8% women; mean age 35.9 ± 12 years) 44.6% reported recurrent headaches during the last 1 year and 871 were diagnosed with migraine at a prevalence rate of 16.4% (8.5% in men and 24.6% in women), whereas only 270 were diagnosed with TTH at a prevalence rate of 5.1% (5.7% in men and 4.5% in women). The 1-year prevalence of probable migraine was 12.4% and probable TTH was 9.5% additionally. The rate of migraine with aura among migraineurs was 21.5%. The prevalence of migraine was highest among 35–40-year-old women while there were no differences in age groups among men and in TTH overall. More than 2/3 of migraineurs had ever consulted a physician whereas only 1/3 of patients with TTH had ever consulted a physician. For women, the migraine prevalence was higher among the ones with a lower income, while among men, it did not show any change by income. Migraine prevalence was lower in those with a lower educational status compared to those with a high educational status. Chronic daily headache was present in 3.3% and the prevalence of medication overuse headache was 2.1% in our population. There was an important impact of migraine with a monthly frequency of 5.9 ± 6, and an attack duration of 35.1 ± 72 h, but only 4.9% were on prophylactic treatment. The one-year prevalence of migraine estimated as 16.4% was similar or even higher than world-wide reported migraine prevalence figures and identical to a previous nation-wide study conducted in 1998, whereas the TTH prevalence was much lower using the same methodology with the ICHD-II criteria.     

Retracted: Prevalence and Burden of Headache Disorders: A Comparative Regional Study in China

Background.— Since the early 1990s, no study has been undertaken examining the prevalence and burden of headache disorders in China. Objective.— We conducted a one‐year survey on the prevalence and burden of primary headache in the Chinese provinces of Guangdong and Guangxi. Our study also evaluated the factors behind similarities and differences affecting prevalence in the 2 regions of study. Methods.— Random samples of 372 local residents in Guangdong and 182 local residents in Guangxi aged 18‐65 years were invited to a face‐to‐face interview. Results.— The one‐year prevalence of primary headache was 22.6% (84/372) in Guangdong and 41.2% (75/182) in Guangxi. The prevalence of migraine (14.3%, n = 26) in Guangxi was higher than prevalence of migraine (8.3%, n = 31) in Guangdong (P = .03). The ratio of headache cost and household income was 2.1% in Guangdong and 3.7% in Guangxi, the ratio in Guangdong was less than that in Guangxi (P = .001). The diagnostic confirmation rate of migraine was low. No migraineur used triptans drugs to treat migraine in either region. Conclusion.— Migraine prevalence was higher in the lower‐income region that also contains a higher proportion of ethnic minorities. Although there was no difference of headache cost between the 2 regions, the headache populations in the lower‐income region would relatively suffer a greater financial burden if taking the economic differences between the 2 regions into account. The improvement of diagnostic and therapeutic levels for the treatment of headache, especially migraine, in the 2 regions may be a matter of urgency.     

Factors associated with triptan use in episodic migraine: results from the American Migraine Prevalence and Prevention Study

Background.— Though triptans are considered the standard of acute therapy for migraine attacks with headache‐related disability, they are used by the minority of potentially eligible persons. Understanding the socio‐demographic and headache features that predict triptan use may help to clarify barriers to optimal treatment. Objective.— To assess the sociodemographic and headache features associated with triptan use in a US population sample of persons with episodic migraine. Methods.— The American Migraine Prevalence and Prevention Study (AMPP) is a longitudinal study conducted in a representative sample of US headache sufferers. Episodic migraineurs (n = 11,388) who provided treatment data in 2005 were included in the current analyses. We assessed factors associated with triptan use through univariate and multivariate analyses. Multivariate analyses were adjusted for sociodemographic factors, headache‐related disability, cutaneous allodynia, depression, and preventive headache medication use. Results.— Among persons with episodic migraine, 18.31% reported current use of triptans for acute headache treatment. In univariate analyses, triptan use was most common in midlife (ages 30‐59), among females, and was more common in Caucasians than in African Americans. Triptan use increased with headache frequency, headache‐related disability and allodynia, but decreased among persons with depression. In multivariate analyses, female gender, Caucasian race, age 40‐49, higher levels of education (college or higher), annual household income of ≥$40,000, having health insurance, the presence of cutaneous allodynia, greater headache‐related disability, and preventive medication use for migraine were significantly associated with triptan use. Conclusions.— Less than 1 in 5 persons with migraine in the United States who were respondents to this survey used triptans for acute headache treatment over the course of a year. Several markers of severe headache, including disability and allodynia, were associated with increased triptan use. Groups less likely to get triptans included males, African Americans, older adults, and the uninsured. Predictors of use provide insight into groups with unmet treatment needs.     

The prevalence and burden of primary headaches in China: a population-based door-to-door survey

Objectives.— In the absence of reliable data on the prevalence and burden of primary headache disorders in the mainland of China, a population‐based survey was initiated by Lifting The Burden: the Global Campaign against Headache. Methods.— Throughout all regions of China, 5041 non‐related adult respondents aged 18‐65 years were randomly sampled from the general population according to the expanded programme on immunization method established by World Health Organization. They were visited by door‐to‐door calling and surveyed using the structured questionnaire developed by Lifting The Burden, translated into Chinese and adapted to Chinese culture after a pilot study. Results.— The responder rate was 94.1%. The estimated 1‐year prevalence of primary headache disorders was 23.8% (95% confidence interval 22.6‐25.0%), of migraine 9.3% (95% confidence interval 8.5‐10.1%), of tension‐type headache (TTH) 10.8% (9.9‐11.6%), and of chronic daily headache (CDH) 1.0% (0.7‐1.2%). Of respondents with migraine, TTH, and CDH, moderate or severe impact and therefore high need for effective medical care were reported by 38.0%, 23.1%, and 47.9%, respectively. The World Health Organization quality of life‐8 questionnaire showed that all 3 types of headache reduced life quality. The total estimated annual cost of primary headache disorders, including migraine, TTH, and CDH was CNY 672.7 billion, accounting for 2.24% of gross domestic product (GDP) (direct cost: CNY 108.8 billion, 0.36% of GDP; indirect cost: CNY 563.9 billion, 1.88% of GDP). Conclusion.— The prevalence of primary headaches is high in China and not dissimilar from the world average. These headaches cause disability, impair work, study and daily activities, decrease life quality, and bring about a heavy and hitherto unrecognized socioeconomic burden.     

Allergy and Immunotherapy: Are They Related to Migraine Headache?

(Headache 2011;51:8‐20) Introduction.— Several studies have reported that migraine headaches are more common in patients with allergic rhinitis and that immunotherapy decreases the frequency of headache in atopic headache sufferers. Objective.— To determine if the degree of allergic sensitization and the administration of immunotherapy are associated with the prevalence, frequency, and disability of migraine headache in patients with allergic rhinitis. Methods.— Consecutive patients between the ages of 18‐65 presenting to an allergy practice that received a diagnosis of an allergic rhinitis subtype (eg, allergic or mixed rhinitis) were enrolled in this study. All participants underwent allergy testing as well as a structured verbal headache diagnostic interview to ascertain the clinical characteristics of each headache type. Those reporting headaches were later assigned a headache diagnosis by a headache specialist blinded to the rhinitis diagnosis based on 2004 International Classification Headache Disorders‐2 (ICHD‐2) diagnostic criteria. Migraine prevalence was defined as the percentage of patients with a diagnosis of migraine headache (ICHD‐2 diagnoses 1.1‐1.5). Migraine frequency represented the number of days per month with migraine headache self‐reported during the headache interview and migraine disability was the number of days with disability obtained from the Migraine Disability Assessment questionnaire. Generalized linear models were used to analyze the migraine prevalence, frequency, and disability with the degree of allergic sensitization (percentage of positive allergy tests) and administration of immunotherapy as covariates. Patients were categorized into high (> 45% positiveallergy tests) and low (≤45% positive allergy tests) atopic groups based on the number of allergy tests that were positive for the frequency and disability analyses. Results.— A total of 536 patients (60% female, mean age 40.9 years) participated in the study. The prevalence of migraine was not associated with the degree of allergic sensitization, but there was a significant age/immunotherapy interaction (P < .02). Migraine headaches were less prevalent in the immunotherapy group than the nonimmunotherapy at ages <40 years and more prevalent in the immunotherapy group at ages ≥40 years of age. In subjects ≤45 years of age, increasing percentages of allergic sensitization were associated with a decreased frequency and disability of migraine headache in the low atopic group (risk ratios [RRs] of 0.80 [95% CI; 0.65, 0.99] and 0.81[95% CI; 0.68, 0.97]) while increasing percentages were associated with an increased frequency (not disability) in the high atopic group (RR = 1.60; [95% CI; 1.11, 2.29]). In subjects ≤45 years of age, immunotherapy was associated with decreased migraine frequency and disability (RRs of 0.48 [95% CI; 0.28, 0.83] and 0.55 [95% CI; 0.35, 0.87]). In those >45 years of age, there was no effect of degree of allergic sensitization or immunotherapy on the frequency and disability of migraine headache. Conclusions.— Our study suggests that the association of allergy with migraine headaches depends upon age, degree of allergic sensitization, administration of immunotherapy, and the type of headache outcome measure that are studied. Lower “degrees of atopy” are associated with less frequent and disabling migraine headaches in younger subjects while higher degrees were associated with more frequent migraines. The administration of immunotherapy is associated with a decreased prevalence, frequency, and disability of migraine headache in younger subjects.     

Prevalence and clinical characteristics of primary headaches among school children in South Korea: a nationwide survey

Objectives.— To determine the 1‐year prevalence of headache and clinical characteristics of primary headaches among school children in South Korea. Background.— Many population‐based studies have estimated the 1‐year prevalence of headache, migraine, and tension‐type headache (TTH). The results of those studies vary in terms of race and region. There have been few epidemiological population‐based studies of headache in children and adolescents in Korea. Methods.— We conducted a cross‐sectional school‐based study of a randomized and proportional sample of 5360 boys and girls. All 180 sampled schools participated in this study. The questionnaires collected demographic data in addition to specific questions about headache according to the International Classification of Headache Disorder criteria, 2nd Edition. Valid questionnaires were returned by 94.1% of the sample population. Modified criteria changed the “duration” of migraine (>1 hour instead of 4 hours). Results.— The prevalence of headache among school children was 29.1% (1465/5039) in South Korea. The prevalence of headache in girls (33.4%) was significantly higher than in boys (24.4%) (P < .001). The mean age of students with headaches (14.02 ± 3.03) was significantly higher than students without headaches (12.73 ± 3.36) (P < .001). The prevalence of headache according to region was 30.7% among students in urban, 31.2% in suburban, and 21.6% in rural areas. The prevalence of headache according to age was 20.8% among students ～6‐12 years, 32.0% ～13‐15 years, and 38.2% ～16‐18 years. The prevalence according to headache types was 8.7% (boys 7.0%, girls 10.3%) in migraine, 13.7% (boys 10.7%, girls 16.3%) in TTH, and 6.7% in others. The mean frequency, severity of headache, and duration of symptoms were significantly higher in girls than in boys (P < .001). Conclusions.— Recurrent primary headaches are quite prevalent among school‐aged children and adolescents in South Korea, and the prevalence rates are similar to those reported elsewhere. TTH was more common than migraine. The prevalence of migraine headache increased with age. The prevalence rate of headache in students in urban and suburban areas was significantly higher than the rate of students in rural areas.     

The Prevalence of Headache and Its Association With Socioeconomic Status Among Schoolchildren in Istanbul, Turkey

Objective.— The etiology and pathogenesis of migraine and other types of headache are still under discussion. An interaction of organic, psychological, and psychosocial factors is operative. In this study, we aimed to determine the prevalence of headache and its association with socioeconomic status among schoolchildren.
Study Design.— A cross-sectional study was performed on 2669 schoolchildren via a parental questionnaire. Socioeconomic status was determined according to the Turkish socioeconomic status scale.
Results.— The mean age of the students was 8.2 ± 2.4 years. The headache prevalence was 46.2% (95% CI: 44.3-48.1). The prevalence of migraine was 3.4% (95% CI: 2.8-4.1), the prevalence of probable migraine was 8.7% (95% CI: 7.6-9.8), and that of non-migraine headache was 34.1% (95% CI: 32.3-35.9). Multivariate analysis revealed that older age, being a girl, having a family history of headache, and exposure to passive smoking at home were independently associated with headache. There was an inverse association between socioeconomic status and all 3 types of headaches after adjusting for age, sex, family history of headache, and presence of passive smoking. When the group with the lowest socioeconomic status was taken as the reference category, the odds ratios for the highest socioeconomic group were 0.33 (95% CI: 0.16-0.69, P  = .003) for the migraine, 0.30 (95% CI: 0.11-0.89, P  = .029) for the probable migraine, and 0.34 (95% CI: 0.16-0.72, P  = 0.005) for the non-migraine headache.
Conclusion.— Headache is more common among children with lower socioeconomic groups. Social causation can play a role in the pathogenesis of headache.     

An epidemiological study of headache in Florianopolis, Brazil

The aim of this study was to estimate the 1-year prevalence of headache, migraine, tension-type headache (TTH) and chronic daily headache (CDH), and the degree of association of migraine with some sociodemographic characteristics of the population of Florianopolis, Brazil. This is a cross-sectional, door-to-door, population-based study. In 300 randomly selected households, 625 subjects, aged 15-64 years, responded to a structured questionnaire. The 1-year prevalence of headache was 80.8%, of migraine 22.1%, of TTH 22.9%, and of CDH 6.4%. Migraine and CDH were significantly more prevalent in females than in males. Migraine was significantly associated with the following variables: low household income, low electricity consumption, and divorced or widowed marital status. We have shown high prevalences of migraine and CDH in Florianopolis, close to the higher rates of previous studies. There was a preponderance of migraine in females, divorced or widowed, with a low socioeconomic level.     

Socio-economic factors, lifestyle, and headache disorders - a population-based study in Sweden

Objective.— To study the association between socio‐economic factors, lifestyle habits, and self‐reported recurrent headache/migraine (RH/M) in a general population. Methods.— The study population comprised a random sample of men and women aged 18‐79 years. The data were obtained using a postal survey questionnaire during March‐May 2000. The overall response rate was 65%. The area investigated covers 58 municipalities with about one million inhabitants in central part of Sweden. The study is based on 43,770 respondents. Odds ratios for RH/M were calculated for a set of variables using multiple logistic regression models. Results.— The overall prevalence of self‐reported RH/M during the last 3 months was 10% among men and 23% among women and decreased with increasing age. Physically inactive subjects were more likely to suffer from headache disorders than physically active subjects. Smoking was only moderately associated with RH/M. There was an inverse relationship between heavy alcohol use and RH/M. Underweight and obesity were not associated with headache disorders when adjusted for socio‐economic factors. Subjects with frequent economic problems had almost twice the risk of RH/M compared with subjects with no economic problems. Poor social support was associated with headache disorders and subjects who had been belittled during the last 3 months were more than twice as likely to suffer from RH/M as subjects who had not been belittled. The effect of educational level was modest. Marital status and country of origin were not associated with headache disorders after adjustment for other socio‐economic factors. Dissatisfaction with work, worry about losing one's job, and absenteeism due to illness were strongly associated with headache disorders. Physical working conditions and working hours were not associated with RH/M. Conclusion.— Headache disorders mainly affect young and middle‐aged adults. There are, however, socio‐economic disparities in self‐reported recurrent headache and migraine. The relationship was particularly evident for economic hardship and psychosocial factors. Of lifestyle factors, physical inactivity was strongly associated with headache disorders independent of economic and psychosocial factors.     

The long-term effect of insomnia on primary headaches: a prospective population-based cohort study (HUNT-2 and HUNT-3)

(Headache 2011;51:570‐580) Objective.— Few prospective studies have evaluated the relationship between insomnia and headache. We aimed to analyze the influence of insomnia at baseline on the risk for headache 11 years later. Methods.— This longitudinal cohort study included subjects who participated in 2 consecutive surveys of the Nord‐Trøndelag Health Study (HUNT‐2 and HUNT‐3). Among the invited individuals aged 20 years or more in HUNT‐2 (n = 92,566) and HUNT‐3 (n = 94,194), a total of 26,197 completed the headache section of both surveys. A proxy insomnia diagnosis based on DSM‐IV at baseline and ICDH‐2‐based headache diagnoses at follow‐up were derived from questionnaires. Headache‐free individuals in HUNT‐2 (n = 15,268) were selected for analysis. The relative risks (RRs) for headache in insomniacs were calculated with logistic regression. Results.— The presence of baseline insomnia was associated with a 40% increased risk for headache in HUNT‐3 (RR = 1.4, 95% CI = 1.2‐1.7). Similar results were found for tension‐type headache (TTH), migraine, and non‐classified headache. Subjects with insomnia‐related working disability had a 60% increased headache risk (RR = 1.6, 95% CI = 1.3‐2.1). The RR was larger for migraine (RR = 2.0, 95% CI = 1.3‐3.1) than for TTH (RR = 1.5, 95% CI = 1.1‐2.1). Insomnia at baseline was related to headache frequency at follow‐up for both migraine (P trend = 0.02) and TTH (P trend < 0.001). Conclusion.— In headache‐free subjects, insomnia was associated with an increased risk of headache 11 years later. The association was particularly strong for chronic headache.     

Prevalence of Migraine in Patients With Celiac Disease and Inflammatory Bowel Disease

Objective.— To assess the prevalence of headache in clinic and support group patients with celiac disease and inflammatory bowel disease (IBD) compared with a sample of healthy controls. Background.— European studies have demonstrated increased prevalence of headache of patients with celiac disease compared with controls. Methods.— Subjects took a self‐administered survey containing clinical, demographic, and dietary data, as well as questions about headache type and frequency. The ID‐Migraine screening tool and the Headache Impact Test (HIT‐6) were also used. Results.— Five hundred and two subjects who met exclusion criteria were analyzed – 188 with celiac disease, 111 with IBD, 25 with gluten sensitivity (GS), and 178 controls (C). Chronic headaches were reported by 30% of celiac disease, 56% of GS, 23% of IBD, and 14% of control subjects (P < .0001). On multivariate logistic regression, celiac disease (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.78‐8.10), GS (OR 9.53, 95%CI 3.24‐28.09), and IBD (OR 2.66, 95%CI 1.08‐6.54) subjects all had significantly higher prevalence of migraine headaches compared with controls. Female sex (P = .01), depression, and anxiety (P = .0059) were independent predictors of migraine headaches, whereas age >65 was protective (P = .0345). Seventy‐two percent of celiac disease subjects graded their migraine as severe in impact, compared with 30% of IBD, 60% of GS, and 50% of C subjects (P = .0919). There was no correlation between years on gluten‐free diet and migraine severity. Conclusions.— Migraine was more prevalent in celiac disease and IBD subjects than in controls. Future studies should include screening migraine patients for celiac disease and assessing the effects of gluten‐free diet on migraines in celiac disease.     

Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study

Background.— Though symptomatic medication overuse is believed to play a major role in progression from episodic to chronic or transformed migraine (TM), population‐based longitudinal data on these agents are limited. Objectives.— To assess the role of specific classes of acute medications in the development of TM in episodic migraine (EM) sufferers after adjusting for other risk factors for headache progression. Methods.— As a part of the American Migraine Prevalence and Prevention study (AMPP), we initially surveyed a population sample of 120,000 individuals to identify a sample of migraineurs to be followed annually over 5 years. Using logistic and linear regression, we modeled the probability of transition from EM in 2005 to TM in 2006 in relation to medication use status at baseline. Adjustments were made for gender, headache frequency and severity, and prevention medication use. Results.— Of 8219 individuals with EM in 2005, 209 (2.5%) had developed TM by 2006. Baseline headache frequency was a risk factor for TM. Using acetaminophen user as the reference group, individuals who used medications containing barbiturates (OR = 2.06, 95%CI = 1.3‐3.1) or opiates (OR = 1.98, 95%CI = 1.4‐2.2) were at increased risk of TM. A dose–response relationship was found for use of barbiturates. Use of triptans (OR = 1.25, 95%CI = 0.9‐1.7) at baseline was not associated with prospective risk of TM. Overall, NSAIDs (OR = 0.85, 95%CI = 0.63‐1.17) were not associated with TM. Indeed, NSAIDs were protective against transition to TM at low to moderate monthly headache days, but were associated with increased risk of transition to TM at high levels of monthly headache days. Conclusion.— EM sufferers develop TM at the rate of 2.5% per year. Any use of barbiturates and opiates was associated with increased risk of TM after adjusting for covariates, while triptans were not. NSAIDs were protective or inducers depending on the headache frequency.     

Scuba diving is not associated with high prevalence of headache: a cross-sectional study in men

Objective.— To study the prevalence of cephalalgia in male divers. Background.— Scuba divers work in stressing environments and have a high cerebrovascular risk, both conditions which are supposed to contribute to the genesis of cephalalgia. However, no study assessed expressly the prevalence of cephalalgia in divers, to date. Methods.— We enrolled 201 professional male scuba divers (41.0 ± 7.2 years) and controls (41.1 ± 7.2 years), and the risk ratio and its corresponding 95% confidence of suffering from cephalalgia was calculated. Results.— We found that 16% of divers and 22% of matched controls were affected by cephalalgia (P > .05), accounting for a risk ratio of 0.71 (95% CI 0.47‐1.07). Divers reported fewer attacks per month (1.8 ± 0.7, n = 32) with regard to controls (2.5 ± 1.8, n = 45) (P = .02), but no differences concerning age at onset and severity were detected (P > .05). Divers suffered from migraine, migraine with aura and tension headache as much as controls. Conclusion.— Scuba diving, an intense physical activity characterized by cerebral micro‐vascular distress, is not associated with cephalalgia, as a whole, or migraine, tension headache or migraine with aura, more commonly than in a matched, non‐diving, population. A longitudinal study may disclose if diving may act as a protective factor in the occurrence of crises of cephalalgia. (Headache 2012;52:385‐392)