Recurrent headache and migraine as a public health problem--a population-based study in Sweden

OBJECTIVE: To study the prevalence of recurrent headache and/or self-considered migraine (RH/M) and its association with self-rated health, other symptoms, and use of health care and medication in the general population. METHODS: The study comprised a random population sample of 43,770 men and women aged 18 to 79 years covering an area of 58 municipalities in Sweden. The data were obtained using a postal survey questionnaire during March to May 2000. The overall response rate was 65%. RESULTS: The overall prevalence of self-reported RH/M was 10% among men and 23% among women. RH was more common (15%) than migraine (4%). The prevalence of RH was highest in the younger age groups (18 to 34 years) and decreased with increasing age. The prevalence of migraine was highest (6%) among 35 to 49 years old. Subjects with RH/M had poorer self-rated health compared to subjects with no reported headache independent of age. Poor self-rated health was most common among subjects with both RH and M. Musculoskeletal pain and psychosomatic symptoms were more common among those with RH/M. The association between RH/M and poor self-rated health was partly explained by these symptoms. Those with RH/M utilized more health care at all levels than those with no RH/M. In addition, subjects with RH/M reported two to three times more often that they had been in need of medical care but not sought it. About two-thirds of the subjects with RH/M had used analgesic during the last 2 weeks compared with less than one-third among subjects with no RH/M. CONCLUSION: RH/M constitutes a substantial public health problem that mainly affects young and middle aged adults. It is associated with poor self-rated health, musculoskeletal and psychosomatic symptoms, increased use of health care and medication as well as unmet needs of health care.