The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies
TL;DR: The American Migraine Prevalence and Prevention study is a privately funded study that provides comparative US population‐based estimates of the prevalence and burden of migraine and chronic migraine.
Abstract: Background
Four ongoing US public health surveillance studies gather information relevant to the prevalence, impact, and treatment of headache and migraine: the National Health Interview Survey, the National Health and Nutrition Examination Survey, the National Ambulatory Care Survey, and the National Hospital Ambulatory Medical Care Survey. The American Migraine Prevalence and Prevention (AMPP) study is a privately funded study that provides comparative US population-based estimates of the prevalence and burden of migraine and chronic migraine.
Objective
To gather in one place and compare the most current available estimates of the US adult prevalence of headache and migraine, and the number of affected people overall and in various subgroups, and to provide estimates of headache burden and treatment patterns by examining migraine and headache as a reason for ambulatory care and emergency department (ED) visits in the United States.
Methods
We reviewed published analyses from available epidemiological studies identified through searches of PubMed and the National Center for Health Statistics. We aimed to identify information about migraine and headache burden, and treatment in national surveys conducted over the last decade. For each source, we selected the best available and most current estimate of migraine or headache prevalence, and selected associated measures of disability, health care use, and treatment patterns.
Results
Compared with a slightly higher proportion of 22.7% in the National Health and Nutrition Examination Survey, 16.6% of adults 18 or older reported having migraine or other severe headaches in the last 3 months in the 2011 National Health Interview Survey. In contrast, the AMPP study found an overall prevalence of migraine of 11.7% and probable migraine of 4.5%, for a total of 16.2%. Data from National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey showed that head pain was the fifth leading cause of ED visits overall in the US and accounted for 1.2% of outpatient visits. The burden of headache was highest in females 18-44, where the 3-month prevalence of migraine or severe headache was 26.1% and head pain was the third leading cause of ED visits. The prevalence and burden of headache was substantial even in the least affected subgroup of males 75 or older, where 4.6% reported experiencing severe headache or migraine in the previous 3 months. Triptans accounted for almost 80% of antimigraine analgesics prescribed at office visits in 2009, nearly half of which were for sumatriptan. Migraine is associated with increased risk for other physical and psychiatric comorbidities, and this risk increases with headache frequency.
Conclusion
This report provides the most current available estimates of the prevalence, impact, and treatment patterns of migraine or severe headache in the United States. Migraine and other severe headaches are a common and major public health problem, particularly among reproductive-aged women. Data about prevalence and disability from the major government-funded surveillance studies are generally consistent with results of studies such as the American Migraine Studies 1 and 2, and the AMPP study.
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TL;DR: This work aimed to identify the most current prevalence estimates of migraine and severe headache in the United States adult civilian and active duty service populations from these national government surveys, to assess stability of prevalence estimates over time, and to identify additional information pertinent to the burden and treatment of headaches.
Abstract: Background and Objectives
The US National Center for Health Statistics, which is part of the Centers for Disease Control, conducts ongoing public health surveillance activities. The US Armed Forces also maintains a comprehensive database of medical information. We aimed to identify the most current prevalence estimates of migraine and severe headache in the United States adult civilian and active duty service populations from these national government surveys, to assess stability of prevalence estimates over time, and to identify additional information pertinent to the burden and treatment of migraine and other severe headache conditions.
Methods
We searched for the most current publicly available summary statistics from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the National Health Interview Survey (NHIS). Summary data from the Defense Medical Surveillance System were also obtained, and PubMed was also searched for publications reporting summary statistics based on these studies. Data were abstracted, double-checked for accuracy, and summarized over time periods and as a function of demographic variables.
Results
14.2% of US adults 18 or older reported having migraine or severe headache in the previous 3 months in the 2012 NHIS. The overall age-adjusted 3-month prevalence of migraine in females was 19.1% and in males 9.0%, but varied substantially depending on age. The prevalence of migraine was highest in females 18-44, where the 3-month prevalence of migraine or severe headache was 23.5%. The 3-month prevalence of migraine or severe headache has remained relatively stable over the period of 2005-2012, with an average prevalence of 20.2% in females, 9.4% in males, and 20.2% overall. During this time, the average female to male sex ratio for migraine or severe headache was 2.17. The unadjusted 1-year prevalence of migraine in active duty US military service members varied from 1% to 1.9% between 1998 and 2010, ranging from 0.7% to 1.2% in males and 3.5% to 6% in females. The 1-year prevalence of “other headache” in this military population ranged from a low of 1.9% in 2003 to a high of 3% in 2010. Headache or pain in the head was the fourth leading cause of visits to the emergency department (ED) in 2009-2010, accounting for 3.1% of all ED visits. Across all ambulatory care settings, migraine accounted for 0.5% of all visits and other headache presentations for 0.4% of all ambulatory care visits. 52.8% of all visits for migraine occurred in primary care settings, 23.2% in specialty outpatient settings, and 16.7% in EDs. In 2010, opioids were administered at 35% of ED visits for headache, while triptans were administered in only 1.5% of visits.
Conclusions
This report summarizes the most recent government statistics on the prevalence and burden of migraine and severe headache in the US civilian and active duty military populations. The prevalence of migraine headaches is high, affecting roughly 1 out of every 7 Americans annually, and has remained relatively stable over the last 8 years. Migraine and headache are leading causes of outpatient and ED visits and remain an important public health problem, particularly among women during their reproductive years.
411 citations
Cites methods from "The prevalence, impact, and treatme..."
...It produces cross-sectional information on the US population based on structured interviews conducted with adults drawn from a representative sample of households and “non-institutional group quarters” (eg, dormitories) across the geographical regions of the United States....
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...In a previous report,we summarized data from nationally representative epidemiologic studies to characterize the prevalence and burden of headache in the United States.1 In this paper, we sought to identify the most recent statistics on the prevalence and burden of migraine in adults from large, nationally representative government health surveillance studies....
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...In a previous report,we summarized data from nationally representative epidemiologic studies to characterize the prevalence and burden of headache in the United States.(1) In this paper, we sought to identify the most recent statistics on the prevalence and burden of migraine in adults from large, nationally representative government health surveillance studies....
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...It is therefore important to have an accurate picture of the prevalence, burden, and treatment of migraine and severe headache in the United States....
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TL;DR: This work compares sexes on prevalence and a range of clinical variables for migraine, PM, and other severe headache in a large sample from the US population to help differentiate the range of headache types.
Abstract: Background
The strikingly higher prevalence of migraine in females compared with males is one of the hallmarks of migraine. A large global body of evidence exists on the sex differences in the prevalence of migraine with female to male ratios ranging from 2 : 1 to 3 : 1 and peaking in midlife. Some data are available on sex differences in associated symptoms, headache-related disability and impairment, and healthcare resource utilization in migraine. Few data are available on corresponding sex differences in probable migraine (PM) and other severe headache (ie, nonmigraine-spectrum severe headache). Gaining a clear understanding of sex differences in a range of severe headache disorders may help differentiate the range of headache types. Herein, we compare sexes on prevalence and a range of clinical variables for migraine, PM, and other severe headache in a large sample from the US population.
Methods
This study analyzed data from the 2004 American Migraine Prevalence and Prevention Study. Total and demographic-stratified sex-specific, prevalence estimates of headache subtypes (migraine, PM, and other severe headache) are reported. Log-binomial models are used to calculate sex-specific adjusted prevalence ratios and 95% confidence intervals for each across demographic strata. A smoothed sex prevalence ratio (female to male) figure is presented for migraine and PM.
Results
One hundred sixty-two thousand seven hundred fifty-six individuals aged 12 and older responded to the 2004 American Migraine Prevalence and Prevention Study survey (64.9% response rate). Twenty-eight thousand two hundred sixty-one (17.4%) reported “severe headache” in the preceding year (23.5% of females and 10.6% of males), 11.8% met International Classification of Headache Disorders-2 criteria for migraine (17.3% of females and 5.7% of males), 4.6% met criteria for PM (5.3% of females and 3.9% of males), and 1.0% were categorized with other severe headache (0.9% of females and 1.0% of males). Sex differences were observed in the prevalence of migraine and PM, but not for other severe headache. Adjusted female to male prevalence ratios ranged from 1.48 to 3.25 across the lifetime for migraine and from 1.22 to 1.53 for PM. Sex differences were also observed in associated symptomology, aura, headache-related disability, healthcare resource utilization, and diagnosis for migraine and PM. Despite higher rates of migraine diagnosis by a healthcare professional, females with migraine were less likely than males to be using preventive pharmacologic treatment for headache.
Conclusions
In this large, US population sample, both migraine and PM were more common among females, but a sex difference was not observed in the prevalence of other severe headache. The sex difference in migraine and PM held true across age and for most other sociodemographic variables with the exception of race for PM. Females with migraine and PM had higher rates of most migraine symptoms, aura, greater associated impairment, and higher healthcare resource utilization than males. Corresponding sex differences were not observed among individuals with other severe headache on the majority of these comparisons. Results suggest that PM is part of the migraine spectrum whereas other severe headache types are not. Results also substantiate existing literature on sex differences in primary headaches and extend results to additional headache types and related factors.
327 citations
Cites background from "The prevalence, impact, and treatme..."
...and fall into 1 of 4 grades of headache-related disability: little or none (0-5), mild (6-10), moderate (11-20), or severe (21-40)....
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...(See MacGregor et al, 2011,28 Smitherman et al, 2013,29 and Merikangas, 201330 for detailed reviews of sex-related differences in migraine and other headache types.)...
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...into 6 age categories (12-17, 18-29, 30-39, 40-49, 50-59, 60), 4 racial groups (Caucasian, African American, “other,” or unknown if data were missing), 4 population density groups (<100,000, 100,000-499,999, 500,000-1,999,999, 2,000,000), 5 annual household income groups (<$22,500, $22,500-$39,999, $40,000$59,999, $60,000-$89,999, $90,000), and 9 US regions (New England, Middle Atlantic, South Atlantic, East North Central, West North Central, East South Central, West South Central, Mountain, and Pacific)....
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TL;DR: The goal was to assess the stability of prevalence estimates over time, and to identify additional information pertinent to the burden and treatment of migraine and other severe headache conditions.
Abstract: Background and objectives In this targeted systematic review, we aimed to identify up-to-date prevalence estimates of migraine and severe headache in adults from population-based US government surveys. Our goal was to assess the stability of prevalence estimates over time, and to identify additional information pertinent to the burden and treatment of migraine and other severe headache conditions. Methods We searched for the most current publicly available summary statistics from the National Health Interview Survey (NHIS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the National Ambulatory Medical Care Survey (NAMCS). We extracted and summarized data from each study over time and as a function of demographic variables. Results The prevalence and burden of self-reported migraine and severe headache in the US adult population is high, affecting roughly 1 out of every 6 American and 1 in 5 women over a 3-month period (15.3% overall [95% CI 14.75-15.85], 9.7% of males [95% CI 9.05-10.35] and 20.7% of females [95% CI 19.84-21.56]). The prevalence has been remarkably stable over a period of 19 years. The prevalence of migraine or severe headache in 2015 was highest in American Indian or Alaska Natives (18.4%) compared with whites, blacks, or Hispanics, with the lowest prevalence in Asians (11.3%). There is a higher burden of migraine in those aged 18-44 (17.9%), people who are unemployed (21.4%), those with family income less than $35,000 per year (19.9%), and the elderly and disabled (16.4%). Headache is consistently the fourth or fifth most common reason for visits to the emergency department, accounting for roughly 3% of all emergency department visits annually. In reproductive aged women, headache is the third leading cause of emergency department visits. Conclusions Severe headache and migraine remain important public health problems that are more common and burdensome for women, particularly women of childbearing age, and other historically disadvantaged segments of the population. These inequities could be exacerbated if new high-cost treatments are inaccessible to those who need them most.
324 citations
Additional excerpts
...similar reviews have included this information and found that prevalence estimates were similar.(1,14)...
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TL;DR: Chronic migraine is the second most disabling condition worldwide and is associated with higher headache-related disability/impact, medical and psychiatric comorbidities, health care resource use, direct and indirect costs, lower socioeconomic status, and health-related quality of life.
294 citations
TL;DR: A summary overview of the substantial current and future economic impact of neurological disease is provided, and an action plan for reducing this burden through neurological research and enhanced clinical management of neurological disorders in the United States is provided.
Abstract: As the expense of health care in the United States rises toward unsustainable levels, we have entered a new age of cost justification in which the prevalence, morbidity, and disability of the diseases we treat are becoming critical to the continued allocation of fiscal resources toward neurological care and research. The return on the considerable investments in cardiovascular disease and cancer research over the past few decades has yielded remarkable therapeutic benefits for those diseases, dramatically increasing overall health and survival. However, less investment has been made in overcoming neurological disorders, and therefore therapeutic gains have been correspondingly limited. Ironically, the burgeoning number of elderly citizens resulting from decreases in the mortality of cardiovascular disease and cancer is producing unprecedented numbers of people affected by neurological disease, because neurological disease is so much more prevalent in the elderly. As of 2011, nearly 100 million Americans were afflicted by at least one of the >1,000 neurological diseases. Although mortality is often the primary outcome measure in many research studies, the cost and societal impact of diseases are largely determined by the disability they cause; consequently, nearly 50% of the total health burden in the United States is due to morbidity and disability. This is particularly true of neurological disorders, and the years lost to disability from neurological and musculoskeletal disorders is greater than that of all other categories of disease. In this editorial, we provide a summary overview of the substantial current and future economic impact of neurological disease, and provide an action plan for reducing this burden through neurological research and enhanced clinical management of neurological disorders in the United States.
274 citations
References
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TL;DR: The prevalence, sociodemographic profile, and the burden of migraine in the United States in 1999 and to compare results with the original American Migraine Study, a 1989 population‐based study employing identical methods are described.
Abstract: Objective.—To describe the prevalence, sociodemographic profile, and the burden of migraine in the United States in 1999 and to compare results with the original American Migraine Study, a 1989 population-based study employing identical methods.
Methods.—A validated, self-administered questionnaire was mailed to a sample of 20 000 households in the United States. Each household member with severe headache was asked to respond to questions about symptoms, frequency, and severity of headaches and about headache-related disability. Diagnostic criteria for migraine were based on those of the International Headache Society. This report is restricted to individuals 12 years and older.
Results.—Of the 43 527 age-eligible individuals, 29 727 responded to the questionnaire for a 68.3% response rate. The prevalence of migraine was 18.2% among females and 6.5% among males. Approximately 23% of households contained at least one member suffering from migraine. Migraine prevalence was higher in whites than in blacks and was inversely related to household income. Prevalence increased from aged 12 years to about aged 40 years and declined thereafter in both sexes. Fifty-three percent of respondents reported that their severe headaches caused substantial impairment in activities or required bed rest. Approximately 31% missed at least 1 day of work or school in the previous 3 months because of migraine; 51% reported that work or school productivity was reduced by at least 50%.
Conclusions.—Two methodologically identical national surveys in the United States conducted 10 years apart show that the prevalence and distribution of migraine have remained stable over the last decade. Migraine-associated disability remains substantial and pervasive. The number of migraineurs has increased from 23.6 million in 1989 to 27.9 million in 1999 commensurate with the growth of the population. Migraine is an important target for public health interventions because it is highly prevalent and disabling.
2,012 citations
TL;DR: The epidemiologic profile of migraine has remained stable in the United States during the past 15 years and more than one in four migraineurs are candidates for preventive therapy, and a substantial proportion of those who might benefit from prevention do not receive it.
Abstract: Objectives: 1) To reassess the prevalence of migraine in the United States; 2) to assess patterns of migraine treatment in the population; and 3) to contrast current patterns of preventive treatment use with recommendations for use from an expert headache panel. Methods: A validated self-administered headache questionnaire was mailed to 120,000 US households, representative of the US population. Migraineurs were identified according to the criteria of the second edition of the International Classification of Headache Disorders. Guidelines for preventive medication use were developed by a panel of headache experts. Criteria for consider or offer prevention were based on headache frequency and impair- ment. Results: We assessed 162,576 individuals aged 12 years or older. The 1-year period prevalence for migraine was 11.7% (17.1% in women and 5.6% in men). Prevalence peaked in middle life and was lower in adolescents and those older than age 60 years. Of all migraineurs, 31.3% had an attack frequency of three or more per month, and 53.7% reported severe impairment or the need for bed rest. In total, 25.7% met criteria for "offer prevention," and in an additional 13.1%, prevention should be considered. Just 13.0% reported current use of daily preventive migraine medication. Conclusions: Compared with previous studies, the epidemiologic profile of migraine has remained stable in the United States during the past 15 years. More than one in four migraineurs are candidates for preventive therapy, and a substantial proportion of those who might benefit from prevention do not receive it.
1,932 citations
"The prevalence, impact, and treatme..." refers background or methods in this paper
...7%.(6) With the highest prevalence observed among those ages 18-59, 17....
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...—The AMPP study is a longitudinal population-based study of Americans with migraine.(6) Previous population-based studies of migraine prevalence, the American Migraine Studies 1 and 2, obtained cross-sectional data on migraine prevalence and disability....
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...The AMPP began in 2004 with a questionnaire that was mailed to a stratified random sample of US households drawn from a panel maintained by a survey sampling company.(6) The sample was created to be representative of the US population for key characteristics such as income, number of family members, and age of household head....
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TL;DR: A population‐based survey was conducted in 1999 to describe the patterns of migraine diagnosis and medication use in a representative sample of the US population and to compare results with a methodologically identical study conducted 10 years earlier.
Abstract: Objective.-A population-based survey was conducted in 1999 to describe the patterns of migraine diagnosis and medication use in a representative sample of the US population and to compare results with a methodologically identical study conducted 10 years earlier. Methods.-A survey mailed to a panel of 20000 US households identified 3577 individuals with severe headache meeting a case definition for migraine based on the International Headache Society (IHS) criteria. Those with severe headache answered questions regarding physician diagnosis and use of medications for headache as well as headache-related disability. Results.-A physician diagnosis of migraine was reported by 48% of survey participants who met IHS criteria for migraine in 1999, compared with 38% in 1989. A total of 41% of IHS-defined migraineurs used prescription drugs for headaches in 1999, compared with 37% in 1989. The proportion of IHS-defined migraineurs using only over-the-counter medications to treat their headaches was 57% in 1999, compared with 59% in 1989. In 1999, 37% of diagnosed and 21% of undiagnosed migraineurs reported 1 to 2 days of activity restriction per episode (P<.001); 38% of diagnosed and 24% of undiagnosed migraineurs missed at least 1 day of work or school in the previous 3 months (P<.001); 57% of diagnosed and 45% of undiagnosed migraineurs experienced at least a 50% reduction in work/school productivity (P<.001). Conclusions.- Diagnosis of migraine has increased over the past decade. Nonetheless, approximately half of migraineurs remain undiagnosed, and the increased rates of diagnosis of migraine have been accompanied by only a modest increase in the proportion using prescription medicines. Migraine continues to cause significant disability whether or not there has been a physician diagnosis. Given the availability of effective treatments, public health initiatives to improve patterns of care are warranted.
698 citations
TL;DR: An overview of the published epidemiological evidence of migraine helps to identify the size of the public–health problem that migraine represents and highlights the need for further epidemiological studies in many parts of the world to gain full understanding of the scale of clinical, economic and humanistic burdens attributable to it.
Abstract: This overview of the published epidemiological evidence of migraine helps to identify the size of the public–health problem that migraine represents. It also highlights the need for further epidemiological studies in many parts of the world to gain full understanding of the scale of clinical, economic and humanistic burdens attributable to it. This paper presents some of the work on migraine undertaken by the World Health Organization (WHO) in the Global Burden of Disease study conducted in 2000 and reported in the World Health Report 2001. Migraine was not included in the first Global Burden of Disease 1990. The paper also discussed the measurement of disability attributable to headache disorders using WHO ICF Classification. Using disabilityadjusted life years (DALYs) as a summary measure of population health (which adds disability to mortality), WHO have shown that mental and neurological disorders collectively account for 30.8% of all years of healthy life lost to disability (YLDs) whilst migraine, one amongst these, alone accounts for 1.4% and is in the top 20 causes of disability worldwide. This information is combined with the increasingly widely accepted belief that disability and functioning are relevant parameters for monitoring the health of nations and that there is an increasing need to measure them. WHO's Classification of Functioning, Disability and Health (ICF) provides a model of human functioning and disability, as well as a classification system, that allows us to highlight and measure all dimensions of disability. ICF applied to headache disorders allows comparability with other health conditions as well as evaluation of the role of the environment as a cause of disability amongst people with headache. Migraine causes a large propotion of the non–fatal disease–related burden worldwide.Our kowledge of headache related burden is incomplete and it is necessary to add to it epidemiological studies in many parts of the world and to combine this with measurements of disability using both DALYs and WHO ‘s ICF Classification. The work described here has been the base for the Global Campaign against Headache disorders: "Lifting the Burden", launched in 2004 jointly by WHO, IHS (International Headache Society), WHA (World Headache Alliance) and EHF (European Headache Federation).
389 citations
"The prevalence, impact, and treatme..." refers background in this paper
...They are associated with substantial personal suffering, disability, and societal expense.(1) In the United States, a number of public health surveillance systems and privately funded studies have collected information on the prevalence, impact, and treatment of headache and migraine....
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TL;DR: In a sample of the US population, this work sought to determine the proportion of active migaineurs who ever consulted a doctor for headache and to identify the headache characteristics and sociodemographic factors associated with consulting.
Abstract: Background.—Migraine headaches are often disabling but usually responsive to treatment. Nonetheless, many people with migraine never consult a doctor for headaches. In a sample of the US population, we sought to determine the proportion of active migaineurs who ever consulted a doctor for headache and to identify the headache characteristics and sociodemographic factors associated with consulting.
Method.—A mailed questionnaire survey was sent to 15 000 US households, selected from a panel to be representative of the US population. Of 20 468 eligible respondents ranging in age from 12 to 80 years, 2479 met a case definition for migraine. We mailed a second questionnaire to all migraineurs identified on the first survey and achieved a 69.4% response rate. The second survey assessed headache characteristics, patterns of medical care use, medication use, and method of payment for health care.
Results.—Sixty-eight percent of female and 57% of male migraineurs reported having ever consulted a doctor for headache. Consultation was more likely with increasing age and in women who ever married. In females, several headache characteristics including pain intensity, number of migraine symptoms, attack duration, and disability were associated with consultation. Of those who never consult, 61% report severe or very severe pain and 67% report severe disability or the need for bed rest with their headaches.
Conclusion.—The results of this survey indicate that a significant proportion of migraine sufferers never consult doctors for their headaches. Given that a large proportion of persons who never consult report high levels of pain and disability, these data suggest that there are opportunities to appropriately increase health care utilization for migraine. Given that 40% of migraineurs who have ever consulted do not report a physician diagnosis of migraine, there is a need to improve headache diagnosis and/or doctor-patient communication about migraine.
368 citations