Sex Differences in Migraine and Other Severe Headache
Sex Differences in Migraine and Other Severe Headache
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.
With few exceptions, it is well established that the majority of primary headache disorders have a higher prevalence in females than males. A review of global population estimates of primary headache subtypes of 107 studies from 6 continents reported prevalence of 42% for tension-type headache, 11% for migraine, and 3% chronic daily headache (3%). Although the report found differences in the prevalence of headache across continents, all three of these headache types were more prevalent among females compared to males on every continent. Female to male sex prevalence ratios (PRs) are most dramatic in migraine and chronic daily headache but also exist in tension-type headache. In fact, the only primary headache types that have not demonstrated a female preponderance are the trigeminal autonomic cephalalgias. The majority of these headache types are more common in men, especially cluster headache, which has female to male sex prevalence estimates ranging from 1 : 3.5 to 1 : 7.
Elevated female to male sex PRs in migraine have been reported from studies around the world with a variety of samples and methodologies. The female to male sex PR for migraine has consistently varied across the lifespan ranging from 3 or 4 to 1 in midlife and lowering to 2 to 1 or less at both ends of the age spectrum. In addition to the female preponderance in migraine prevalence, some studies have reported that females may experience greater symptomology and headache-related disability. Sex differences have also been observed in the prevalence of probable migraine (PM), although the direction is not always consistent. Few data are available on sex differences in associated symptomology, frequency, and disability in PM. (See MacGregor et al, 2011, Smitherman et al, 2013, and Merikangas, 2013 for detailed reviews of sex-related differences in migraine and other headache types.)
Several large scale studies have reported sex prevalence differences in migraine, including the American Migraine Study (AMS) I and II and the American Migraine Prevalence and Prevention (AMPP) Study. In 1989, a self-administered questionnaire was sent to 15,000 households as part of the AMS I. Questionnaires collected data on sociodemographics, headache symptomology, frequency, and related disability among other topics. Of 20,468 respondents, 17.6% of females and 5.7% of males were found to have one or more migraine headaches per year (a 3 to 1 female to male sex PR). Researchers also found that females with migraine had more frequent attacks than males but the sexes did not differ substantially in terms of headache-related disability. In 1999, 20,000 households were surveyed as part of the AMS II. Of 29,727 respondents, the prevalence of migraine was 18.2% among females and 6.5% among males. Although the reported frequency of severe headache pain was similar for female and male migraineurs, females were somewhat more likely to report "severe impairment" during migraine, longer duration of impairment, and were more likely to report photophobia, phonophobia, unilateral pain, nausea, vomiting, blurred vision, and aura associated with headache.
In 2004, the AMPP Study collected data from 120,000 US households and assessed headache symptomology, frequency, headache-related disability, and other data. Surveys asked about "severe headache" and second edition of International Classification of Headache Disorders (ICHD-2) criteria, which were applied to determine the 3 most severe headache types experienced by respondents. Data were received from 162,756 individuals aged 12 and older to determine the consistency of sex-specific patterns across 3 defined subgroups of "severe" headache including migraine, PM, and other (ie, nonmigraine spectrum) severe headache. Previous analyses of AMPP Study data have revealed sex differences in migraine and PM prevalence. The prevalence of migraine was found to be 17.1% in females and 5.6% in males, and PM was 5.1% in females and 3.9% in males. However, data on sex differences in symptomology, aura, headache-related disability, health resource utilization, and comorbidities for individuals meeting criteria for migraine, PM, and other types of "severe" headache have not yet been systematically reported from the 2004 AMPP Study sample.
In the current study, sex-specific patterns on multiple variables were examined in the 2004 AMPP Study population overall as well as by major racial subgroups, age groups, and by other sociodemographic variables. We report the sex-specific prevalence of migraine, PM, and other severe headache. We also report the sex-specific occurrence of headache symptoms, reported aura, headache-related disability, healthcare resource utilization (eg, consulting behavior, emergency department/urgent care clinic visits for headache), and healthcare professional (HCP) assigned headache diagnoses, among other variables, by headache subtype. In addition, we will examine prevalence and female to male PRs by age, race, and annual household income for each of the 3 types of severe headache.
Abstract and Introduction
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.
Introduction
With few exceptions, it is well established that the majority of primary headache disorders have a higher prevalence in females than males. A review of global population estimates of primary headache subtypes of 107 studies from 6 continents reported prevalence of 42% for tension-type headache, 11% for migraine, and 3% chronic daily headache (3%). Although the report found differences in the prevalence of headache across continents, all three of these headache types were more prevalent among females compared to males on every continent. Female to male sex prevalence ratios (PRs) are most dramatic in migraine and chronic daily headache but also exist in tension-type headache. In fact, the only primary headache types that have not demonstrated a female preponderance are the trigeminal autonomic cephalalgias. The majority of these headache types are more common in men, especially cluster headache, which has female to male sex prevalence estimates ranging from 1 : 3.5 to 1 : 7.
Elevated female to male sex PRs in migraine have been reported from studies around the world with a variety of samples and methodologies. The female to male sex PR for migraine has consistently varied across the lifespan ranging from 3 or 4 to 1 in midlife and lowering to 2 to 1 or less at both ends of the age spectrum. In addition to the female preponderance in migraine prevalence, some studies have reported that females may experience greater symptomology and headache-related disability. Sex differences have also been observed in the prevalence of probable migraine (PM), although the direction is not always consistent. Few data are available on sex differences in associated symptomology, frequency, and disability in PM. (See MacGregor et al, 2011, Smitherman et al, 2013, and Merikangas, 2013 for detailed reviews of sex-related differences in migraine and other headache types.)
Several large scale studies have reported sex prevalence differences in migraine, including the American Migraine Study (AMS) I and II and the American Migraine Prevalence and Prevention (AMPP) Study. In 1989, a self-administered questionnaire was sent to 15,000 households as part of the AMS I. Questionnaires collected data on sociodemographics, headache symptomology, frequency, and related disability among other topics. Of 20,468 respondents, 17.6% of females and 5.7% of males were found to have one or more migraine headaches per year (a 3 to 1 female to male sex PR). Researchers also found that females with migraine had more frequent attacks than males but the sexes did not differ substantially in terms of headache-related disability. In 1999, 20,000 households were surveyed as part of the AMS II. Of 29,727 respondents, the prevalence of migraine was 18.2% among females and 6.5% among males. Although the reported frequency of severe headache pain was similar for female and male migraineurs, females were somewhat more likely to report "severe impairment" during migraine, longer duration of impairment, and were more likely to report photophobia, phonophobia, unilateral pain, nausea, vomiting, blurred vision, and aura associated with headache.
In 2004, the AMPP Study collected data from 120,000 US households and assessed headache symptomology, frequency, headache-related disability, and other data. Surveys asked about "severe headache" and second edition of International Classification of Headache Disorders (ICHD-2) criteria, which were applied to determine the 3 most severe headache types experienced by respondents. Data were received from 162,756 individuals aged 12 and older to determine the consistency of sex-specific patterns across 3 defined subgroups of "severe" headache including migraine, PM, and other (ie, nonmigraine spectrum) severe headache. Previous analyses of AMPP Study data have revealed sex differences in migraine and PM prevalence. The prevalence of migraine was found to be 17.1% in females and 5.6% in males, and PM was 5.1% in females and 3.9% in males. However, data on sex differences in symptomology, aura, headache-related disability, health resource utilization, and comorbidities for individuals meeting criteria for migraine, PM, and other types of "severe" headache have not yet been systematically reported from the 2004 AMPP Study sample.
In the current study, sex-specific patterns on multiple variables were examined in the 2004 AMPP Study population overall as well as by major racial subgroups, age groups, and by other sociodemographic variables. We report the sex-specific prevalence of migraine, PM, and other severe headache. We also report the sex-specific occurrence of headache symptoms, reported aura, headache-related disability, healthcare resource utilization (eg, consulting behavior, emergency department/urgent care clinic visits for headache), and healthcare professional (HCP) assigned headache diagnoses, among other variables, by headache subtype. In addition, we will examine prevalence and female to male PRs by age, race, and annual household income for each of the 3 types of severe headache.
Source...