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      Epidemiological profiles of patients with chronic migraine and chronic tension-type headache

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          Abstract

          Background

          We evaluated risk factors associated with chronic headache (CH) such as age, gender, smoking, frequent drinking of alcoholic beverages (drinking), obesity, education and frequent intake of acute pain drugs to test their usefulness in clinical differentiation between chronic migraine (CM) and chronic tension-type headache (CTTH).

          Methods

          We used baseline data from the population-based German Headache Consortium Study including 9,944 participants aged 18–65 years, screened 2003–2005, using validated questionnaires. CM and CTTH were defined according to IHS criteria. Multinominal logistic regression analyses were used to investigate the association of CM or CTTH with risk factors by estimating odds ratios (OR) and 95% confidence intervals (95%CI).

          Results

          The prevalence of CH was 2.6% (N = 255, mean age 46 ± 14.1 years, 65.1% women), CM 1.1% (N = 108, 45 ± 12.9 years, 73.1%), CTTH 0.5% (N = 50, 49 ± 13.9 years, 48.0%). Participants with CM compared to CTTH were more likely to be female (OR: 2.34, 95%CI: 1.00-5.49) and less likely to drink alcohol (0.31, 0.09-1.04). By trend they seemed more likely to smoke (1.81, 0.76-4.34), to be obese (1.85, 0.54-6.27), to report frequent intake of acute pain drugs (1.68, 0.73-3.88) and less likely to be low educated (0.72, 0.27-1.97).

          Conclusions

          We concluded that the careful assessment of different risk factors might aid in the clinical differentiation between CM and CTTH.

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          Most cited references35

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          The global burden of headache: a documentation of headache prevalence and disability worldwide.

          This study, which is a part of the initiative 'Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide', assesses and presents all existing evidence of the world prevalence and burden of headache disorders. Population-based studies applying International Headache Society criteria for migraine and tension-type headache, and also studies on headache in general and 'chronic daily headache', have been included. Globally, the percentages of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache and 3% for chronic daily headache. Our calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for the two genders, and into the five most disabling for women.
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            The triggers or precipitants of the acute migraine attack.

            L. Kelman (2007)
            The aim of this study was to evaluate and define the triggers of the acute migraine attack. Patients rated triggers on a 0-3 scale for the average headache. Demographics, prodrome, aura, headache characteristics, postdrome, medication responsiveness, acute and chronic disability, sleep characteristics and social and personal characteristics were also recorded. One thousand two hundred and seven International Classification of Headache Disorders-2 (1.1-1.2, and 1.5.1) patients were evaluated, of whom 75.9% reported triggers (40.4% infrequently, 26.7% frequently and 8.8% very frequently). The trigger frequencies were stress (79.7%), hormones in women (65.1%), not eating (57.3%), weather (53.2%), sleep disturbance (49.8%), perfume or odour (43.7%), neck pain (38.4%), light(s) (38.1%), alcohol (37.8%), smoke (35.7%), sleeping late (32.0%), heat (30.3%), food (26.9%), exercise (22.1%) and sexual activity (5.2%). Triggers were more likely to be associated with a more florid acute migraine attack. Differences were seen between women and men, aura and no aura, episodic and chronic migraine, and between migraine and probable migraine.
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              Obesity and migraine: a population study.

              To assess the influence of body mass index (BMI) on the prevalence, attack frequency, and clinical features of migraine. In a population-based telephone interview study, the authors gathered information on headache, height, and weight. The 30,215 participants were divided into five categories, based on BMI: 1, underweight ( or = 35). Migraine prevalence and modeled headache features were assessed as a function of BMI, adjusting by covariates (age, sex, marital status, income, medical treatment, depression). Subjects were predominantly female (65% female) and in middle life (mean age 38.4). BMI group was not associated with the prevalence of migraine, but was associated with the frequency of headache attacks. In the normal weight group, 4.4% had 10 to 15 headache days per month, increasing to 5.8% of the overweight (odds ratio [OR] = 1.3), 13.6% of the obese (OR = 2.9), and 20.7% of the morbidly obese (OR = 5.7). The proportion of subjects with severe headache pain increased with BMI, doubling in the morbidly obese relative to the normally weighted (OR = 1.9). Similar significant associations were demonstrated with BMI category for disability, photophobia, and phonophobia. Though migraine prevalence is not associated with body mass index, attack frequency, severity, and clinical features of migraine increase with body mass index group.
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                Author and article information

                Journal
                J Headache Pain
                J Headache Pain
                The Journal of Headache and Pain
                Springer
                1129-2369
                1129-2377
                2013
                7 May 2013
                : 14
                : 1
                : 40
                Affiliations
                [1 ]Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
                [2 ]Department of Neurology, University Hospital of University Duisburg-Essen, Hufelandstr. 55, Essen, 45122, Germany
                [3 ]Department of Neurology, Evangelisches Krankenhaus Unna, Holbeinstraße 10, Unna, 59423, Germany
                [4 ]Department of Neurology, St. Joseph Hospital, Ruhr-University of Bochum, Gudrunstr. 56, Bochum, 44791, Germany
                Article
                1129-2377-14-40
                10.1186/1129-2377-14-40
                3655106
                23651174
                1e2d63b7-5a98-4204-8cd2-5b4a38940338
                Copyright ©2013 Schramm et al.; licensee Springer.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 April 2013
                : 4 May 2013
                Categories
                Research Article

                Anesthesiology & Pain management
                chronic migraine,chronic tension-type headache,epidemiology,risk factors

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