Comorbidities of primary headache disorders: a literature review with meta-analysis

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Abstract

Background

Primary headache disorders are common and burdensome conditions. They are associated to several comorbidities, such as cardiovascular or psychiatric ones, which, in turn, contribute to the global burden of headache. The aim of this study is to provide a comprehensive description of the pooled prevalence of comorbidities of primary headache disorders using a meta-analytical approach based on studies published between 2000 and 2020.

Methods

Scopus was searched for primary research (clinical and population studies) in which medical comorbidities were described in adults with primary headache disorders. Comorbidities were extracted using a taxonomy derived from the Global Burden of Disease (GBD) study. We compared prevalence of comorbidities among headache sufferers against general population using GBD-2019 estimates, and compared comorbidities’ proportions in clinical vs. population studies, and by age and gender.

Results

A total of 139 studies reporting information on 4.19 million subjects with primary headaches were included: in total 2.75 million comorbidities were reported (median per subject 0.64, interquartile range 0.32–1.07). The most frequently addressed comorbidities were: depressive disorders, addressed in 51 studies (pooled proportion 23 %, 95 % CI 20–26 %); hypertension, addressed in 48 studies (pooled proportion 24 %, 95 % CI 22–26 %); anxiety disorders addressed in 40 studies (pooled proportion 25 %, 95 % CI 22–28 %). For conditions such as anxiety, depression and back pain, prevalence among headache sufferers was higher than in GBD-2109 estimates. Associations with average age and female prevalence within studies showed that hypertension was more frequent in studies with higher age and less females, whereas fibromyalgia, restless leg syndrome, and depressive disorders were more frequent in studies with younger age and more female.

Conclusions

Some of the most relevant comorbidities of primary headache disorders – back pain, anxiety and depression, diabetes, ischemic heart disease and stroke – are among the most burdensome conditions, together with headache themselves, according to the GBD study. A joint treatment of headaches and of these comorbidities may positively impact on headache sufferers’ health status and contribute to reduce the impact of a group of highly burdensome diseases.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-021-01281-z.

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Most cited references 202

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Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Theo Vos, Stephen S Lim, Cristiana Abbafati … (2023)

Summary Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding Bill & Melinda Gates Foundation.

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Author and article information

Contributors

Valeria Caponnetto: valeria.caponnetto@univaq.it

Manuela Deodato: mdeodato@units.it

Journal

Journal ID (nlm-ta): J Headache Pain

Journal ID (iso-abbrev): J Headache Pain

Title: The Journal of Headache and Pain

Publisher: Springer Milan (Milan )

ISSN (Print): 1129-2369

ISSN (Electronic): 1129-2377

Publication date (Electronic): 14 July 2021

Publication date PMC-release: 14 July 2021

Publication date Collection: 2021

Volume: 22

Issue: 1

Electronic Location Identifier: 71

Affiliations

[1 ]GRID grid.158820.6, ISNI 0000 0004 1757 2611, SS Filippo & Nicola Hospital , , University of L’Aquila, ; Avezzano, Italy

[2 ]GRID grid.5133.4, ISNI 0000 0001 1941 4308, Department of Life Sciences, , University of Trieste, ; Trieste, Italy

[3 ]GRID grid.5133.4, ISNI 0000 0001 1941 4308, Department of Medical, Surgical and Health Sciences, , University of Trieste, ; Trieste, Italy

[4 ]Centro di Diagnosi e Cura delle Cefalee, Palazzo della Salute, Gruppo San Donato, Milano, Italy

[5 ]PainClinicMilano, Centro Medico Visconti di Modrone, Milano, Italy

[6 ]Thriassio General Hospital of Elefsina, Elefsina, Greece

[7 ]GRID grid.7841.a, Internal Medicine Unit, Department of Clinical and Molecular Medicine, , Sapienza University, ; Rome, Italy

[8 ]GRID grid.10776.37, ISNI 0000 0004 1762 5517, UO Neuropsichiatria Infantile, , Policlinico Universitario Paolo Giaccone, Università degli Studi di Palermo, ; Palermo, Italy

[9 ]GRID grid.158820.6, ISNI 0000 0004 1757 2611, Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, , University of L’Aquila, ; L’Aquila, Italy

[10 ]GRID grid.9027.c, ISNI 0000 0004 1757 3630, Clinica Neurologica, Dipartimento di Medicina, , Università degli Studi di Perugia, ; Perugia, Italy

[11 ]GRID grid.412765.3, Department of Neurology, , University Hospital Center ‘Mother Teresa’, ; Tirana, Albania

[12 ]GRID grid.8982.b, ISNI 0000 0004 1762 5736, Department of Brain and Behavioral Sciences, , University of Pavia, ; Pavia, Italy

[13 ]GRID grid.419416.f, ISNI 0000 0004 1760 3107, Headache Science and Neurorehabilitation Center, , IRCCS Mondino Foundation, ; Pavia, Italy

[14 ]GRID grid.417894.7, ISNI 0000 0001 0707 5492, Dipartimento di Ricerca e Sviluppo Clinico, , Fondazione IRCCS Istituto Neurologico Carlo Besta, ; Milano, Italy

[15 ]GRID grid.7841.a, Department of Clinical and Molecular Medicine, , Sapienza University, ; Roma, Italy

[16 ]GRID grid.18887.3e, ISNI 0000000417581884, Regional Referral Headache Center, , Sant’Andrea University Hospital, ; Roma, Italy

[17 ]GRID grid.417894.7, ISNI 0000 0001 0707 5492, UOC Neurologia, Salute Pubblica, Disabilità, , Fondazione IRCCS Istituto Neurologico Carlo Besta, ; Milano, Italy

Author information

Alberto Raggi http://orcid.org/0000-0002-7433-7779

Article

Publisher ID: 1281

DOI: 10.1186/s10194-021-01281-z

PMC ID: 8278743

PubMed ID: 34261435

SO-VID: a97a7df5-e380-42e4-a01c-0866d9fdb3d8

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 14 June 2021

Date accepted : 22 June 2021

Custom metadata

ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: primary headache,migraine,tth,ch,comorbidity,depression,obesity,diabetes,hypertension,stroke,sleep disorders

Data availability:

ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: primary headache, migraine, tth, ch, comorbidity, depression, obesity, diabetes, hypertension, stroke, sleep disorders

Comorbidities of primary headache disorders: a literature review with meta-analysis

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Abstract

Background

Methods

Results

Conclusions

Supplementary Information

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Cardiovascular Innovations and Applications

Most cited references 202

Measuring inconsistency in meta-analyses.

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

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