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18-09-2011 | Internal medicine | Article

Migraine patients have increased long-term risk for other headache types


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MedWire News: Study findings suggest that migraine is a more common condition than previously believed and the majority of patients with this condition develop other headache subtypes in the long term.

Indeed, "the cumulative 30 year prevalence rates of subtypes of headache are substantially greater than those derived from cross sectional and retrospective studies of headaches," explain Kathleen Merikangas (National Institutes of Health, Bethesda, Maryland, USA) and colleagues.

And in the study, 84% of participants with migraine with aura at one interview reported a different type of headache at a later interview, add the authors in the BMJ.

Among a group of 591 Swiss individuals aged approximately 20 years, migraine with aura, migraine without aura, and tension-type headaches occurred at respective mean rates of 0.9%, 10.9%, and 11.5% per year. Over a 30-year follow-up period, the respective headache types occurred at cumulative rates of 3.0%, 36.0%, and 29.5%.

Merikangas and colleagues explain that most reported cases of migraine without aura were short lived and present for a mean period of 33.7 days per year.

Only 20% of these cases recurred over a period of more than 15 years. The authors note that tension-type headaches were more common among men than women, whereas migraine with and without aura was more prevalent among women than men.

Specifically, total 30-year tension headache rates were 31.4% in men and 24.6% in women, migraine without aura rates were 20.7% in men and 50.7% in women, and migraine with aura rates were 2.1% in men and 3.9% in women.

Interviews with the study participants revealed that work impairment, distress, and disability frequently occurred as a direct consequence of having headaches.

This, say Merikangas et al, supports "international evidence that migraine is one of the top 10 leading causes of disability worldwide."

When long-term headache patterns were assessed, the findings revealed that 69% of individuals with any migraine type continued to have migraine with or without another type of headache over the 30 years of follow-up.

"The findings have important implications for health policy and for the clinical care, classification, and study of migraine and other headaches," say Merikangas and team.

They conclude: "Clinicians should attempt to obtain maximal information on the history, including ancillary information where possible, rather than relying on the clinical presentation in treatment decision making."

By Lauretta Ihonor

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