Epidemiology of headache in the Republic of San Marino.

Abstract

SUMMARY An epidemiological survey on headache was performed in the Republic of San Marino, which is the smallest independent State in the world, located near the Adriatic Coast, within Italy. Among a random sample of 1500 inhabitants over 7 years of age the frequency of headache, severe headache and migraine in the previous year was 35 3%, 12-2%, 9-3% respectively for men, and 46-2%, 20-6%, 18% for women. The most common factors reported to provoke headache were emotional stress, physical strain, lack of sleep, particular foods or drinks and for women menstruation. Migraine patients differed from people without headache in that they had a higher consumption of coffee, more frequently reported bad sleep, allergic disease and previous appendectomy. Furthermore, migraine patients and severe headache sufferers had a higher diastolic blood pressure than non headache subjects. The first three parts concerned general demographic findings, life habits and past medical history. The first question of the fourth part was: "Do you suffer or have you suffered over the past year from headache?" In the case of an affirmative answer the questionnaire was completed. Otherwise people were asked if they had suffered from headache in the past and if such headache was frequent or rare, at which age it had begun and ended and the questionnaire was stopped. Blood pressure was taken with a standard mercury manometer on the right arm, with the subject sitting, at the end of the third part of the questionnaire and before the first question of the fourth part. Interviewers were trained at the Headache Centre of our Clinic where they interviewed together 50 patients with headache under the supervision of a physician expert on headache. Subsequently they did 80 cross-interviews to volunteer inhabitants of San Marino encountered in government offices and 20 children in primary and junior schools. Agreement between the two interviewers ranged from 76% to 100% depending on single items. Agreement between the two interviewers on the major questions is shown in table 1. Among people who answered the questionnaire a random sample of 80 suffering from headache were invited to come forward to be interviewed and examined by a neurologist expert on headache. Sixtyone of them agreed to be examined. All 42 people who answered affirmatively to question No 65 were also interviewed (personally or by telephone) by two of us in order to ascertain classic migraine cases.Among 346 people who refused to answer the questionnaire we interviewed 169 (84 men, 85 women) of them by telephone, asking if they suffered from headache and its severity. Distribution by age and sex of the whole popu-21

Headaches and the Treatment of Blood Pressure

“…These sources of bias are regression dilution bias arising from the fluctuation on blood pressure in each individual person 42 and the failure of some studies to adjust for age in the statistical analysis, which introduces bias because blood pressure increases with increasing age but the prevalence of headaches declines. 9,12,16,20 Whether these factors are sufficient to account for the absence of an association in many cross-sectional studies is uncertain. The conclusion that the 4 classes of blood pressure-lowering drugs reduce the prevalence of headache by about a third (whatever the mechanism) is firm, but the issue of whether higher blood pressure per se causes headache remains unresolved.…”

“…4 Subsequent explanations were that anger-or anxiety-induced hyperventilation may both cause headache and raise blood pressure. 5,6 Cross-sectional studies have generally shown no association between blood pressure and headache, 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] reinforcing the prevailing view that there is no link with headache 22 or that, if there is, the headaches are attributable to anxiety and tension induced by being told one has "hypertension." 23 Recently, an editorial asked, "Why does the hypertension headache myth persist?"…”

Epidemiology of headache in Europe

“…‘do you suffer from headache?’‘do you have intense headache?’, ‘do you have repeated headaches?’, etc). In studies reporting the 1‐year prevalence of headache with a screening question specifying some headache degree, the prevalence rates vary between 29 and 49% among adults [40–43]. In those with higher figures [11,44], the exact way of questioning has not been given.…”

A face-to-face interview of participants in HUNT 3: the impact of the screening question on headache prevalence

“…One or a few screening questions that limit the study population are commonly used [e.g., 2–12]. Validation of the method is always required in epidemiological surveys [1, 13], and it should include evaluation of headache prevalence among screen-negative individuals if a screening question is used.…”