Magnitude, impact, and stability of primary headache subtypes: 30 year prospective Swiss cohort study

Abstract

Objective To determine the prevalence, impact, and stability of different subtypes of headache in a 30 year prospective follow-up study of a general population sample. Design Prospective cohort study. Setting Canton of Zurich, Switzerland. Participants 591 people aged 19–20 from a cohort of 4547 residents of Zurich, Switzerland, interviewed seven times across 30 years of follow-up. Main outcome measures Prevalence of headache; stability of the predominant subtype of headache over time; and age of onset, severity, impact, family history, use of healthcare services, and drugs for headache subtypes. Results The average one year prevalences of subtypes of headache were 0.9% (female:male ratio of 2.8) for migraine with aura, 10.9% (female:male ratio of 2.2) for migraine without aura, and 11.5% (female:male ratio of 1.2) for tension-type headache. Cumulative 30 year prevalences of headache subtypes were 3.0% for migraine with aura, 36.0% for migraine without aura, and 29.3% for tension-type headache. Despite the high prevalence of migraine without aura, most cases were transient and only about 20% continued to have migraine for more than half of the follow-up period. 69% of participants with migraine and 58% of those with tension-type headache manifested the same predominant subtype over time. However, the prospective stability of the predominant headache subtypes was quite low, with substantial crossover among the subtypes and no specific ordinal pattern of progression. A gradient of severity of clinical correlates and service use was present across headache subtypes; the greatest effect was for migraine with aura followed by migraine without aura, and then tension-type headache and unclassified headaches. Conclusions These findings highlight the importance of prospective follow-up of people with headache. The substantial longitudinal overlap among subtypes of headache shows the developmental heterogeneity of headache syndromes. Studies of the causes of headache that apply diagnostic nomenclature based on distinctions between discrete headache subtypes may not capture the true nature of headache in the general population.

Potentially traumatic interpersonal events, psychological distress and recurrent headache in a population-based cohort of adolescents: the HUNT study

“…This may indicate that exposure to PTIEs predisposes to more severe and complex head pains,57 reflecting a pattern similar to that observed in the relationship between PTIE-exposure and comorbidity of psychiatric disorders 29. Such an interpretation complies with previous findings that migraines in general and combined migraines specifically tend to be clinically more severe and disabling, compared to TTH only 18 19. On the other hand, the observed discrepancies in strength of associations may be an artefact of underlying chronification of complaints, as migraine with TTH was more often experienced weekly or daily, as opposed to migraine or TTH only, which mostly recurred monthly.…”

“…Knowing that recurrent headaches are among the most common causes of disability in adults and adolescents alike,1 18 substantiated empirical evidence of a strong, consistent and cumulative relationship between exposure to PTIEs, psychological distress and recurrent headache, regardless of subtype, demands further investigation 23. We are currently at a stage where we recognise that childhood victimisation and adversities do little good for psychological and somatic health and development, and yet we lack valid, distinct and precise knowledge to guide public health interventions and clinical practice.…”

“…The aetiological factors, and pathways leading to the onset and chronification of headache disorders, are largely unknown,9 yet recognised as multifactorial, including heredity, age and sex, somatic, psychological and behavioural disorders,10 11 head injuries,12 unfavourable lifestyle (such as smoking, inactivity13 and inadequacy of sleep1) and lack of social and economic resources within families, in schools and societies 14–16. Despite distinguishing features related to migraine headaches, the primary headaches may in part share pathophysiological mechanisms, related to the chronification of disorders,9 17 reflected in an observed continuum of clinical severity, ranging from tension-type complaints, through migraine,18 to combined migraine with tension-type headache (TTH) 19…”

Temporal change in headache and its contribution to the risk of developing first-onset temporomandibular disorder in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study

“…In a 12-year prospective Danish population-based study, 42% of participants with migraine and 45% of participants with previous frequent episodic TTH experienced remission at follow-up, while 20% of participants with migraine and 16% of TTH sufferers developed chronic severe headaches [36]. In a 30-year prospective Swiss cohort study, only 21% of people with migraine and 7% of those with TTH continued to have the same headache for more than half of the follow-up period [39]. A bi-directional crossover of 20–25% between migraine and TTH was reported in a 7-year prospective study of a clinical sample of children and adolescents [29].…”

Tension-Type Headache: A Life-Course Review

“…Research suggests that the one-year prevalence rate of TTH changes during adulthood and that TTH is a dynamic condition [48,49]. For instance, rates of TTH increased from 79% to 87% over a 12-year period among young adults in Denmark [7].…”