Severe headache and migraine remain significant public health problems, and their prevalence has been stable for years, according to a review published online ahead of print March 12 in Headache. Results confirm that “migraine disproportionately affects women and several other historically disadvantaged segments of the population,” according to the authors. “These inequities could be exacerbated if new high-cost treatments are inaccessible to those who need them most.”
Rebecca Burch, MD, Instructor in Neurology at Harvard Medical School in Boston, and colleagues reviewed population-based US government surveys to obtain updated estimates of the prevalence of migraine and severe headache in adults. The authors examined the most recent data from the National Health Interview Survey, the National Hospital Ambulatory Medical Care Survey, and the National Ambulatory Medical Care Survey.
The most recent National Health Interview Survey data were from 2015. They indicated that the overall prevalence of migraine or severe headache was 15.3%. The prevalence was 20.7% in women and 9.7% in men. The age group with the highest prevalence of migraine (17.9%) included patients between ages 18 and 44. Prevalence was 15.9% in people between ages 45 and 64.
The prevalence of migraine or severe headache also varied by race. The highest prevalence (20.3%) was among native Hawaiians and other Pacific islanders. Prevalence was 18.4% among American Indians or Alaska natives, 16.2% among blacks or African Americans, 15.4% among whites, and 11.3% among Asians.
Data indicated that prevalence varied with income and insurance status. People living below the poverty line had a prevalence of 21.7%, and those with an annual family income of less than $35,000 had a prevalence of 19.9%. For people younger than 65, prevalence was higher in people insured by Medicaid (26.0%), compared with people with private insurance (15.1%) or no insurance (17.1%).
The most recent data for the National Hospital Ambulatory Medical Care Survey were from 2014. In that year, headache or pain in the head prompted approximately four million emergency department visits. Women of childbearing age made more than half of emergency department visits for headache.
Headache or pain in the head accounted for 3.0% of all emergency department visits and was the fifth leading cause of visits to the emergency department, as reported by patients. Headache was the 12th most common diagnosis among emergency department physicians (1.8% of all visits). It was the sixth most common diagnosis for women aged 15 to 64 (1.7%), and migraine was the 15th most common for this population (0.8%). Headache was the 19th most common diagnosis among men between ages 15 and 64 (0.5%).
No new data about headache or head pain from the National Ambulatory Medical Care Survey were available. Headache has not been among the top 20 reasons for outpatient visits since the 2009–2010 survey.
“It is important to understand the distribution of headache in specific segments of the population,” said Dr. Burch and colleagues. “This can guide efforts to ensure that treatments are accessible to those with the highest level of need.”
Burch R, Rizzoli P, Loder E. The prevalence and impact of migraine and severe headache in the United States: figures and trends from government health studies. Headache. 2018 Mar 12 [Epub ahead of print].