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Original Article
Gender influences headache characteristics with increasing age in migraine patients
Cephalalgia 0(0) 1–9 ! International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0333102414559735 cep.sagepub.com
Hayrunnisa Bolay1,2, Aynur Ozge3, Petek Saginc2, Gulhan Orekici4, Derya Uludu¨z5, Osman Yalın2, Aksel Siva5, ¨ ztu¨rk8 S¸ebnem Bıc¸akc¸ı6, Ba¸sak Karakurum7 and Musa O Abstract Background and aims: Migraine headache is one of the most common primary headache disorders and is three times more prevalent in women than in men, especially during the reproductive ages. The neurobiological basis of the female dominance has been partly established. The present study aimed to investigate the effect of gender on the headache manifestations in migraine patients. Methods: The study group consisted of 2082 adult patients from five different hospitals’ tertiary care-based headache clinics. The relationship between headache characteristics and gender was evaluated in migraine with aura (MwA) and migraine without aura (MwoA). The duration, severity, frequency of headache and associated symptoms were evaluated in both genders and age-dependent variations and analyzed in two subgroups. Results: Women with migraine were prone to significantly longer duration and intensity of headache attacks. Nausea, phonophobia and photophobia were more prevalent in women. Median headache duration was also longer in women than in men in MwA (p ¼ 0.013) and MwoA (p < 0.001). Median headache intensity was higher in women than in men in MwA (p ¼ 0.010) and MwoA (p ¼ 0.009). The frequency of nausea was significantly higher in women than in men in MwA (p ¼ 0.049). Throbbing headache quality and associated features (nausea, photophobia, and phonophobia) were significantly more frequent in women than in men in MwoA. The gender impact varied across age groups and significant changes were seen in female migraineurs after age 30. No age-dependent variation was observed in male migraineurs. Conclusion: Gender has an influence on the characteristics of the headache as well as on the associated symptoms in migraine patients, and this impact varies across the age groups, particularly in women. Keywords Women, gender, migraine, aura, headache symptoms, attack duration, intensity, photophobia, nausea, phonophobia Date received: 11 December 2012; revised: 4 June 2014; 1 September 2014; 17 October 2014; accepted: 18 October 2014
Introduction Migraine is an important public health issue in all age groups as it causes disability and economic loss. Epidemiological studies have demonstrated a significant female preponderance of migraine worldwide with a ratio of 52% versus 37% (1–3). A recent population-based study in Turkey, which represents a population of both Asian and European origin, indicated that the prevalence of migraine headache is significantly higher in women (24%) than in men (12%) (4,5).
1 Department of Neurology and Algology, Gazi University School of Medicine, Turkey 2 Neuropsychiatry Centre, Gazi University School of Medicine, Turkey 3 Department of Neurology, Mersin University School of Medicine, Turkey 4 Department of Biostatistics, Mersin University School of Medicine, Turkey 5 Istanbul University, Cerrahpa¸sa School of Medicine, Turkey 6 C ¸ ukurova University School of Medicine, Turkey 7 Baskent University Faculty of Medicine, Turkey 8 Department of Second Neurology, Bakırkoy Training Hospital, Turkey
Corresponding author: Hayrunnisa Bolay, Department of Neurology and Algology, Neuropsychiatry Centre, Gazi University, Ankara, 06510 Turkey. Emails: [email protected]; [email protected]
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2 Migraine headache is three times more prevalent in women than in men, especially during the reproductive ages (6). The high prevalence of migraine in females is related to fluctuating levels of ovarian steroids to a great extent. Migraine frequency is high between puberty and menopause (7), and attacks are triggered by menstruation when the serum levels of estradiol and progesterone rapidly decline (8–10). Female sex steroids such as estrogen and progesterone also influence peripheral and central pain transmission via serotonergic, noradrenergic, glutamatergic, GABAergic and opioidergic neurotransmitter systems (11,12). However, persistence of the gender difference regarding the prevalence of migrainetype headache after menopause suggests that some other factors could also be involved. Pain susceptibility is also higher in females, even when healthy, independently of cycling hormone levels (13,14) and suggests an intrinsic gender difference. In this context, functional differences have been demonstrated in pain processing between the sexes even in healthy individuals (15–19). The sex difference affects functional brain circuits, with emotional circuitry apparently involved to a greater extent compared to sensory processing in migraine patients (20). Studies are either focused on epidemiology or the description of pain characteristics in the literature. A few investigators have noted a gender influence on the duration, severity or frequency of migraine headache. Kelman demonstrated a gender effect on the duration of a migraine attack, while primarily studying the pain characteristics of acute migraine attacks (21). Some other studies have also noted a gender influence on the duration and intensity of headache (22–24). Nonetheless, the headache features and associated symptoms have not been studied in relation to gender as the main interest. It is still not clear whether the diagnostic criteria for migraine differ for females and males. In this study, we aimed to test the hypothesis that gender has an impact on the clinical symptomatology of migraine. This broad-spectrum, case-controlled study conducted at our tertiary headache center consisting of multiple centers aimed to investigate whether the clinical diagnostic features of migraine such as duration, severity, frequency and the associated symptoms of nausea/vomiting, photophobia and phonophobia were different in females and males. To the best of our knowledge, this is the first study conducted with a detailed analysis of clinical variables according to gender with several age groups.
Methods Data collection Patients diagnosed by a neurologist after a face-to-face interview and proper neurological examination and
Cephalalgia 0(0) investigations were entered in headache database. After obtaining written informed consent from center representatives, the data of 9300 patients entered into the Headache Database from 1999 to 2009 were screened for study inclusion. The study protocol was approved by the coordination center (MEU.0.01.00.06/265, 20.10.2008). Consent was also obtained from patients to use their data for academic purposes. Patients’ personal data were blinded except for gender and age and reviewed by two headache specialists. Patients with the following features were excluded from the study: i) diagnosis other than migraine (according to the International Classification of Headache Disorders, first edition (ICHD-I) (25) and second edition (ICHD-II) (26)); ii) missing or non-evaluable data for gender, age, headache characteristics and associated symptoms; iii) pregnant patient or using hormones; and iv) younger than 18 years.
Data evaluation The data of 2082 patients pooled from five different university hospitals were included for the study and the database were analyzed for two migraine subtypes: The migraine with aura (MwA) group included patients with visual and sensory auras and the migraine without aura (MwoA) group included probable migraine without aura patients. The gender effect was further analyzed in both sexes using four different age groups: 18– 29, 30–39, 40–49, and 50þ years. Pain intensity was assessed using the visual analog scale (VAS). Descriptive analyses were performed as follows: The frequencies of MwA and MwoA by age and gender were determined. The pain properties for each type of pain (duration, intensity, frequency, laterality) and associated features of the patients were analyzed.
Statistics The Shapiro-Wilk Test was used to examine the frequency distribution of headache duration, intensity and frequency data to determine whether they fit into the normal distribution in the gender, age and headache groups. For the descriptive statistics, means and standard deviations were calculated in normally distributed groups such as for age, whereas medians and quartiles were used in groups that did not have a normal distribution. Nominal and percentage values are provided for categorical variables. Kruskal-Wallis analysis was used to determine whether there was a difference between the age groups in terms of headache duration, intensity and frequency. The Dunn test was used to compare the group means in pairs. The z-test was used for proportional comparison of headache features
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(CEP)
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Bolay et al. in both genders. Chi-square analysis was applied to test the relationship between the age groups and headache characteristics. The Bonferroni correction (p/k) (k ¼ 4) was applied for the prevention of inflation for type one error for the subgroup numbers that emerged during the sex-age interaction test. The error one ratio was accepted as 0.0125 for the sex-age interaction comparisons between the groups as a result. P values were reported without adjustment for multiplicity. The statistical evaluation of the data was performed using SPSS 11.5 and [email protected] software.
unilaterality of headache attacks. Nausea was more prevalent in women than in men (p ¼ 0.049) and was most marked in women in the 30- to 49-years age group (p ¼ 0.009). No significant gender or age impact was seen for vomiting. Phonophobia was more frequent in women than in men (p ¼ 0.033) and displayed an increase after the age of 30 years in women (p ¼ 0.021). Similarly photophobia was also more marked after the age of 30 years in women (p ¼ 0.015).
Results
Median headache duration was longer and increased after the age of 30 years in women compared to younger ages. On the other hand, headache duration was significantly different between women in the 18to 29-years age group and women aged 50þ years (p ¼ 0.0407) (Table 2 and Figure 2(a)). Mean VAS and headache frequency were significantly different between women in the 18- to 29-years and 40- to 49-years age groups (p ¼ 0.0355, p ¼ 0.0000) (Table 2 and Figure 2(b)). There was a significant difference between women in the 18- to 29-years and 40- to 49age groups (p ¼ 0.0000) and the 50þ years age group (p ¼ 0.0013) in headache frequency in the last month (Table 2 and Figure 2(c)). As seen in Table 3, no significant gender effect was seen regarding unilaterality. The prevalence of unilaterality decreased in women after the age of 50 years (p < 0.001). Nausea was more prevalent in women than in men (p < 0.001). More women reported nausea as a symptom after 30 years of age (p ¼ 0.007). No significant gender and age impact was seen for vomiting. Phonophobia was more frequent in women (p < 0.001) and more prevalent between 30 and 49 years (p ¼ 0.003). Photophobia was more prevalent in women (p < 0.001) and less prevalent after the age of 50 years in women (p ¼ 0.008).
The study covered a total of 2082 adult patients who were diagnosed with migraine. There was a nonsignificant difference between age according to gender in the two groups. A total of 312 MwA patients were included and the mean age was 46.43 13.04 years for the 276 women and 40.08 14.00 years for the 36 men. The MwoA group consisted of 1770 patients, of whom 1528 were female (mean age SD 45.34 12.70 years) and 242 were male (mean age SD 42.74 14.46 years).
MwA The median headache duration was longer in females, particularly after the age of 30 (p ¼ 0.0043) (Table 1). The 18- to 29-years age group females had longer headache duration compared to the 30- to 39-years (p ¼ 0.036), 40- to 49-years (p ¼ 0.0025) and 50þ years (p ¼ 0.0407) age groups (Figure 1(a)). There was no significant difference in the headache intensity among the groups (Table 1, Figure 1(b)). Women in the 18- to 29-years age group had a higher headache frequency than the 30- to 39-years age group (p ¼ 0.0308). (Table 1, Figure 1(c)). As seen in Table 2, there was no significant gender or age impact in the
MwoA
Table 1. The characteristics of headache attacks in migraine patients. 18–29
30–39
40–49
50
Migraine with aura
Med (Q1–Q3)a
Med (Q1–Q3)
Med (Q1–Q3)
Me (Q1–Q3)
Male
Frequency Duration Intensity
15.5 (6–25) 5 (4–6) 8 (6–9.5)
11 (8–22.5) 13.5 (4–42) 7 (5–8)
12 (6–25.5) 4 (4–48) 7 (6.25–7)
14 (10–30) 6 (4–24) 7 (5.5–8.5)
0.827 0.6141 0.690
Female
Frequency Duration Intensity
15 (7–30) 10 (4–24) 7.5 (6–8)
6.5b (4–15) 24b (5–48) 8 (7–10)
7 (3–15.25) 24b (12–48) 8 (7–10)
8 (3.75–15) 24b (4–48) 8 (7–10)
0.0389 0.0043 0.086
p
a Due to the lack of a normal distribution of the variables, median values have been used instead of means and deviations have been presented as quartiles 25 and 75 (Q1–Q3). b Significant changes of the 18- to 29-year age group compared to the other groups.
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4
Cephalalgia 0(0)
(a)
Migraine with Aura 120 *
100
†
Duration
80
†
†
60 40 20 0 All
(b)
30-39 50+ 18-29 40-49 Male
All
30-39 50+ 18-29 40-49 Female
(c)
Migraine with Aura
Migraine with Aura 35
11
†
*
10
30
9
25 Frequency
8 Intensity
Median 25%-75% Non-Outlier Range
7 6 5
20 15 10 5
4
0
3 2
-5 All
30-39 50+ 18-29 40-49 Male
All
30-39 50+ 18-29 40-49 Female
All
Median 25%-75% Non-Outlier Range
30-39 50+ 18-29 40-49 Male
All
30-39 50+ 18-29 40-49 Female
Median 25%-75% Non-Outlier Range
Figure 1. (a) The women in the 18- to 29-years age group had longer headache duration when compared with the 30- to 39(p ¼ 0.036), 40- to 49- (p ¼ 0.0025) and 50þ years age groups (p ¼ 0.0407). (b) There was no significant difference between the groups in terms of headache intensity. (c) Women in the 18- to 29-years age group reported higher headache frequency than the 30- to 39years age group (p ¼ 0.0308).
Table 2. Gender-dependent changes in clinical features. MwA
MwoA Age-dependent change
Age-dependent change
Headache features
Gender impact
Women
Men
Gender impact
Women
Men
Duration Intensity Frequency Unilaterality Nausea Vomiting Phonophobia Photophobia
Yes Yes No No Yes No Yes No
Yes No Yes No Yes No Yes Yes
No No No No No No No No
Yes Yes No No Yes No Yes Yes
Yes Yes Yes Yes Yes No Yes Yes
No No No No No No No No
MwA: migraine with aura; MwoA: migraine without aura.
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Bolay et al.
(a)
Migraine without Aura 120 †
*
100
†
Duration
80 60
†
40 20 0 All
(b)
30-39 50+ All 30-39 50+ 18-29 40-49 18-29 40-49 Male Female
(c)
Migraine without Aura
Median 25%-75% Non-Outlier Range
Migraine without Aura 35
11 †
*
10
†
30
9
†
25 Frequency
Intensity
8 7 6 5 4
20 15 10 5
3 0
2
-5
1 All
30-39 50+ 18-29 40-49 Male
All
30-39 50+ 18-29 40-49 Female
Median 25%-75% Non-Outlier Range
All
30-39 50+ 18-29 40-49 Male
All
30-39 50+ 18-29 40-49 Female
Median 25%-75% Non-Outlier Range
Figure 2. (a) Two-group comparisons showed that women in the 18- to 29-years age group and the 30- to 39-years age group (p ¼ 0.0062), 40-to 49-years age group (p ¼ 0.0002) and 50þ years age group (p ¼ 0.0000) had significant differences in headache duration. (b) There was a significant difference for headache intensity between women in the 18- to 29-years and 40- to 49-years age groups (p ¼ 0.0355). (c) Two-group comparisons showed that there was a significant difference for headache frequency in the last month between women in the 18- to 29-years age group and the 40- to 49-years age group (p ¼ 0.0000) and 50þ years age group (p ¼ 0.0013).
Table 3. The existence of gender impact and its variance with age in migraine patients. 18–29
30–39
40–49
50
Med (Q1–Q3)a
Med (Q1–Q3)
Med (Q1–Q3)
Med (Q1–Q3)
7 (3.25–12) 9 (4–24) 8 (5–9)
10 (3–15) 10 (4–24) 7 (5.75–9)
p Migraine without aura Male
Frequency Duration Intensity
8 (4–12) 5 (4–24) 8 (6–10)
Female
Frequency Duration Intensity
10 (4–20) 12 (4–24) 7 (6–9)
6.5 (4–15) 24b (6–24) 8 (7–9)
5b (3–12) 24b (6–48) 8b (7–10)
8 (3–15) 12 (4–24) 7 (6–9) 6b (3–14.25) 24b (6–48) 7 (7–10)
0.9275 0.2799 0.7947 0.0001
(CEP)
[1–9] [PREPRINTER stage]
Original Article
Gender influences headache characteristics with increasing age in migraine patients
Cephalalgia 0(0) 1–9 ! International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0333102414559735 cep.sagepub.com
Hayrunnisa Bolay1,2, Aynur Ozge3, Petek Saginc2, Gulhan Orekici4, Derya Uludu¨z5, Osman Yalın2, Aksel Siva5, ¨ ztu¨rk8 S¸ebnem Bıc¸akc¸ı6, Ba¸sak Karakurum7 and Musa O Abstract Background and aims: Migraine headache is one of the most common primary headache disorders and is three times more prevalent in women than in men, especially during the reproductive ages. The neurobiological basis of the female dominance has been partly established. The present study aimed to investigate the effect of gender on the headache manifestations in migraine patients. Methods: The study group consisted of 2082 adult patients from five different hospitals’ tertiary care-based headache clinics. The relationship between headache characteristics and gender was evaluated in migraine with aura (MwA) and migraine without aura (MwoA). The duration, severity, frequency of headache and associated symptoms were evaluated in both genders and age-dependent variations and analyzed in two subgroups. Results: Women with migraine were prone to significantly longer duration and intensity of headache attacks. Nausea, phonophobia and photophobia were more prevalent in women. Median headache duration was also longer in women than in men in MwA (p ¼ 0.013) and MwoA (p < 0.001). Median headache intensity was higher in women than in men in MwA (p ¼ 0.010) and MwoA (p ¼ 0.009). The frequency of nausea was significantly higher in women than in men in MwA (p ¼ 0.049). Throbbing headache quality and associated features (nausea, photophobia, and phonophobia) were significantly more frequent in women than in men in MwoA. The gender impact varied across age groups and significant changes were seen in female migraineurs after age 30. No age-dependent variation was observed in male migraineurs. Conclusion: Gender has an influence on the characteristics of the headache as well as on the associated symptoms in migraine patients, and this impact varies across the age groups, particularly in women. Keywords Women, gender, migraine, aura, headache symptoms, attack duration, intensity, photophobia, nausea, phonophobia Date received: 11 December 2012; revised: 4 June 2014; 1 September 2014; 17 October 2014; accepted: 18 October 2014
Introduction Migraine is an important public health issue in all age groups as it causes disability and economic loss. Epidemiological studies have demonstrated a significant female preponderance of migraine worldwide with a ratio of 52% versus 37% (1–3). A recent population-based study in Turkey, which represents a population of both Asian and European origin, indicated that the prevalence of migraine headache is significantly higher in women (24%) than in men (12%) (4,5).
1 Department of Neurology and Algology, Gazi University School of Medicine, Turkey 2 Neuropsychiatry Centre, Gazi University School of Medicine, Turkey 3 Department of Neurology, Mersin University School of Medicine, Turkey 4 Department of Biostatistics, Mersin University School of Medicine, Turkey 5 Istanbul University, Cerrahpa¸sa School of Medicine, Turkey 6 C ¸ ukurova University School of Medicine, Turkey 7 Baskent University Faculty of Medicine, Turkey 8 Department of Second Neurology, Bakırkoy Training Hospital, Turkey
Corresponding author: Hayrunnisa Bolay, Department of Neurology and Algology, Neuropsychiatry Centre, Gazi University, Ankara, 06510 Turkey. Emails: [email protected]; [email protected]
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(CEP)
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2 Migraine headache is three times more prevalent in women than in men, especially during the reproductive ages (6). The high prevalence of migraine in females is related to fluctuating levels of ovarian steroids to a great extent. Migraine frequency is high between puberty and menopause (7), and attacks are triggered by menstruation when the serum levels of estradiol and progesterone rapidly decline (8–10). Female sex steroids such as estrogen and progesterone also influence peripheral and central pain transmission via serotonergic, noradrenergic, glutamatergic, GABAergic and opioidergic neurotransmitter systems (11,12). However, persistence of the gender difference regarding the prevalence of migrainetype headache after menopause suggests that some other factors could also be involved. Pain susceptibility is also higher in females, even when healthy, independently of cycling hormone levels (13,14) and suggests an intrinsic gender difference. In this context, functional differences have been demonstrated in pain processing between the sexes even in healthy individuals (15–19). The sex difference affects functional brain circuits, with emotional circuitry apparently involved to a greater extent compared to sensory processing in migraine patients (20). Studies are either focused on epidemiology or the description of pain characteristics in the literature. A few investigators have noted a gender influence on the duration, severity or frequency of migraine headache. Kelman demonstrated a gender effect on the duration of a migraine attack, while primarily studying the pain characteristics of acute migraine attacks (21). Some other studies have also noted a gender influence on the duration and intensity of headache (22–24). Nonetheless, the headache features and associated symptoms have not been studied in relation to gender as the main interest. It is still not clear whether the diagnostic criteria for migraine differ for females and males. In this study, we aimed to test the hypothesis that gender has an impact on the clinical symptomatology of migraine. This broad-spectrum, case-controlled study conducted at our tertiary headache center consisting of multiple centers aimed to investigate whether the clinical diagnostic features of migraine such as duration, severity, frequency and the associated symptoms of nausea/vomiting, photophobia and phonophobia were different in females and males. To the best of our knowledge, this is the first study conducted with a detailed analysis of clinical variables according to gender with several age groups.
Methods Data collection Patients diagnosed by a neurologist after a face-to-face interview and proper neurological examination and
Cephalalgia 0(0) investigations were entered in headache database. After obtaining written informed consent from center representatives, the data of 9300 patients entered into the Headache Database from 1999 to 2009 were screened for study inclusion. The study protocol was approved by the coordination center (MEU.0.01.00.06/265, 20.10.2008). Consent was also obtained from patients to use their data for academic purposes. Patients’ personal data were blinded except for gender and age and reviewed by two headache specialists. Patients with the following features were excluded from the study: i) diagnosis other than migraine (according to the International Classification of Headache Disorders, first edition (ICHD-I) (25) and second edition (ICHD-II) (26)); ii) missing or non-evaluable data for gender, age, headache characteristics and associated symptoms; iii) pregnant patient or using hormones; and iv) younger than 18 years.
Data evaluation The data of 2082 patients pooled from five different university hospitals were included for the study and the database were analyzed for two migraine subtypes: The migraine with aura (MwA) group included patients with visual and sensory auras and the migraine without aura (MwoA) group included probable migraine without aura patients. The gender effect was further analyzed in both sexes using four different age groups: 18– 29, 30–39, 40–49, and 50þ years. Pain intensity was assessed using the visual analog scale (VAS). Descriptive analyses were performed as follows: The frequencies of MwA and MwoA by age and gender were determined. The pain properties for each type of pain (duration, intensity, frequency, laterality) and associated features of the patients were analyzed.
Statistics The Shapiro-Wilk Test was used to examine the frequency distribution of headache duration, intensity and frequency data to determine whether they fit into the normal distribution in the gender, age and headache groups. For the descriptive statistics, means and standard deviations were calculated in normally distributed groups such as for age, whereas medians and quartiles were used in groups that did not have a normal distribution. Nominal and percentage values are provided for categorical variables. Kruskal-Wallis analysis was used to determine whether there was a difference between the age groups in terms of headache duration, intensity and frequency. The Dunn test was used to compare the group means in pairs. The z-test was used for proportional comparison of headache features
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(CEP)
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3
Bolay et al. in both genders. Chi-square analysis was applied to test the relationship between the age groups and headache characteristics. The Bonferroni correction (p/k) (k ¼ 4) was applied for the prevention of inflation for type one error for the subgroup numbers that emerged during the sex-age interaction test. The error one ratio was accepted as 0.0125 for the sex-age interaction comparisons between the groups as a result. P values were reported without adjustment for multiplicity. The statistical evaluation of the data was performed using SPSS 11.5 and [email protected] software.
unilaterality of headache attacks. Nausea was more prevalent in women than in men (p ¼ 0.049) and was most marked in women in the 30- to 49-years age group (p ¼ 0.009). No significant gender or age impact was seen for vomiting. Phonophobia was more frequent in women than in men (p ¼ 0.033) and displayed an increase after the age of 30 years in women (p ¼ 0.021). Similarly photophobia was also more marked after the age of 30 years in women (p ¼ 0.015).
Results
Median headache duration was longer and increased after the age of 30 years in women compared to younger ages. On the other hand, headache duration was significantly different between women in the 18to 29-years age group and women aged 50þ years (p ¼ 0.0407) (Table 2 and Figure 2(a)). Mean VAS and headache frequency were significantly different between women in the 18- to 29-years and 40- to 49-years age groups (p ¼ 0.0355, p ¼ 0.0000) (Table 2 and Figure 2(b)). There was a significant difference between women in the 18- to 29-years and 40- to 49age groups (p ¼ 0.0000) and the 50þ years age group (p ¼ 0.0013) in headache frequency in the last month (Table 2 and Figure 2(c)). As seen in Table 3, no significant gender effect was seen regarding unilaterality. The prevalence of unilaterality decreased in women after the age of 50 years (p < 0.001). Nausea was more prevalent in women than in men (p < 0.001). More women reported nausea as a symptom after 30 years of age (p ¼ 0.007). No significant gender and age impact was seen for vomiting. Phonophobia was more frequent in women (p < 0.001) and more prevalent between 30 and 49 years (p ¼ 0.003). Photophobia was more prevalent in women (p < 0.001) and less prevalent after the age of 50 years in women (p ¼ 0.008).
The study covered a total of 2082 adult patients who were diagnosed with migraine. There was a nonsignificant difference between age according to gender in the two groups. A total of 312 MwA patients were included and the mean age was 46.43 13.04 years for the 276 women and 40.08 14.00 years for the 36 men. The MwoA group consisted of 1770 patients, of whom 1528 were female (mean age SD 45.34 12.70 years) and 242 were male (mean age SD 42.74 14.46 years).
MwA The median headache duration was longer in females, particularly after the age of 30 (p ¼ 0.0043) (Table 1). The 18- to 29-years age group females had longer headache duration compared to the 30- to 39-years (p ¼ 0.036), 40- to 49-years (p ¼ 0.0025) and 50þ years (p ¼ 0.0407) age groups (Figure 1(a)). There was no significant difference in the headache intensity among the groups (Table 1, Figure 1(b)). Women in the 18- to 29-years age group had a higher headache frequency than the 30- to 39-years age group (p ¼ 0.0308). (Table 1, Figure 1(c)). As seen in Table 2, there was no significant gender or age impact in the
MwoA
Table 1. The characteristics of headache attacks in migraine patients. 18–29
30–39
40–49
50
Migraine with aura
Med (Q1–Q3)a
Med (Q1–Q3)
Med (Q1–Q3)
Me (Q1–Q3)
Male
Frequency Duration Intensity
15.5 (6–25) 5 (4–6) 8 (6–9.5)
11 (8–22.5) 13.5 (4–42) 7 (5–8)
12 (6–25.5) 4 (4–48) 7 (6.25–7)
14 (10–30) 6 (4–24) 7 (5.5–8.5)
0.827 0.6141 0.690
Female
Frequency Duration Intensity
15 (7–30) 10 (4–24) 7.5 (6–8)
6.5b (4–15) 24b (5–48) 8 (7–10)
7 (3–15.25) 24b (12–48) 8 (7–10)
8 (3.75–15) 24b (4–48) 8 (7–10)
0.0389 0.0043 0.086
p
a Due to the lack of a normal distribution of the variables, median values have been used instead of means and deviations have been presented as quartiles 25 and 75 (Q1–Q3). b Significant changes of the 18- to 29-year age group compared to the other groups.
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[1–9] [PREPRINTER stage]
(CEP)
4
Cephalalgia 0(0)
(a)
Migraine with Aura 120 *
100
†
Duration
80
†
†
60 40 20 0 All
(b)
30-39 50+ 18-29 40-49 Male
All
30-39 50+ 18-29 40-49 Female
(c)
Migraine with Aura
Migraine with Aura 35
11
†
*
10
30
9
25 Frequency
8 Intensity
Median 25%-75% Non-Outlier Range
7 6 5
20 15 10 5
4
0
3 2
-5 All
30-39 50+ 18-29 40-49 Male
All
30-39 50+ 18-29 40-49 Female
All
Median 25%-75% Non-Outlier Range
30-39 50+ 18-29 40-49 Male
All
30-39 50+ 18-29 40-49 Female
Median 25%-75% Non-Outlier Range
Figure 1. (a) The women in the 18- to 29-years age group had longer headache duration when compared with the 30- to 39(p ¼ 0.036), 40- to 49- (p ¼ 0.0025) and 50þ years age groups (p ¼ 0.0407). (b) There was no significant difference between the groups in terms of headache intensity. (c) Women in the 18- to 29-years age group reported higher headache frequency than the 30- to 39years age group (p ¼ 0.0308).
Table 2. Gender-dependent changes in clinical features. MwA
MwoA Age-dependent change
Age-dependent change
Headache features
Gender impact
Women
Men
Gender impact
Women
Men
Duration Intensity Frequency Unilaterality Nausea Vomiting Phonophobia Photophobia
Yes Yes No No Yes No Yes No
Yes No Yes No Yes No Yes Yes
No No No No No No No No
Yes Yes No No Yes No Yes Yes
Yes Yes Yes Yes Yes No Yes Yes
No No No No No No No No
MwA: migraine with aura; MwoA: migraine without aura.
XML Template (2014) [21.11.2014–1:04pm] //blrnas3.glyph.com/cenpro/ApplicationFiles/Journals/SAGE/3B2/CEPJ/Vol00000/140183/APPFile/SG-CEPJ140183.3d
(CEP)
[1–9] [PREPRINTER stage]
5
Bolay et al.
(a)
Migraine without Aura 120 †
*
100
†
Duration
80 60
†
40 20 0 All
(b)
30-39 50+ All 30-39 50+ 18-29 40-49 18-29 40-49 Male Female
(c)
Migraine without Aura
Median 25%-75% Non-Outlier Range
Migraine without Aura 35
11 †
*
10
†
30
9
†
25 Frequency
Intensity
8 7 6 5 4
20 15 10 5
3 0
2
-5
1 All
30-39 50+ 18-29 40-49 Male
All
30-39 50+ 18-29 40-49 Female
Median 25%-75% Non-Outlier Range
All
30-39 50+ 18-29 40-49 Male
All
30-39 50+ 18-29 40-49 Female
Median 25%-75% Non-Outlier Range
Figure 2. (a) Two-group comparisons showed that women in the 18- to 29-years age group and the 30- to 39-years age group (p ¼ 0.0062), 40-to 49-years age group (p ¼ 0.0002) and 50þ years age group (p ¼ 0.0000) had significant differences in headache duration. (b) There was a significant difference for headache intensity between women in the 18- to 29-years and 40- to 49-years age groups (p ¼ 0.0355). (c) Two-group comparisons showed that there was a significant difference for headache frequency in the last month between women in the 18- to 29-years age group and the 40- to 49-years age group (p ¼ 0.0000) and 50þ years age group (p ¼ 0.0013).
Table 3. The existence of gender impact and its variance with age in migraine patients. 18–29
30–39
40–49
50
Med (Q1–Q3)a
Med (Q1–Q3)
Med (Q1–Q3)
Med (Q1–Q3)
7 (3.25–12) 9 (4–24) 8 (5–9)
10 (3–15) 10 (4–24) 7 (5.75–9)
p Migraine without aura Male
Frequency Duration Intensity
8 (4–12) 5 (4–24) 8 (6–10)
Female
Frequency Duration Intensity
10 (4–20) 12 (4–24) 7 (6–9)
6.5 (4–15) 24b (6–24) 8 (7–9)
5b (3–12) 24b (6–48) 8b (7–10)
8 (3–15) 12 (4–24) 7 (6–9) 6b (3–14.25) 24b (6–48) 7 (7–10)
0.9275 0.2799 0.7947 0.0001
