Brief Report

Lifetime prevalence and underdiagnosis of migraine in a population sample of Mexican women

Cephalalgia 0(0) 1–5 ! International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0333102414529196 cep.sagepub.com

C Arroyo-Quiroz1, T Kurth2,3, C Cantu-Brito4, R Lopez-Ridaura1, I Romieu5 and M Lajous1,6,7 Abstract Objective: The objective of this report is to evaluate migraine, migraine characteristics, and underdiagnosis of migraine in a large population sample of Mexican women. Methods: Participants are part of a prospective cohort of Mexican teachers. Between 2011 and 2013, 77,855 participants completed a detailed questionnaire on headache characteristics. Migraine was defined according to criteria of the International Classification of Headache Disorders (ICDH-II). Results: We found lifetime migraine prevalence was 19%, prevalence peaked at 40–44 years (20.4%) and only 45.1% participants with migraine had a previous diagnosis of the disease. Conclusion: Estimated lifetime prevalence of migraine was higher than previous reports in Latin America. Migraine may be underdiagnosed and undertreated in Mexico despite its considerable burden. Keywords Migraine prevalence, migraine underdiagnosis, migraine epidemiology Date received: 30 October 2013; revised: 14 January 2014; accepted: 1 March 2014

Introduction Migraine is ranked as one of the 10 leading causes of disability worldwide (1) and is associated with a number of neurological, cardiovascular and psychiatric diseases (2–4).The prevalence of migraine among adults is 11% (16% in women and 6% in men) (5), and it is somewhat higher in Western countries as compared to other regions of the world. In Latin America it is estimated that fewer than 10% of adults are affected (6), yet, despite its considerable burden, migraine is underdiagnosed and undertreated (5). There is only limited information on the prevalence, diagnosis and characteristics of migraine in Mexico. In this study, we sought to evaluate migraine and migraine characteristics in a large population sample of Mexican women.

Methods The Mexican Teachers’ Cohort (MTC, ESMaestras) is a prospective study of 115,343 Mexican female teachers who responded to a questionnaire on lifestyle, reproductive factors and medical conditions in 2006–2008. In the first follow-up cycle (2011–2013), 77,855

participants updated their information and completed a detailed questionnaire on headache and headache characteristics. After excluding 6807 (8.7%) participants with missing values in headache-related questions, the final study population was 71,048. Participants were first asked: Have you ever had a headache that was not 1

Center for Research on Population Health, National Institute of Public Health, Mexico 2 Inserm Research Center for Epidemiology and Biostatistics (U897) – Team Neuroepidemiology, France 3 University of Bordeaux, France 4 Department of Neurology and Psychiatry, National Institute of Medical Sciences and Nutrition, Mexico 5 International Agency for Research on Cancer, France 6 Department of Epidemiology, Harvard School of Public Health, USA 7 National Institute of Health and Medical Research (INSERM), Center for Research in Epidemiology and Population Health (CESP), U1018, Gustave-Roussy Cancer Institute, France Corresponding author: Martin Lajous, Center for Research on Population Health, Instituto Nacional de Salud Pu´blica, 7a Cerrada Fray Pedro de Gante # 50, Mexico City 14000, Mexico. Email: [email protected]

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caused by a head injury, hangover or an illness such as a cold or the flu? Participants who responded yes were asked to respond to the following set of questions: Have you had at least 5 attacks (in all of your life) fulfilling the following criteria: a) Lasts a minimum of 4 hours without treatment and a maximum of 72 hours; b) Pain is predominantly on one side of the head; c) Throbbing pain; d) Moderate or severe pain intensity (which limits normal daily activities or forces you to rest); e) Pain is worsened by physical activity (like walking or walking up stairs); f) Pain is associated to nausea or vomiting; g) Pain is worsened by light or noise. In

addition to a positive answer to the first screening question, women were considered to have migraine if they answered yes to a) and either f) or g), and yes to at least one of b), c), d) or e). Aura episodes were self-reported according to the following question: How frequently do you experience changes in your vision (or auras) with this painful headache?, which was made after a small introduction to this section that stated: ‘‘Auras are changes in vision, numbness or tingling in the body, that are experienced with a headache or followed by it; however, sometimes they may be experienced without any headache.’’ Our definition of migraine is based on the

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Lifetime prevalence and underdiagnosis of migraine in a population sample of Mexican women.

The objective of this report is to evaluate migraine, migraine characteristics, and underdiagnosis of migraine in a large population sample of Mexican...
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