ISSN 0017-8748 doi: 10.1111/head.12482 Published by Wiley Periodicals, Inc.
Headache © 2015 American Headache Society
Feature Article The Prevalence and Burden of Migraine and Severe Headache in the United States: Updated Statistics From Government Health Surveillance Studies Rebecca C. Burch, MD; Stephen Loder, BA; Elizabeth Loder, MD, MPH; Todd A. Smitherman, PhD
Background and Objectives.—The US National Center for Health Statistics, which is part of the Centers for Disease Control, conducts ongoing public health surveillance activities. The US Armed Forces also maintains a comprehensive database of medical information. We aimed to identify the most current prevalence estimates of migraine and severe headache in the United States adult civilian and active duty service populations from these national government surveys, to assess stability of prevalence estimates over time, and to identify additional information pertinent to the burden and treatment of migraine and other severe headache conditions. Methods.—We searched for the most current publicly available summary statistics from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the National Health Interview Survey (NHIS). Summary data from the Defense Medical Surveillance System were also obtained, and PubMed was also searched for publications reporting summary statistics based on these studies. Data were abstracted, double-checked for accuracy, and summarized over time periods and as a function of demographic variables. Results.—14.2% of US adults 18 or older reported having migraine or severe headache in the previous 3 months in the 2012 NHIS. The overall age-adjusted 3-month prevalence of migraine in females was 19.1% and in males 9.0%, but varied substantially depending on age. The prevalence of migraine was highest in females 18-44, where the 3-month prevalence of migraine or severe headache was 23.5%. The 3-month prevalence of migraine or severe headache has remained relatively stable over the period of 2005-2012, with an average prevalence of 20.2% in females, 9.4% in males, and 20.2% overall. During this time, the average female to male sex ratio for migraine or severe headache was 2.17. The unadjusted 1-year prevalence of migraine in active duty US military service members varied from 1% to 1.9% between 1998 and 2010, ranging from 0.7% to 1.2% in males and 3.5% to 6% in females. The 1-year prevalence of “other headache” in this military population ranged from a low of 1.9% in 2003 to a high of 3% in 2010. Headache or pain in the head was the fourth leading cause of visits to the emergency department (ED) in 2009-2010, accounting for 3.1% of all ED visits. Across all ambulatory care settings, migraine accounted for 0.5% of all visits and other headache presentations for 0.4% of all ambulatory care visits. 52.8% of all visits for migraine occurred in primary care settings, 23.2% in specialty outpatient settings, and 16.7% in EDs. In 2010, opioids were administered at 35% of ED visits for headache, while triptans were administered in only 1.5% of visits. Conclusions.—This report summarizes the most recent government statistics on the prevalence and burden of migraine and severe headache in the US civilian and active duty military populations. The prevalence of migraine headaches is high, affecting roughly 1 out of every 7 Americans annually, and has remained relatively stable over the last 8 years. Migraine and headache are leading causes of outpatient and ED visits and remain an important public health problem, particularly among women during their reproductive years.
From the Graham Headache Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (R.C. Burch); Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, MA, USA (S. Loder); Division of Headache and Pain, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (E. Loder); Department of Psychology, University of Mississippi, Oxford, MS, USA (T.A. Smitherman). Address all correspondence to R.C. Burch, 1153 Centre Street – Suite 4970, Boston, MA 02130, USA. Accepted for publication September 23, 2014.
21
22
January 2015
Key words: headache, migraine, prevalence, epidemiology, military (Headache 2015;55:21-34)
Migraine and other recurrent headache disorders are prominent causes of personal suffering and decreased economic productivity. It is therefore important to have an accurate picture of the prevalence, burden, and treatment of migraine and severe headache in the United States. In a previous report, we summarized data from nationally representative epidemiologic studies to characterize the prevalence and burden of headache in the United States.1 In this paper, we sought to identify the most recent statistics on the prevalence and burden of migraine in adults from large, nationally representative government health surveillance studies. Our aims were to update prior national prevalence estimates, to evaluate the stability of migraine and severe headache prevalence estimates over time, and to identify other information relevant to the burden and treatment of these disorders.
METHODS We searched the National Center for Health Statistics and Medical Surveillance Monthly Report websites using the term “migraine” to identify reports of summary data from nationally representative or other population-based surveillance studies conducted by the US government in the last 5 years.To be eligible for inclusion, studies had to report US-wide data on the prevalence or burden of migraine or severe headache in adults. For each source of information, we identified the most recent available statistics. In selected cases, we abstracted data from previous years to evaluate the stability of estimates over time. Data sources included in this review were the National Health Interview Survey (NHIS), the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the Defense Medical Surveillance System (DMSS). The National Health and Nutrition Examination Survey stopped collecting information about migraine and severe headache in 2004, so no statistics from that study are
included in this paper. The key characteristics of these studies are described in Table 1 and a brief description of each is presented below. The NHIS.—NHIS has been conducted every year since 1957. It produces cross-sectional information on the US population based on structured interviews conducted with adults drawn from a representative sample of households and “non-institutional group quarters” (eg, dormitories) across the geographical regions of the United States. Racial and ethnic minorities are oversampled to compensate for historically lower rates of response. All adult members of selected households available at the time of the interview are asked to complete the Family Core component of the interview, and an adult selected at random is chosen to answer the Sample Adult Questionnaire. This includes the question “During the past 3 months, did you have . . . severe headache or migraine?” The survey also obtains standardized information about sociodemographic details and healthcare use.2 The DMSS.—DMSS is a comprehensive database of medical surveillance information for the US military, and is thus a population-based national database. Each individual active duty armed services member has a longitudinal record in the database, which is updated with information from each healthcare encounter in the military healthcare system.The database includes data for current and previous diagnoses and medical events as well as longitudinal data on both medical history and deployment history. Data for outpatient encounters are collected for active duty service members, activated Reserves and National Guard, and other beneficiaries of the military healthcare system. Diagnoses are categorized by International Classification of Disease (ICD) codes in use at the time of the encounter. All codes for 346 (“migraine”) were considered diagnoses of migraine, and all other diagnostic codes that specified non-migraine headache were considered “other headache.”A patient who received any diagnosis of migraine was considered to have migraine, even if other headache diagnoses had been
Headache
23 Table 1.—Data Sources and Characteristics
Survey and Year (URL)
Sample and Size
Design
Headache-Relevant Data
NHIS, 2012 (http://www.cdc.gov/nchs/ data/series/sr_10/ sr10_252.pdf)
Adults 18 years of age or older; n = 27,157, response rate 60.8%
Multistage cluster sample of US households; data collected via structured interview at the level of individual respondents.
“During the past 3 months did you have severe headache or migraine?” Respondents were instructed to report pain that had lasted a whole day or more and not to report fleeting or minor aches or pains.
NAMCS, 2010 (http://www.cdc.gov/nchs/ ahcd.htm)
1,482 physicians participated, with 31,229 patient record forms completed
Sampling of visits to office-based physician settings (including community health centers but excluding anesthesiologists, pathologists, and radiologists). Physicians provide data on up to 30 patient visits during a randomly assigned 1-week period. Data collected are a sample of visits, not patients.
Principal reason for visit and medications given. Headacherelevant reasons for a visit are limited to: S210 Headache, pain in head; S410.1 Sinus headache; and D365.0 Migraine. Headache-relevant diagnoses are ICD-9 CM 784.0 (headache) and 346.0 (migraine).
NHAMCS, 2010 (http://www.cdc.gov/nchs/ ahcd.htm)
357 hospitals participated, with 34,936 patient record forms completed
Sampling of visits to hospital settings (outpatient, emergency, and surgery centers) across geographic regions. Medical staff provide data on a random sample of patient visits during a randomly selected 4-week period. Data collected are a sample of visits, not patients.
Data captured include patient-stated reasons for visits, physician diagnoses, and testing and medications used. Headache-relevant reasons for a visit are limited to: S210 Headache, pain in head; S410.1 Sinus headache; and D365.0 Migraine. Headache-relevant diagnoses are ICD-9 CM 784.0 (headache) and 346.0 (migraine).
DMSS (http://www.afhsc.mil/ dmss)
9.9 million past and present active duty service members in the US armed forces
Central repository for medical encounter, diagnosis, deployment information. Information is updated with each encounter.
Data are captured using ICD-9 codes for various types of headaches.
recorded. Summary data were initially reported in the Medical Surveillance Monthly Report in February 2012.3 As access to the database itself is restricted to Department of Defense researchers, we contacted the authors and were given access to their extracted summary data. The NAMCS.—NAMCS began in 1973 and has been conducted yearly since 1989. It produces crosssectional information on outpatient visits to nonfederally employed, office-based physicians providing direct patient care (excluding anesthesiologists, pathologists, and radiologists). Trained interviewers visit physicians to train them in survey procedures and the use of data collection forms. Physicians provide data for a randomly assigned 1-week report-
ing period. Data collected include symptoms, diagnoses, medication prescriptions, and other treatments. Patient-reported principal reasons for visits are categorized using the “Reason for Visit Classification” of the American Medical Records Association, and physician diagnoses are classified according to the ICD, Ninth Revision, Clinical Modification (ICD-9_CM). The NHAMCS.—NHAMCS produces crosssectional information on services provided in hospital-based ambulatory care settings including emergency departments (EDs), hospital outpatient departments and clinics, and, since 2009, ambulatory surgery centers. Like NAMCS, NHAMCS produces information on visits rather than patients. The survey is designed to obtain a geographically representative
24 sample of hospitals in the 50 states and District of Columbia, excluding Federal, military, or Veterans Administration hospitals. Trained interviewers visit selected facilities to train staff in data collection procedures using the Patient Record form. Data on a random sample of patient visits over a 4-week period is collected, including chief medical complaint, diagnoses, testing/procedures, medications administered, and demographic information. The patient-reported reasons for visit and physician diagnoses are classified, as in NAMCS, using the “Reason for Visit Classification” and ICD-9_CM. A dynamic search tool for both the NAMCS and NHAMCS is available at http://www.cdc.gov/nchs/hdi.htm. The main outcome measures were: self-reported prevalence of migraine or severe headache in the preceding 3 months (NHIS); 1-year period prevalence for migraine or other headache diagnoses, and encounter rates for these diagnoses (DMSS); frequency of outpatient visits for headache, sinus headache, or migraine, and medications prescribed at those visits (NAMCS); and frequency of ED visits for headache, sinus headache, migraine, and testing and medications associated with those visits (NHAMCS). Unless otherwise specified, reported estimates have been age and sex standardized to the US population. Trends in prevalence data over time were examined using 8 consecutive years of survey data from NHIS.
RESULTS The NHIS.—The most recent NHIS data are from 2012 and are summarized in Table 2.2 These show that, overall, 14.1% of those interviewed reported experiencing migraine or severe headache during the 3 months before the interview. Pain elsewhere in the head or neck region was also commonly reported, with 14% of adults reporting neck pain and 5% reporting pain in the face or jaw area in the last 3 months. When examined across various demographic variables, migraine was roughly twice as common in women as men, and was more common in whites and blacks than Asians. Respondents who were unemployed or employed only part time were more likely to report headaches than those working full time. Migraine prevalence was inversely related to income, and also varied according to insurance status.
January 2015 Figure 1 shows the age-adjusted 3-month population prevalence overall and by sex for migraine or severe headache from 2005 to 2012. For the population overall, 3-month prevalence ranged from a low of 12.3% in 2007 to a high of 16.6% in 2010. For women, it ranged from 17.2% in 2007 to 22.1% in 2011, and for men from 7.3% in 2007 to 11.0% in 2010. Figure 2 shows the 2005-2012 average age-adjusted 3-month prevalence of migraine or severe headache in the population overall and by sex. Figure 3 displays the female to male sex ratio for migraine or severe headache from 2005 to 2012 (ie, headache prevalence in females divided by headache prevalence in males). This varied from a low of 2.0 in 2010 to a high of 2.36 in 2007, but never fell below 2. The DMSS.—Data were reported for active component service members on active duty at the beginning of each year from 1998 to 2010.3 Detailed data, provided by Armed Forces Health Surveillance Center staff, are available in Appendix A. Figure 4 shows the unadjusted 1-year prevalence of migraine in active duty service members from 1998 to 2010. One percent of active duty service members in 1998 were diagnosed with migraine, including 0.7% of males and 3.5% of females. The most recent 1-year prevalence data were reported for 2010, when 1.9% of service members received a diagnosis of migraine, including 1.2% of males and 6% of females. Figure 5 demonstrates that the prevalence of migraine in both sexes increased over the study period, with a slightly greater increase in males (84.9% increase vs 73.6% increase in females.) One-year prevalence did not differ meaningfully by age in 1998, but increases in migraine prevalence were greatest in the 25 to 44-year-old and over 44-year-old age groups. The most recent prevalence data show that migraine among active duty military personnel is most common in the 35 to 44-year-old age group (2.45%) and least common in the 17 to 24-year-old age group (1.4%). Both the number of encounters for both migraine and other headache diagnoses and the encounter rates per 10,000 person-years increased over the study period. Encounter rates were much lower in males than females (Fig. 6). Males were evaluated for
Headache
25 Table 2.—Summary Data From the National Health Interview Study
Selected Characteristic
Total 3-month prevalence (age-adjusted) Male Female Education Less than a high school diploma High school diploma or GED Some college Bachelor’s degree or higher Employment status Employed Full-time Part-time Not employed, worked previously Not employed, never worked Income level 44
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
1.05 0.67 3.46
1.27 0.82 4.07
1.30 0.80 4.3
1.28 0.77 4.26
1.33 0.79 4.41
1.41 0.83 4.71
1.54 0.9 5.19
1.56 0.93 5.23
1.63 0.97 5.53
1.64 1.02 5.38
1.74 1.09 5.68
1.79 1.12 5.83
1.91 1.23 6
0.99 1.02 1.18 1.26
1.26 1.26 1.3 1.4
1.25 1.32 1.33 1.38
1.18 1.36 1.3 1.35
1.24 1.4 1.37 1.47
1.34 1.47 1.43 1.55
1.43 1.63 1.58 1.66
1.38 1.67 1.7 1.77
1.46 1.72 1.75 1.86
1.43 1.78 1.82 1.7
1.46 1.88 2.04 1.9
1.46 1.95 2.14 1.92
1.43 2.12 2.45 2.17
One-year prevalence of “other headache” in active duty service members in the US Armed Forces.
34
January 2015 All figures are percentages.
Overall Males Females Age 17-24 25-34 35-44 >44
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2.14 1.73 4.69
2.29 1.88 4.81
2.28 1.87 4.69
2.05 1.68 4.18
2 1.66 4
1.92 1.59 3.81
1.95 1.62 3.86
1.79 1.5 3.5
1.99 1.69 3.74
2.26 1.99 3.86
2.6 2.31 4.34
2.79 2.46 4.79
3.06 2.68 5.34
2.74 1.79 1.73 1.9
2.93 1.95 1.82 1.88
2.97 1.86 1.76 1.83
2.59 1.75 1.58 1.59
2.48 1.7 1.6 1.59
2.34 1.67 1.53 1.51
2.33 1.72 1.59 1.76
2.11 1.57 1.56 1.66
2.41 1.77 1.59 1.69
2.73 2.02 1.8 1.91
3.07 2.39 2.11 2.12
3.28 2.56 2.27 2.4
3.47 2.87 2.66 2.67
Encounter rates for migraine by sex and year.
Rates are per 10,000 person-years.
Male Female
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
106.5 600
131.2 722.9
132.8 792.9
135.5 815.6
143 874.1
175.1 1034.9
181 1109.8
188.1 1105.5
201.3 1143.8
221.3 1158.4
242.7 1261.2
245 1303
276.1 1366.6
APPENDIX B: NHIS 2012 ADDITIONAL DATA
Selected characteristic
Total 3 month prevalence (age-adjusted) 65 and over by insurance status Private Medicare and Medicaid Medicare only Other Uninsured Marital status Married Widowed Divorced or separated Never married Living with a partner
Migraine/Severe Headache % (Standard Error)
Pain in Neck† % (Standard Error)
Pain in Face or Jaw‡ % (Standard Error)
14.1 (0.26)
13.9 (0.25)
4.8 (0.15)
4.7 9.7 5.8 7.3 21.3
14.5 22.3 12.4 13.4 19.6
3.4 7.9 3.6 3.2 –
13.1 21.6 19.3 13.5 16.9
13.5 18.7 19.0 11.8 17.2
4.1 9.8 9.8 4.4 6.3
†Respondents were asked “During the past three months, did you have neck pain?” (lasting a whole day or more). ‡Respondents were asked “During the past three months, did you have facial ache or pain in the jaw muscles or the joint in front of the ear?” (lasting a whole day or more).
Headache © 2015 American Headache Society
Feature Article The Prevalence and Burden of Migraine and Severe Headache in the United States: Updated Statistics From Government Health Surveillance Studies Rebecca C. Burch, MD; Stephen Loder, BA; Elizabeth Loder, MD, MPH; Todd A. Smitherman, PhD
Background and Objectives.—The US National Center for Health Statistics, which is part of the Centers for Disease Control, conducts ongoing public health surveillance activities. The US Armed Forces also maintains a comprehensive database of medical information. We aimed to identify the most current prevalence estimates of migraine and severe headache in the United States adult civilian and active duty service populations from these national government surveys, to assess stability of prevalence estimates over time, and to identify additional information pertinent to the burden and treatment of migraine and other severe headache conditions. Methods.—We searched for the most current publicly available summary statistics from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the National Health Interview Survey (NHIS). Summary data from the Defense Medical Surveillance System were also obtained, and PubMed was also searched for publications reporting summary statistics based on these studies. Data were abstracted, double-checked for accuracy, and summarized over time periods and as a function of demographic variables. Results.—14.2% of US adults 18 or older reported having migraine or severe headache in the previous 3 months in the 2012 NHIS. The overall age-adjusted 3-month prevalence of migraine in females was 19.1% and in males 9.0%, but varied substantially depending on age. The prevalence of migraine was highest in females 18-44, where the 3-month prevalence of migraine or severe headache was 23.5%. The 3-month prevalence of migraine or severe headache has remained relatively stable over the period of 2005-2012, with an average prevalence of 20.2% in females, 9.4% in males, and 20.2% overall. During this time, the average female to male sex ratio for migraine or severe headache was 2.17. The unadjusted 1-year prevalence of migraine in active duty US military service members varied from 1% to 1.9% between 1998 and 2010, ranging from 0.7% to 1.2% in males and 3.5% to 6% in females. The 1-year prevalence of “other headache” in this military population ranged from a low of 1.9% in 2003 to a high of 3% in 2010. Headache or pain in the head was the fourth leading cause of visits to the emergency department (ED) in 2009-2010, accounting for 3.1% of all ED visits. Across all ambulatory care settings, migraine accounted for 0.5% of all visits and other headache presentations for 0.4% of all ambulatory care visits. 52.8% of all visits for migraine occurred in primary care settings, 23.2% in specialty outpatient settings, and 16.7% in EDs. In 2010, opioids were administered at 35% of ED visits for headache, while triptans were administered in only 1.5% of visits. Conclusions.—This report summarizes the most recent government statistics on the prevalence and burden of migraine and severe headache in the US civilian and active duty military populations. The prevalence of migraine headaches is high, affecting roughly 1 out of every 7 Americans annually, and has remained relatively stable over the last 8 years. Migraine and headache are leading causes of outpatient and ED visits and remain an important public health problem, particularly among women during their reproductive years.
From the Graham Headache Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (R.C. Burch); Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, MA, USA (S. Loder); Division of Headache and Pain, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (E. Loder); Department of Psychology, University of Mississippi, Oxford, MS, USA (T.A. Smitherman). Address all correspondence to R.C. Burch, 1153 Centre Street – Suite 4970, Boston, MA 02130, USA. Accepted for publication September 23, 2014.
21
22
January 2015
Key words: headache, migraine, prevalence, epidemiology, military (Headache 2015;55:21-34)
Migraine and other recurrent headache disorders are prominent causes of personal suffering and decreased economic productivity. It is therefore important to have an accurate picture of the prevalence, burden, and treatment of migraine and severe headache in the United States. In a previous report, we summarized data from nationally representative epidemiologic studies to characterize the prevalence and burden of headache in the United States.1 In this paper, we sought to identify the most recent statistics on the prevalence and burden of migraine in adults from large, nationally representative government health surveillance studies. Our aims were to update prior national prevalence estimates, to evaluate the stability of migraine and severe headache prevalence estimates over time, and to identify other information relevant to the burden and treatment of these disorders.
METHODS We searched the National Center for Health Statistics and Medical Surveillance Monthly Report websites using the term “migraine” to identify reports of summary data from nationally representative or other population-based surveillance studies conducted by the US government in the last 5 years.To be eligible for inclusion, studies had to report US-wide data on the prevalence or burden of migraine or severe headache in adults. For each source of information, we identified the most recent available statistics. In selected cases, we abstracted data from previous years to evaluate the stability of estimates over time. Data sources included in this review were the National Health Interview Survey (NHIS), the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the Defense Medical Surveillance System (DMSS). The National Health and Nutrition Examination Survey stopped collecting information about migraine and severe headache in 2004, so no statistics from that study are
included in this paper. The key characteristics of these studies are described in Table 1 and a brief description of each is presented below. The NHIS.—NHIS has been conducted every year since 1957. It produces cross-sectional information on the US population based on structured interviews conducted with adults drawn from a representative sample of households and “non-institutional group quarters” (eg, dormitories) across the geographical regions of the United States. Racial and ethnic minorities are oversampled to compensate for historically lower rates of response. All adult members of selected households available at the time of the interview are asked to complete the Family Core component of the interview, and an adult selected at random is chosen to answer the Sample Adult Questionnaire. This includes the question “During the past 3 months, did you have . . . severe headache or migraine?” The survey also obtains standardized information about sociodemographic details and healthcare use.2 The DMSS.—DMSS is a comprehensive database of medical surveillance information for the US military, and is thus a population-based national database. Each individual active duty armed services member has a longitudinal record in the database, which is updated with information from each healthcare encounter in the military healthcare system.The database includes data for current and previous diagnoses and medical events as well as longitudinal data on both medical history and deployment history. Data for outpatient encounters are collected for active duty service members, activated Reserves and National Guard, and other beneficiaries of the military healthcare system. Diagnoses are categorized by International Classification of Disease (ICD) codes in use at the time of the encounter. All codes for 346 (“migraine”) were considered diagnoses of migraine, and all other diagnostic codes that specified non-migraine headache were considered “other headache.”A patient who received any diagnosis of migraine was considered to have migraine, even if other headache diagnoses had been
Headache
23 Table 1.—Data Sources and Characteristics
Survey and Year (URL)
Sample and Size
Design
Headache-Relevant Data
NHIS, 2012 (http://www.cdc.gov/nchs/ data/series/sr_10/ sr10_252.pdf)
Adults 18 years of age or older; n = 27,157, response rate 60.8%
Multistage cluster sample of US households; data collected via structured interview at the level of individual respondents.
“During the past 3 months did you have severe headache or migraine?” Respondents were instructed to report pain that had lasted a whole day or more and not to report fleeting or minor aches or pains.
NAMCS, 2010 (http://www.cdc.gov/nchs/ ahcd.htm)
1,482 physicians participated, with 31,229 patient record forms completed
Sampling of visits to office-based physician settings (including community health centers but excluding anesthesiologists, pathologists, and radiologists). Physicians provide data on up to 30 patient visits during a randomly assigned 1-week period. Data collected are a sample of visits, not patients.
Principal reason for visit and medications given. Headacherelevant reasons for a visit are limited to: S210 Headache, pain in head; S410.1 Sinus headache; and D365.0 Migraine. Headache-relevant diagnoses are ICD-9 CM 784.0 (headache) and 346.0 (migraine).
NHAMCS, 2010 (http://www.cdc.gov/nchs/ ahcd.htm)
357 hospitals participated, with 34,936 patient record forms completed
Sampling of visits to hospital settings (outpatient, emergency, and surgery centers) across geographic regions. Medical staff provide data on a random sample of patient visits during a randomly selected 4-week period. Data collected are a sample of visits, not patients.
Data captured include patient-stated reasons for visits, physician diagnoses, and testing and medications used. Headache-relevant reasons for a visit are limited to: S210 Headache, pain in head; S410.1 Sinus headache; and D365.0 Migraine. Headache-relevant diagnoses are ICD-9 CM 784.0 (headache) and 346.0 (migraine).
DMSS (http://www.afhsc.mil/ dmss)
9.9 million past and present active duty service members in the US armed forces
Central repository for medical encounter, diagnosis, deployment information. Information is updated with each encounter.
Data are captured using ICD-9 codes for various types of headaches.
recorded. Summary data were initially reported in the Medical Surveillance Monthly Report in February 2012.3 As access to the database itself is restricted to Department of Defense researchers, we contacted the authors and were given access to their extracted summary data. The NAMCS.—NAMCS began in 1973 and has been conducted yearly since 1989. It produces crosssectional information on outpatient visits to nonfederally employed, office-based physicians providing direct patient care (excluding anesthesiologists, pathologists, and radiologists). Trained interviewers visit physicians to train them in survey procedures and the use of data collection forms. Physicians provide data for a randomly assigned 1-week report-
ing period. Data collected include symptoms, diagnoses, medication prescriptions, and other treatments. Patient-reported principal reasons for visits are categorized using the “Reason for Visit Classification” of the American Medical Records Association, and physician diagnoses are classified according to the ICD, Ninth Revision, Clinical Modification (ICD-9_CM). The NHAMCS.—NHAMCS produces crosssectional information on services provided in hospital-based ambulatory care settings including emergency departments (EDs), hospital outpatient departments and clinics, and, since 2009, ambulatory surgery centers. Like NAMCS, NHAMCS produces information on visits rather than patients. The survey is designed to obtain a geographically representative
24 sample of hospitals in the 50 states and District of Columbia, excluding Federal, military, or Veterans Administration hospitals. Trained interviewers visit selected facilities to train staff in data collection procedures using the Patient Record form. Data on a random sample of patient visits over a 4-week period is collected, including chief medical complaint, diagnoses, testing/procedures, medications administered, and demographic information. The patient-reported reasons for visit and physician diagnoses are classified, as in NAMCS, using the “Reason for Visit Classification” and ICD-9_CM. A dynamic search tool for both the NAMCS and NHAMCS is available at http://www.cdc.gov/nchs/hdi.htm. The main outcome measures were: self-reported prevalence of migraine or severe headache in the preceding 3 months (NHIS); 1-year period prevalence for migraine or other headache diagnoses, and encounter rates for these diagnoses (DMSS); frequency of outpatient visits for headache, sinus headache, or migraine, and medications prescribed at those visits (NAMCS); and frequency of ED visits for headache, sinus headache, migraine, and testing and medications associated with those visits (NHAMCS). Unless otherwise specified, reported estimates have been age and sex standardized to the US population. Trends in prevalence data over time were examined using 8 consecutive years of survey data from NHIS.
RESULTS The NHIS.—The most recent NHIS data are from 2012 and are summarized in Table 2.2 These show that, overall, 14.1% of those interviewed reported experiencing migraine or severe headache during the 3 months before the interview. Pain elsewhere in the head or neck region was also commonly reported, with 14% of adults reporting neck pain and 5% reporting pain in the face or jaw area in the last 3 months. When examined across various demographic variables, migraine was roughly twice as common in women as men, and was more common in whites and blacks than Asians. Respondents who were unemployed or employed only part time were more likely to report headaches than those working full time. Migraine prevalence was inversely related to income, and also varied according to insurance status.
January 2015 Figure 1 shows the age-adjusted 3-month population prevalence overall and by sex for migraine or severe headache from 2005 to 2012. For the population overall, 3-month prevalence ranged from a low of 12.3% in 2007 to a high of 16.6% in 2010. For women, it ranged from 17.2% in 2007 to 22.1% in 2011, and for men from 7.3% in 2007 to 11.0% in 2010. Figure 2 shows the 2005-2012 average age-adjusted 3-month prevalence of migraine or severe headache in the population overall and by sex. Figure 3 displays the female to male sex ratio for migraine or severe headache from 2005 to 2012 (ie, headache prevalence in females divided by headache prevalence in males). This varied from a low of 2.0 in 2010 to a high of 2.36 in 2007, but never fell below 2. The DMSS.—Data were reported for active component service members on active duty at the beginning of each year from 1998 to 2010.3 Detailed data, provided by Armed Forces Health Surveillance Center staff, are available in Appendix A. Figure 4 shows the unadjusted 1-year prevalence of migraine in active duty service members from 1998 to 2010. One percent of active duty service members in 1998 were diagnosed with migraine, including 0.7% of males and 3.5% of females. The most recent 1-year prevalence data were reported for 2010, when 1.9% of service members received a diagnosis of migraine, including 1.2% of males and 6% of females. Figure 5 demonstrates that the prevalence of migraine in both sexes increased over the study period, with a slightly greater increase in males (84.9% increase vs 73.6% increase in females.) One-year prevalence did not differ meaningfully by age in 1998, but increases in migraine prevalence were greatest in the 25 to 44-year-old and over 44-year-old age groups. The most recent prevalence data show that migraine among active duty military personnel is most common in the 35 to 44-year-old age group (2.45%) and least common in the 17 to 24-year-old age group (1.4%). Both the number of encounters for both migraine and other headache diagnoses and the encounter rates per 10,000 person-years increased over the study period. Encounter rates were much lower in males than females (Fig. 6). Males were evaluated for
Headache
25 Table 2.—Summary Data From the National Health Interview Study
Selected Characteristic
Total 3-month prevalence (age-adjusted) Male Female Education Less than a high school diploma High school diploma or GED Some college Bachelor’s degree or higher Employment status Employed Full-time Part-time Not employed, worked previously Not employed, never worked Income level 44
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
1.05 0.67 3.46
1.27 0.82 4.07
1.30 0.80 4.3
1.28 0.77 4.26
1.33 0.79 4.41
1.41 0.83 4.71
1.54 0.9 5.19
1.56 0.93 5.23
1.63 0.97 5.53
1.64 1.02 5.38
1.74 1.09 5.68
1.79 1.12 5.83
1.91 1.23 6
0.99 1.02 1.18 1.26
1.26 1.26 1.3 1.4
1.25 1.32 1.33 1.38
1.18 1.36 1.3 1.35
1.24 1.4 1.37 1.47
1.34 1.47 1.43 1.55
1.43 1.63 1.58 1.66
1.38 1.67 1.7 1.77
1.46 1.72 1.75 1.86
1.43 1.78 1.82 1.7
1.46 1.88 2.04 1.9
1.46 1.95 2.14 1.92
1.43 2.12 2.45 2.17
One-year prevalence of “other headache” in active duty service members in the US Armed Forces.
34
January 2015 All figures are percentages.
Overall Males Females Age 17-24 25-34 35-44 >44
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2.14 1.73 4.69
2.29 1.88 4.81
2.28 1.87 4.69
2.05 1.68 4.18
2 1.66 4
1.92 1.59 3.81
1.95 1.62 3.86
1.79 1.5 3.5
1.99 1.69 3.74
2.26 1.99 3.86
2.6 2.31 4.34
2.79 2.46 4.79
3.06 2.68 5.34
2.74 1.79 1.73 1.9
2.93 1.95 1.82 1.88
2.97 1.86 1.76 1.83
2.59 1.75 1.58 1.59
2.48 1.7 1.6 1.59
2.34 1.67 1.53 1.51
2.33 1.72 1.59 1.76
2.11 1.57 1.56 1.66
2.41 1.77 1.59 1.69
2.73 2.02 1.8 1.91
3.07 2.39 2.11 2.12
3.28 2.56 2.27 2.4
3.47 2.87 2.66 2.67
Encounter rates for migraine by sex and year.
Rates are per 10,000 person-years.
Male Female
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
106.5 600
131.2 722.9
132.8 792.9
135.5 815.6
143 874.1
175.1 1034.9
181 1109.8
188.1 1105.5
201.3 1143.8
221.3 1158.4
242.7 1261.2
245 1303
276.1 1366.6
APPENDIX B: NHIS 2012 ADDITIONAL DATA
Selected characteristic
Total 3 month prevalence (age-adjusted) 65 and over by insurance status Private Medicare and Medicaid Medicare only Other Uninsured Marital status Married Widowed Divorced or separated Never married Living with a partner
Migraine/Severe Headache % (Standard Error)
Pain in Neck† % (Standard Error)
Pain in Face or Jaw‡ % (Standard Error)
14.1 (0.26)
13.9 (0.25)
4.8 (0.15)
4.7 9.7 5.8 7.3 21.3
14.5 22.3 12.4 13.4 19.6
3.4 7.9 3.6 3.2 –
13.1 21.6 19.3 13.5 16.9
13.5 18.7 19.0 11.8 17.2
4.1 9.8 9.8 4.4 6.3
†Respondents were asked “During the past three months, did you have neck pain?” (lasting a whole day or more). ‡Respondents were asked “During the past three months, did you have facial ache or pain in the jaw muscles or the joint in front of the ear?” (lasting a whole day or more).
