Joshua N. Liberman

Prevalence of frequent headache in a population sample.

Purpose.—Patients with daily or near‐daily headaches are commonly seen in neurology practices and in headache subspecialty centers, but there is little information on the prevalence of this condition in the general population. We present the first US‐based study describing the prevalence and characteristics of frequent headache in the general population.

Migraine in the United States Epidemiology and patterns of health care use

ObjectiveTo determine the prevalence and distribution of migraine in the United States as well as current patterns of health care use. MethodsA random-digit-dial, computer-assisted telephone interview (CATI) survey was conducted in Philadelphia County, PA, in 1998. The CATI identifies individuals with migraine (categories 1.1 and 1.2) as defined by the diagnostic criteria of the International Headache Society with high sensitivity (85%) and specificity (96%). Interviews were completed in 4,376 subjects to identify 568 with migraine. Those with 6 or more attacks per year (n = 410) were invited to participate in a follow-up interview about health care utilization and family impact of migraine; 246 (60.0%) participated. ResultsThe 1-year prevalence of migraine was 17.2% in females and 6.0% in males. Prevalence was highest between the ages of 30 and 49. Whereas 48% of migraine sufferers had seen a doctor for headache within the last year (current consulters), 31% had never done so in their lifetimes and 21% had not seen a doctor for headache for at least 1 year (lapsed consulters). Of current or lapsed consulters, 73% reported a physician-made diagnosis of migraine; treatments varied. Of all migraine sufferers, 49% were treated with over-the-counter medications only, 23% with prescription medication only, 23% with both, and 5% with no medications at all. ConclusionRelative to prior cross-sectional surveys, epidemiologic profiles for migraine have remained stable in the United States over the last decade. Self-reported rates of current medical consultation have more than doubled. Moderate increases were seen in the percentage of migraine sufferers who use prescription medications and in the likelihood of receiving a physician diagnosis of migraine.

Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features.

Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features

Variation in migraine prevalence by race

Purpose: Estimates of migraine prevalence from African and Asian populations are lower than those observed in European and North American populations. To determine if these international differences reflect differences in cultural, environmental, or genetic factors, we compared the prevalence of migraine among Caucasians, African Americans, and Asian Americans in the United States. If genetic factors predominate, racial differences should persist in the United States. Methods: In Baltimore County, Maryland, 12,328 individuals 18 to 65 years of age were selected by random-digit dialing and interviewed by telephone about their headaches. Migraine diagnoses were assigned using International Headache Society criteria. Results: In women, migraine prevalence was significantly higher in Caucasians (20.4%) than in African (16.2%) or Asian (9.2%) Americans. A similar pattern was observed among men (8.6%, 7.2%, and 4.2%). African Americans were less likely to report nausea or vomiting with their attacks, but more likely to report higher levels of headache pain. In contrast, African Americans tended to be less disabled by their attacks than Caucasians. There were no statistically significant differences in associated features between Asian American and Caucasian migraineurs. Conclusions: In the United States, migraine prevalence is highest in Caucasians, followed by African Americans and Asian Americans. While differences in socioeconomic status, diet, and symptom reporting may contribute to differences in estimated prevalence, we suggest that race-related differences in genetic vulnerability to migraine are more likely to predominate as an explanatory factor. NEUROLOGY 1996;47: 52-59

The Prevalence and Disability Burden of Adult Migraine in England and their Relationships to Age, Gender and Ethnicity:

This study estimates the 1-year prevalence of migraine in adults in England in relation to the major demographic variables of age, gender and ethnicity, and describes some of its features, including aspects of consequential disability. A telephone survey was conducted of a random sample (n = 4007) of the population aged 16-65 years of mainland England using a previously validated diagnostic interview. The response rate was 76.5%. Overall, 7.6% of males and 18.3% of females reported migraine with or without aura within the last year meeting diagnostic criteria closely approximate to those of the International Headache Society. Prevalence of migraine varied with age, rising through early adult life and declining in the late 40s and early 50s. Prevalence was higher in Caucasians than in other races. Attack rates were ≥ 1/month in most migraineurs, and most experienced interference with daily activities in ≥ 50% of their attacks. On average, an estimated 5.7 working days were lost per year for every working or student migraineur, although the most disabled 10% accounted for 85% of the total. Results were in keeping with those from surveys in other countries. If these findings in mainland England are projected to the entire UK population, we estimate that 5.85 million people aged 16-65 years experience 190 000 migraine attacks every day and lose 25 million days from work or school each year because of them. Migraine is an important public health problem in the UK, associated with very substantial costs.

Obesity and migraine A population study

Objective: To assess the influence of body mass index (BMI) on the prevalence, attack frequency, and clinical features of migraine. Methods: In a population-based telephone interview study, the authors gathered information on headache, height, and weight. The 30,215 participants were divided into five categories, based on BMI: 1, underweight (<18.5), normal weight (18.5 to 24.9), overweight (25 to 29.9), obese (30 to 24.9), and morbidly obese (≥35). Migraine prevalence and modeled headache features were assessed as a function of BMI, adjusting by covariates (age, sex, marital status, income, medical treatment, depression). Results: Subjects were predominantly female (65% female) and in middle life (mean age 38.4). BMI group was not associated with the prevalence of migraine, but was associated with the frequency of headache attacks. In the normal weight group, 4.4% had 10 to 15 headache days per month, increasing to 5.8% of the overweight (odds ratio [OR] = 1.3), 13.6% of the obese (OR = 2.9), and 20.7% of the morbidly obese (OR = 5.7). The proportion of subjects with severe headache pain increased with BMI, doubling in the morbidly obese relative to the normally weighted (OR = 1.9). Similar significant associations were demonstrated with BMI category for disability, photophobia, and phonophobia. Conclusion: Though migraine prevalence is not associated with body mass index, attack frequency, severity, and clinical features of migraine increase with body mass index group.

Validity of the Migraine Disability Assessment (MIDAS) score in comparison to a diary-based measure in a population sample of migraine sufferers

&NA; The Migraine Disability Assessment (MIDAS) questionnaire is a brief, self‐administered questionnaire designed to quantify headache‐related disability over a 3 month period. The MIDAS score has been shown to have moderately high test–retest reliability in headache sufferers and is correlated with clinical judgment regarding the need for medical care. The aim of the study was to examine the validity of the MIDAS score, and the five items comprising the score, compared to data from a 90 day daily diary used, in part, to record acute disability from headache. In a population‐based sample, 144 clinically diagnosed migraine headache sufferers were enrolled in a 90 day diary study and completed the MIDAS questionnaire at the end of the study. The daily diary was used to record detailed information on headache features as well as activity limitations in work, household chores, and non‐work activities (social, family and leisure activities). The MIDAS score was the sum of missed work or school days, missed household chores days, missed non‐work activity days, and days at work or school plus days of household chores where productivity was reduced by half or more in the last 3 months. Validity was assessed by comparing MIDAS items and the MIDAS score with equivalent measures derived from the diary. The MIDAS items for missed days of work or school (mean 0.96, median 0) and for missed days of household work (mean 3.64, median 2.0) were similar to the corresponding diary‐based estimates of missed work or school (mean 1.23, median 0) and of missed household work (mean 3.93, median 2.01). Values for missed days of non‐work activities (MIDAS mean 2.6 and median 1 versus diary mean 2.22 and median 0.95) were also similar. Responses to MIDAS questions about number of days where productivity was reduced by half or more in work (mean 3.77, median 2.00) and in household work (mean 3.92, median 2.00) significantly overestimated the corresponding diary‐based measures for work (mean 2.94, median 1.06) and household work (mean 2.22, median 0.98). Nonetheless, the overall MIDAS score (mean 14.53, median 9.0) was not significantly different form the reference diary‐based measure (mean 13.5, median 8.4). The correlation between the MIDAS summary score and an equivalent diary score was 0.63. The group estimate of the MIDAS score was found to be a valid estimate of a rigorous diary‐based measure of disability. The mean and median values for the MIDAS score in a population‐based sample of migraine cases were similar to equivalent diary measures. The correlation between the two measures was in the low moderate range, but expected given that two very different methods of data collection were compared.

Medication Adherence Leads To Lower Health Care Use And Costs Despite Increased Drug Spending

Researchers have routinely found that improved medication adherence--getting people to take medicine prescribed for them--is associated with greatly reduced total health care use and costs. But previous studies do not provide strong evidence of a causal link. This article employs a more robust methodology to examine the relationship. Our results indicate that although improved medication adherence by people with four chronic vascular diseases increased pharmacy costs, it also produced substantial medical savings as a result of reductions in hospitalization and emergency department use. Our findings indicate that programs to improve medication adherence are worth consideration by insurers, government payers, and patients, as long as intervention costs do not exceed the estimated health care cost savings.

Health-related quality of life among adults with symptoms of overactive bladder: results from a U.S. community-based survey

OBJECTIVES To assess, by means of a survey, the impact of the symptoms of overactive bladder (urinary frequency, urgency, and urge incontinence) on the quality of life in a community-based sample of the U.S. population. METHODS A telephone survey was conducted in the United States among an age and sex-stratified sample of 4896 noninstitutionalized adults 18 years of age and older. From the responses to the telephone survey, a total of 483 individuals with symptoms of overactive bladder and 191 controls completed a mailed follow-up questionnaire to assess their quality of life using the Medical Outcomes Study Short-Form 20. RESULTS After adjustment for age, sex, and the use of medical care, the greatest differences in the quality-of-life scores between the patients with incontinent overactive bladders and the controls were in the health perception (17.6 points; P <0.001) and role functioning (13.0 points; P <0.001) scales. Those with an overactive bladder with the symptoms of frequency or urgency, or both, but without incontinence, also had significantly lower scores than did the controls in mental health (P = 0.026), health perception (P = 0.01), and bodily pain (P = 0.016). CONCLUSIONS These data indicate that individuals with an overactive bladder experience decrements in their quality of life relative to community controls. An important new finding from this study is that individuals with an overactive bladder, even without demonstrable urine loss, also have a poorer quality of life than that of controls.

Age-dependent prevalence and clinical features of migraine

Background: Available data suggest two seemingly opposite trends with regard to the natural history of migraine. Migraine prevalence decreases with age. In some individuals, migraine progresses to chronic daily headache. Objective: To contrast the clinical features of migraine across the life span. Methods: A validated computer-assisted telephone interview (CATI) was used to identify a population sample in three urban centers in the United States. Eligible participants were older than 18 years. The CATI covered the International Classification of Headache Disorders criteria for migraine and probable migraine (PM). Prevalence and clinical features of migraine and PM were examined by age. Results: This sample consists of 145,335 participants. The overall prevalence of migraine was 15%, whereas the overall prevalence of PM was 14.6%. Migraine prevalence was highest between ages 30 and 39 years. In older ages, PM was more prevalent than migraine. Among those with migraine, the prevalence of unilateral and throbbing pain peaked at intermediate ages and declined after that. The prevalence of photophobia and phonophobia related to the attacks declined with ages, whereas the prevalence of aura increased. The proportion of those with 10 to 14 headache days per month also increased, from 12.5% in those ages 18 to 29 to 41.0% (odds ratio = 4.8, 95% CI = 3.9 to 7.1) in those older than 70. Conclusion: The profile of migraine changes over the life span and suggests three nonexclusive profiles. In many, migraine remits. In some patients with migraine, attacks get less typical, resembling probable migraine instead of full migraine. In some, migraine progresses.