Stability of headache subtype over long term follow up

January 01, 0001

Stability of headache subtype over long term follow up

Various types of headaches have differing treatment regimens. These US and Swiss researchers looked at the prevalence, impact, and stability of different headache types over 30 years. They performed a prospective cohort study involving 591 nineteen and twenty year olds from a cohort of 4547 residents of Zurich, Switzerland. Enrollees were interviewed seven times over the 30 year follow-up.

The researchers found: "The average one year prevalences of subtypes of headache were 0.9% (female:male ratio of 2.8) for migraine with aura, 10.9% (female:male ratio of 2.2) for migraine without aura, and 11.5% (female:male ratio of 1.2) for tension-type headache. Cumulative 30 year prevalences of headache subtypes were 3.0% for migraine with aura, 36.0% for migraine without aura, and 29.3% for tension-type headache. Despite the high prevalence of migraine without aura, most cases were transient and only about 20% continued to have migraine for more than half of the follow-up period. 69% of participants with migraine and 58% of those with tension-type headache manifested the same predominant subtype over time. However, the prospective stability of the predominant headache subtypes was quite low, with substantial crossover among the subtypes and no specific ordinal pattern of progression. A gradient of severity of clinical correlates and service use was present across headache subtypes. The greatest effect was for migraine with aura followed by migraine without aura, and then tension-type headache and unclassified headaches."

The researchers concluded: "These findings highlight the importance of prospective follow-up of people with headache. The substantial longitudinal overlap among subtypes of headache shows the developmental heterogeneity of headache syndromes. Studies of the causes of headache that apply diagnostic nomenclature based on distinctions between discrete headache subtypes may not capture the true nature of headache in the general population."

People suffering from specific headache syndromes may experience a change in headache subtypes over time.

For the full abstract, click here.

BMJ 343:d5076, 25 August 2011 © 2011 BMJ Publishing Group Ltd.
Magnitude, impact, and stability of primary headache subtypes: 30 year prospective Swiss cohort study. Kathleen R Merikangas, Lihong Cui, Amanda Kalaydjian Richardson, et al. Correspondence to K R Merikangas: [email protected]

Category: N. Neurological. Keywords: headaches, migraine, aura, tension, heterogeneity, prospective cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 27 September 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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