Chapter 17

Headache is a common pain symptom that inflicts a substantial burden on individual sufferers and on society. Headache has many causes; a range of headache diagnoses was defined by the International Headache Society (IHS) in 1988.1 The IHS distinguishes two broad groups of headache disorders: primary headache disorders and secondary headache disorders. Secondary headache disorders result from an underlying condition, such as a sinus infection or brain tumor. In primary headache disorders, the headache disorder is the fundamental problem. The two most common types of primary headache disorders are episodic tension-type headache (ETTH) and migraine.

The epidemiology of headache varies by headache type and demographics. ETTH, the most common headache type, affects slightly more women than men.2–7 Between the ages of 18 and 65, about 36% of men and 42% of women suffer from ETTH.8 In contrast, migraine occurs approximately three times more often in women than in men: approximately 18% of women and 6% of men between 12 and 80 years of age suffer from migraine.9,10

ETTH exerts a modest impact on the individual; however, the aggregate societal impact is high because the disorder is so prevalent. Although migraine is less common, individual attacks are considerably more painful and disabling and often result in lost work time. Because the societal impact of both ETTH and migraine is significant, this chapter focuses on the epidemiology of the two disorders. This chapter does not cover secondary headaches because the epidemiology of the underlying condition is an important determinant of the epidemiology of the related headaches. This chapter begins with a review of the diagnostic criteria for migraine and tension-type headache, followed by a review of migraine epidemiology, including incidence, prevalence, and public health impact. We close with a review of the epidemiology of tension-type headache.

Migraine is characterized by various combinations of neurologic, gastrointestinal, and autonomic changes that occur during different phases of the migraine attack. Although the IHS defines seven subtypes of migraine (IHS, 1.0), by far, the two most important are migraine without aura (IHS, 1.1) and migraine with aura (IHS, 1.2). The IHS definitions for migraine with and without aura are found in Tables 17-1 and 17-2. Migraine is both a diagnosis of inclusion, because specific diagnostic features are required, and a diagnosis of exclusion, because secondary headache disorders have to be eliminated based on the history, physical examination, or laboratory studies.

Table 17-1 International Headache Society (IHS) Diagnostic Criteria for Migraine Without Aura

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