Prevalence of frequent headache in young Finnish adults starting a family

Association between dysmenorrhea and chronic pain: a systematic review and meta-analysis of population-based studies

OBJECTIVE

The objective of the study was to synthesize the epidemiological findings for the associations between dysmenorrhea, including primary dysmenorrhea and endometriosis-associated dysmenorrhea and any chronic pain conditions, including chronic pelvic pain, and chronic nonpelvic pain.

DATA SOURCES

The data sources included PubMed, Embase, and CINAHL from inception to December 2019.

STUDY ELIGIBILITY CRITERIA

The study criteria included observational population-based studies in which the relationship between dysmenorrhea and the presence or severity of chronic pain was examined.

STUDY APPRAISAL AND SYNTHESIS METHODS

Each study was double coded and evaluated for bias based on the modified Newcastle and Ottawa Scale. Random-effect meta-analyses were conducted to quantify the associations between dysmenorrhea and the presence of chronic pelvic and nonpelvic pain.

RESULTS

Out of 9452 records, 32 studies were included, with 14 reporting associations between dysmenorrhea and chronic pelvic pain, and 20 for dysmenorrhea and chronic nonpelvic pain. Primary dysmenorrhea and endometriosis-associated dysmenorrhea were examined in 7 studies, respectively. More than 30% of the studies were categorized as poor quality, 56% as moderate, and 12.5% as high. Dysmenorrhea was positively associated with both the presence and severity of chronic pelvic and nonpelvic pain conditions. Based on 6689 women from 8 studies, those with chronic pelvic pain had 2.43 (95% confidence interval, 1.98-2.99, I², 42%) times the odds of having dysmenorrhea compared with those without. Based on 3750 women from 11 studies, those with chronic nonpelvic pain had 2.62 (95% confidence interval, 1.84-3.72, I², 72%) times the odds of having dysmenorrhea compared with those without. Overall, dysmenorrhea was associated with 2.50 (95% confidence interval, 2.02-3.10) times the odds of chronic pain, which did not differ by chronic pelvic vs chronic nonpelvic pain, community vs clinical populations, or different geographical regions.

CONCLUSIONS

Dysmenorrhea may be a general risk factor for chronic pain, although whether primary dysmenorrhea increases the risk for chronic pain is unclear. Given that adolescence is a sensitive period for neurodevelopment, elucidating the role of primary dysmenorrhea in pain chronicity in future longitudinal studies is important for preventing both chronic pelvic and nonpelvic pain.

Changing Headache from Preschool Age to Puberty. A Controlled Study

The characteristics of disturbing primary headache and the occurrence of headache types were studied by sending a questionnaire to 1132 Finnish families of 6-year-old children. Children with headache in the preceding 6 months and their controls were clinically examined at the ages of 6 and 13. During the follow-up, half of the headaches, classified as migraine at age 6 years, were unchanged and 32% turned into tension-type headache. In children with tension-type headache, the situation was unchanged in 35%, and in 38% of children the headache type had changed to migraine. At preschool age the most common location of headache was bilateral and supraorbital, and at puberty bilateral and temporal. During the follow-up, symptoms concurrent with headache, such as odour phobia, dizziness and balance disturbances became more typical, whereas restlessness, flushing and abdominal symptoms became less marked. The early manifestation of both migraine and tension-type headache predict equally often migraine in puberty with marked changes in concurrent symptoms and pain localization.

Background morbidity of headache in an adult general population. Results of the Austrian SERMO (Self-Reported Morbidity) study

STUDY OBJECTIVE

To assess period and point prevalence of headache in Austria and the influence of sociodemographic factors and seasonal variations.

DESIGN

Data for the prevalence of headache were drawn from the database of seven representative surveys in the SERMO study (Self-Reported Morbidity Study). The aims of the SERMO study are to describe and monitor the characteristics of background morbidity in the Austrian population. The study is based on face-to-face interviews. Headache/migraine was one of 36 disorders the interviewed persons were asked about.

SETTING

The representative samples of the Austrian general population were selected by the "quota-procedure". Thus each cross sectional sample is representative for the entire Austrian population.

PARTICIPANTS

The study population consisted of 7,162 Austrian people over 15 years of age.

RESULTS

About one fifth (20.1%) of the Austrian adult population reported having headaches during the year (prevalence 26.4% in women vs. 13.0% in men, p<0.001). Period prevalences varied from 19.6% in August to 23.1% in October 1995. Mean point prevalence in the general population was 5.7% (3.6% in men vs. 7.7% in women, p<0.001). The highest point prevalence (8.0%) was observed among people over 60. Whereas period prevalence showed no trend with age or education, we found increasing point prevalence with age and lower levels of education. In general, significantly more people with self-reported headache suffered from stress (39.1% vs. 33.7%, p<0.001) and chronic diseases (33.6% vs. 23.2%, p<0.001) and took drugs regularly (all kinds of medication: 44.3% vs. 26.8%, p<0.001).

CONCLUSIONS

Headache is one of the most commonly experienced symptoms in Austria. The most common concomitant disease in the study population as a whole was hypertension. People with headache had a higher prevalence of hypertension, rheumatic diseases, venous diseases, diabetes and a higher consumption of drugs. Therefore, headache, as one aspect of multimorbidity or a symptom of other diseases, could be an indicator of impaired well-being and poor health.

Changes in headache prevalence between pre-school and pre-pubertal ages

The prevalence rates of headache in first-born children were determined at the ages of 6 and 12 years in over 1000 families. A headache questionnaire was mailed to 1132 families when the children were 6 years old, and to 1126 families when the children were 12 years old. Seven hundred and ninety-eight families responded to both questionnaires. The prevalence of headache before the 6 months preceding the questionnaire ('previous headache') was 19% when the children were 6 years of age and 31% when the children were 12 years of age. The corresponding prevalences of headache during the 6 months immediately proceeding the questionnaire ('present headache') were 16% and 19%. Variation in occurrence of headache was high during follow-up years. Maternal frequent headache (> or = 1/month) was significantly associated with the increase in prevalence of present headache in boys between the ages of 6 and 12 years. Frequent headache in mothers, fathers and siblings, and the occurrence of chronic illness, were also significantly associated with headache in the 12-year-old children.

Pain experience of children with headache and their families: A controlled study

OBJECTIVE

This study reports the pain sensitivity of children with headache and their family members, as well as the prevalence of recurring aches, psychosocial life, and family environment of children with headache at preschool age.

DESIGN

A representative population-based sample of 1443 families expecting their first child were followed over 7 years. A screening questionnaire relating to the child's headache was sent to parents of a representative sample of 1132 6-year-old children. Of 144 children suffering from headache, 106 (76%) were examined and interviewed clinically. Ninety-six children with primary headache (58 migraine and 38 tension-type headache children) and matched controls (n = 96) were included in further examinations.

RESULTS

Children with headache were more often extremely sensitive to pain according to their parents, were more excited about physical examinations, cried more often during blood sampling or vaccination, avoided play or games more often because they were afraid of hurting themselves, and had recurring abdominal and growing pains more often than did control children. The fathers of children with headache were more often extremely sensitive to pain. Children with headache reacted with somatic symptoms, usually with pain and functional intestinal disorders in stress situations, felt more tired, and had more ideations of death during the previous month. They had also had more problems in day care and fewer hobbies such as scout or club meetings than did control children. More mothers of tension-type headache children than those of migraine children reported that they were considerably sensitive to pain. Tension-type headache children also had a poorer family environment; the family atmosphere was more often unhappy and the relationship between the parents was more often distant than in the families of children with migraines.

CONCLUSIONS

In addition to somatic factors, it is important to consider the child's pain sensitivity, reaction to various stress situations, and family functioning when studying childhood headache. The child's coping mechanisms can be supported by information given by the parents. School entry can be considered a suitable period for careful investigation into possible occurrence of headache and also for giving information about headache and its management.

School start and occurrence of headache

OBJECTIVES

The purpose of the study was to examine the occurrence of childhood headache at the start of school.

STUDY DESIGN

An unselected population-based population-based questionnaire study on the occurrence of headache was conducted in 1433 children between the ages of 6 and 7 years old (ranging from 6 years 8 months to 7 years 8 months) who started school in 1992. The first questionnaire was given within 3 months of school entry in 1992. Of 1433 children, 1290 responded satisfactorily to the second headache questionnaire at the end of the second school year. The children (n = 725) who had had headache in 1994 were sent a more detailed questionnaire concerning risk factors of headache.

RESULTS

A significant increase in the incidence density of overall headache in children was found during the first 12 school months compared with the 6 months immediately before school started or with the subsequent 6 school months (13th-18th month). The increase was attributable to occasional headache. During the first school months, the frequency of headache increased in 20% of children who had had headache before the 6 months preceding the start of school. The mothers and fathers of 129 children who started to have headache after school entry had a higher socioeconomic status than the mothers and fathers of children who had headache before the start of school. No significant difference in family history of headache or school-related factors was found among children. Predictably, the incidence density of recurrent headache after school start was higher than before school start. However, occasional headache showed a distinct peak at school start but regained its initial level at the end of the second school year.

CONCLUSION

School start appears to increase the incidence of overall headache (occasional headache in particular) in children, independent of other factors.

Gender variations in clinical pain experience

This review is a critical summary of research examining gender variations in clinical pain experience. Gender-comparative pain research was identified through Medline and Psychlit searches and references obtained from bibliographies of pertinent papers and books. Review of this research demonstrates that women are more likely than men to experience a variety of recurrent pains. In addition, many women have moderate or severe pains from menstruation, pregnancy and childbirth. In most studies, women report more severe levels of pain, more frequent pain and pain of longer duration than do men. Women may be at greater risk for pain-related disability than men but women also respond more aggressively to pain through health related activities. Women may be more vulnerable than men to unwarranted psychogenic attributions by health care providers for pain. Underlying biological mechanisms of pain and the contribution of psychological and social factors as they contribute to the meaning of pain for women and men warrant greater attention in pain research.