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Albers L, Kries RV, Straube A, Heinen F, Landgraf MN, Obermeier V, Ruscheweyh R. Age- and sex-specific first health care use for migraine in 2016 in children and adolescents from prospectively collected health insurance data in Germany. Cephalalgia 2019; 39:1156-1163. [PMID: 30974953 DOI: 10.1177/0333102419844543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Migraine in children and adolescents is associated with significant disability and a high risk of persistence into adulthood. OBJECTIVE Data on migraine incidence in children and adolescents are few and relatively coarse. To tailor interventions starting shortly after disease onset, detailed information on age- and sex-specific incidence of migraine in children and adolescents is needed. METHODS We used health care data prospectively collected by the BARMER statutory health insurance, representing ∼11% of the German population. The incidence of migraine diagnoses (International Classification of Diseases (ICD)-10 code G43) in the year 2016 was assessed in subjects aged 0-19 years, who had been continuously insured with the BARMER between 2005 and 2016 or during their entire lifespan. RESULTS Data from ∼1.2 million children and adolescents were available. The incidence of migraine diagnoses steadily increased with age, reaching ∼1% per year around the age of 10 for both sexes, and 3.49% per year in females and 1.72% per year in males at the age of 19. Incidences in males and females were similar up to the age of 13 and higher in females from there on. The proportion of incident migraine diagnoses specified as "definite" versus "probable" migraine increased with age. CONCLUSION The present study provides a representative estimation of the first documented health care use for migraine in children and adolescents in Germany within 1-year age bins, separately for boys and girls. These data will be helpful for tailoring early healthcare interventions to reduce disability and prevent migraine chronification.
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Affiliation(s)
- Lucia Albers
- 1 Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig Maximilians University, Munich, Germany
| | - Rüdiger von Kries
- 1 Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig Maximilians University, Munich, Germany
| | - Andreas Straube
- 2 Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Heinen
- 3 Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mirjam N Landgraf
- 3 Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Viola Obermeier
- 1 Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig Maximilians University, Munich, Germany
| | - Ruth Ruscheweyh
- 2 Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany
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Abstract
Neurological disorders place a considerable burden upon individuals, their families, and society. Some like stroke are common, while others like amyotrophic lateral sclerosis are much rarer. Some conditions such as multiple sclerosis are reported to vary by latitude, while others such as traumatic brain injury can vary considerably by locality. Depending upon the nature of the lesion, and factors such as time since onset, the consequences to the individual may also vary considerably, not just among different disorders, but within a given disorder. Consequently the patterns of disease incidence, its prevalence, and its consequences are complex and may vary not just because of the condition itself, but also because, for example, case ascertainment may vary from study to study. The cumulative annual incidence of disabling neurological disorders is likely to exceed 1000 per 100000, or 1% of the population. The incidence is characterized by significant variation, which is mediated by genetic, geographical, demographic, and environmental factors. While useful comparisons can be made through standardization techniques, planning for local services should be based upon local epidemiology, whenever available.
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Dixit A, Bhardwaj M, Sharma B. Headache in pregnancy: a nuisance or a new sense? Obstet Gynecol Int 2012; 2012:697697. [PMID: 22518165 PMCID: PMC3306951 DOI: 10.1155/2012/697697] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 11/30/2011] [Indexed: 11/23/2022] Open
Abstract
Headache is a very commonly encountered symptom in pregnancy and is usually due to primary headache disorders which are benign in nature. It can however be quite debilitating for some women who may need therapeutic treatment of which there are several options safe to use in pregnancy. It is equally important though to recognise that headache may be a sign of serious underlying pathology. This paper aims to provide a clinically useful guidance for differentiation between primary and secondary headaches in pregnancy. The primary headache disorders and their management in pregnancy are explored in depth with brief overviews of the causes for secondary headaches and their further investigation and management.
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Affiliation(s)
- Archana Dixit
- West Middlesex University Hospital, Twickenham Road, Isleworth, Middlesex TW7 6AF, UK
| | - Manish Bhardwaj
- ST6 Anaesthesia, John Radcliffe Hospital, Oxford QX3 9DU, UK
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Chai NC, Rosenberg JD, Lee Peterlin B. The epidemiology and comorbidities of migraine and tension-type headache. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.trap.2012.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Winkler AS, Dent W, Stelzhammer B, Kerschbaumsteiner K, Meindl M, Kaaya J, Matuja WBP, Schmutzhard E. Prevalence of migraine headache in a rural area of northern Tanzania: A community-based door-to-door survey. Cephalalgia 2009; 30:582-92. [PMID: 19735479 DOI: 10.1111/j.1468-2982.2009.01994.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Our aim was to assess the 1-year prevalence of migraine headache in a rural population within the catchment area of the Haydom Lutheran Hospital in northern Tanzania. From December 2003 until June 2004 a community-based door-to-door survey was carried out, using a questionnaire based on the criteria of the International Headache Society, including 1192 households with 7412 individuals selected by multistage cluster-random sampling. The overall 1-year prevalence of migraine headache was found to be 4.3% [316/7412, 95% confidence interval (CI) 3.8, 4.7] with an age-adjusted rate of 6.0% and a male : female ratio of 1:2.94 ( P < 0.001). Of these individuals, 132 did not fulfil all criteria for migraine headache, hence, these patients had to be classified as migrainous disorders with a crude prevalence rate of 1.8% (132/7412. 95% CI 1.5, 2.1). The remaining 184 patients met all criteria for migraine resulting in a 1-year prevalence of 2.5% (184/7412, 95% CI 2.1, 2.9) and a male : female ratio of 1:2.51 ( P < 0.001). The present survey shows that migraine headache is not uncommon in northern Tanzania. The recorded prevalence of migraine headache is located within the median of previous African prevalence surveys, which confirms the trend of lower migraine frequencies in rural Africa compared with western countries.
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Affiliation(s)
- AS Winkler
- Interdisciplinary Centre for Palliative Care and Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
- Haydom Lutheran Hospital, Tanzania
| | - W Dent
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - B Stelzhammer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - K Kerschbaumsteiner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Meindl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Kaaya
- Babati District Hospital, Manyara Region, Tanzania
| | - WBP Matuja
- Department of Neurology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - E Schmutzhard
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Hazard E, Munakata J, Bigal ME, Rupnow MFT, Lipton RB. The burden of migraine in the United States: current and emerging perspectives on disease management and economic analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:55-64. [PMID: 18671771 DOI: 10.1111/j.1524-4733.2008.00404.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Migraine is often perceived as a low-impact condition that imposes a limited burden to society and the health-care system. This study reviews the current understanding of the burden of migraine in the U.S., the history of economic understanding of migraine treatment and identifies emergent trends for future studies evaluating clinical and economic outcomes of migraine treatment. METHODS This study traced the history of economic articles published on migraine by performing a literature search using PubMed MEDLINE database and ancestral searches of relevant articles. The intention was not to provide an exhaustive review of every article or adjudicate between studies with different findings. RESULTS Migraine affects millions of individuals worldwide, generally during the most productive years of a person's life. Studies show that migraineurs are underdiagnosed, undertreated, and experience substantial decreases in functioning and productivity, which in turn translates into diminished quality of life for individuals, and financial burdens to both health-care systems and employers. Economic evaluations of migraine therapies have evolved with new clinical developments beginning with cognitive-behavioral therapy, introduction of triptans, concern over medication overuse, and emergence of migraine prophylaxis. Now recent clinical studies suggest that migraine may be a progressive disease with cardiovascular, cerebrovascular, and long-term neurologic effects. CONCLUSIONS Migraine imposes a substantial burden on patients, families, employers and societies. The economic standards by which migraine and treatment are evaluated have evolved in response to clinical developments. Emerging evidence suggests that migraine is a chronic and progressive disease. If confirmed, approaches to acute and prophylactic treatments and economic evaluations of migraine treatment may require major reconsideration.
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Chitkara DK, Talley NJ, Locke GR, Weaver AL, Katusic SK, De Schepper H, Rucker MJ. Medical presentation of constipation from childhood to early adulthood: a population-based cohort study. Clin Gastroenterol Hepatol 2007; 5:1059-64. [PMID: 17632040 DOI: 10.1016/j.cgh.2007.04.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Constipation is a common disorder in children and adults, but the role of gender and early life risk factors remains undefined. The aims of the study were as follows: (1) to estimate the incidence of medical presentation for constipation in a population-based birth cohort, and (2) to examine factors associated with constipation presentation from childhood to adulthood. METHODS A birth cohort of all children born between 1976 and 1982 to mothers who were residents of Rochester, Minnesota, and who remained in the community until age 5 was used for this study. Medical visits for constipation were identified by diagnoses codes and chart review. Subjects were followed up based on their diagnoses accumulated while younger than 21 years old, and 80% of subjects remained in the area until 18 years of age. RESULTS Of 5299 birth cohort members without constipation presentation before age 5, the overall age- and sex-adjusted incidence was 3.9 per 1000 person-years. A higher incidence for constipation in females occurred beginning at 13 years to early adulthood (rate ratio, 2.6 for 13-16 y and 4.2 for 17 to <21 y). Children with a diagnosis for constipation at younger than 5 years of age had a significantly higher incidence for subsequent medical visits for constipation through adolescence and early adulthood compared with the incidence rate of children without an early medical presentation (rate ratio, 4.5 for 5-8 y, 2.5 for 9-12 y, and 3.9 for 17-20 y). CONCLUSIONS Early medical presentation and female sex influence incident and repeat medical visits for constipation from childhood to early adulthood.
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Affiliation(s)
- Denesh K Chitkara
- University of North Carolina Center for Functional GI and Motility Disorders, Division of Pediatric Gastroenterology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Unger J. Migraine headaches: a historical prospective, a glimpse into the future, and migraine epidemiology. Dis Mon 2007; 52:367-84. [PMID: 17157610 DOI: 10.1016/j.disamonth.2006.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jeff Unger
- Chino Medical Group Diabetes and Headache Intervention Center, Quadrant Medical Education, CA, USA
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Lyngberg AC, Rasmussen BK, Jørgensen T, Jensen R. Incidence of primary headache: a Danish epidemiologic follow-up study. Am J Epidemiol 2005; 161:1066-73. [PMID: 15901627 DOI: 10.1093/aje/kwi139] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The incidence of migraine in a general population has been assessed in few longitudinal studies, and the incidence of tension-type headache has never been assessed. The authors aimed to assess the incidence of migraine and tension-type headache in Denmark by conducting a 12-year follow-up study of a general population (1989-2001). The design and methods of follow-up replicated the baseline study exactly, including use of the International Headache Society's diagnostic criteria and administration of headache diagnostic interviews by a physician. Of 740 persons aged 25-64 years examined in 1989, 673 were eligible in 2001 and 549 (81.6%) participated. The incidence of migraine was 8.1 per 1,000 person-years (male:female ratio, 1:6), and the incidence of frequent tension-type headache was 14.2 per 1,000 person-years (male:female ratio, 1:3). Both rates decreased with age. The incidence of migraine was higher than that previously calculated from cross-sectional studies. Risk factors for migraine were familial disposition, no vocational education, a high work load, and frequent tension-type headache. For tension-type headache, risk factors were poor self-rated health, inability to relax after work, and sleeping few hours per night. The gender difference for tension-type headache differed from that for migraine, and no association with educational level was observed.
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Affiliation(s)
- A C Lyngberg
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark.
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Black DF, Swanson JW, Stang PE. Decreasing Incidence of Cluster Headache: A Population‐Based Study in Olmsted County, Minnesota. Headache 2005; 45:220-3. [PMID: 15836596 DOI: 10.1111/j.1526-4610.2005.05048.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The incidence of medically recognized cluster headache within Olmsted County, Minnesota, from 1989 through 1990, was determined by using modified International Headache Society criteria. The results were compared with previously published incidence data from 1979 through 1981. The overall age- and sex-adjusted incidence decreased from 9.8/100,000 person-years in 1979-1981 to 2.07/100,000 person-years in 1989-1990.
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Affiliation(s)
- David F Black
- Department of Neurology, Mayo Clinic of Medicine, Rochester, Minnesota 55905, USA
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Abstract
Headache is a frequent symptom in women of childbearing age and during pregnancy. Benign and pathologic headaches may change in response to changes in estrogen after conception. Expected patterns of change are described for headaches that occur commonly during pregnancy. In addition, although treatment options are limited during pregnancy, a variety of effective medication and nonmedication treatments are available and should be offered to women with benign headaches that persist into the second trimester of pregnancy.
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Affiliation(s)
- Dawn A Marcus
- Pain Evaluation and Treatment Institute, 5750 Centre Avenue, Pittsburgh, PA 15206, USA.
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M S, Lamont AC, Alias NA, Win MN. Red flags in patients presenting with headache: clinical indications for neuroimaging. Br J Radiol 2003; 76:532-5. [PMID: 12893694 DOI: 10.1259/bjr/89012738] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Headache is a very common patient complaint but secondary causes for headache are unusual. Neuroimaging is both expensive and has a low yield in this group. Most patients with intracranial pathology have clinical features that would raise a "red flag". Appropriate selection of patients with headache for neuroimaging to look for secondary causes is very important. Red flags act as screening tools to help in identifying those patients presenting with headache who would benefit from prompt neuroimaging, and may increase the yield. The aim of this study is to evaluate clinical features in patients with headache using neuroimaging as a screening tool for intracranial pathology. 20 red flags were defined. A retrospective study of 111 patients was performed and the outcomes were divided into positive and negative. Abnormal neuroimaging was present in 39 patients. Results were analysed using the Logistic Regression model. Sensitivity and specificity of red flags were analysed to establish the cut-off point to predict abnormal neuroimaging and a receiver operating characteristic (ROC) curve plotted to show the sensitivity of the diagnostic test. Three red flag features proved to be statistically significant with the p-value of less than 0.05 on both univariate and multivariate analysis. These were: paralysis; papilloedema; and "drowsiness, confusion, memory impairment and loss of consciousness". In addition, if three or more red flags from the list were present, this showed strong indication of abnormal neuroimaging, from cut-off point of ROC curve (area under the curve =0.76).
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Affiliation(s)
- Sobri M
- Department of Radiology, University Putra Malaysia-Hospital Kuala Lumpur, Malaysia
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Abstract
Migraine is a common disorder that remains largely undiagnosed and has a profound economic impact. In the future, better recognition and treatment can decrease costs and improve the lives of millions of Americans.
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