The prevalence and impact of migraine and severe headache in the United States: Updated age, sex, and socioeconomic-specific estimates from government health surveys.

BACKGROUND AND OBJECTIVES: Accurate, up-to-date estimates of the burden of migraine and severe headache are important for evidence-based decision-making about workforce needs and the distribution of health resources. We used data from US government health surveys to report the prevalence, trends, and impact of this condition by age, sex, and poverty status. METHODS: We identified the most recent, publicly available summary statistics from the National Hospital Ambulatory Medical Care Survey, the National Ambulatory Medical Care Survey, and the National Health Interview Survey. We extracted and compiled relevant information from each study, with an emphasis on sex, age, and economic-related statistics. RESULTS: The age-adjusted prevalence of migraine and severe headache in the United States has remained stable over many years. In 2018, the age-adjusted prevalence was 15.9% across all adults. The sex ratio also remains stable, with 21% of women and 10.7% of men affected. Migraine continues to be an important public health problem, accounting for roughly 4 million emergency department (ED) visits in 2016, when headache was the fifth most common reason for an ED visit overall and the third most common reason for ED visits in females 15-64. Migraine also accounted for over 4.3 million office visits. Many adults with migraine or severe headaches are disadvantaged. In 2018, for example, roughly 40% of US adults with migraine were unemployed, and a similar proportion were classified as poor or "near poor." Roughly one in five had no health insurance and about a third had a high school education or less. CONCLUSIONS: Migraine and severe headaches are a serious public health issue in the United States, with the highest impact in women of childbearing age and those of lower socioeconomic status. Socioeconomic disadvantages also are highly prevalent among those with headaches. The economic consequences of the current coronavirus pandemic are likely to exacerbate all of these inequities. Increased attention to this high impact chronic pain condition, and improved funding for treatment provision and research, are warranted to reduce the future burden of disease.

The Prevalence and Impact of Migraine and Severe Headache in the United States: Figures and Trends From Government Health Studies.

BACKGROUND AND OBJECTIVES: In this targeted systematic review, we aimed to identify up-to-date prevalence estimates of migraine and severe headache in adults from population-based US government surveys. Our goal was to assess the stability of prevalence estimates over time, and to identify additional information pertinent to the burden and treatment of migraine and other severe headache conditions. METHODS: We searched for the most current publicly available summary statistics from the National Health Interview Survey (NHIS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the National Ambulatory Medical Care Survey (NAMCS). We extracted and summarized data from each study over time and as a function of demographic variables. RESULTS: The prevalence and burden of self-reported migraine and severe headache in the US adult population is high, affecting roughly 1 out of every 6 American and 1 in 5 women over a 3-month period (15.3% overall [95% CI 14.75-15.85], 9.7% of males [95% CI 9.05-10.35] and 20.7% of females [95% CI 19.84-21.56]). The prevalence has been remarkably stable over a period of 19 years. The prevalence of migraine or severe headache in 2015 was highest in American Indian or Alaska Natives (18.4%) compared with whites, blacks, or Hispanics, with the lowest prevalence in Asians (11.3%). There is a higher burden of migraine in those aged 18-44 (17.9%), people who are unemployed (21.4%), those with family income less than $35,000 per year (19.9%), and the elderly and disabled (16.4%). Headache is consistently the fourth or fifth most common reason for visits to the emergency department, accounting for roughly 3% of all emergency department visits annually. In reproductive aged women, headache is the third leading cause of emergency department visits. CONCLUSIONS: Severe headache and migraine remain important public health problems that are more common and burdensome for women, particularly women of childbearing age, and other historically disadvantaged segments of the population. These inequities could be exacerbated if new high-cost treatments are inaccessible to those who need them most.

The comorbidity burden of patients with cluster headache: a population-based study.

BACKGROUND: Evidence is limited regarding the comorbidity burden of patients with cluster headache (CH). We aimed to characterize comorbid conditions in a cohort of CH patients diagnosed by headache experts, using electronic health record information from the Partners Research Patient Data Registry (RPDR). METHODS: We identified and reviewed the charts of unique patients diagnosed by headache specialists over an 11-year period, and a set of matched controls. Patients were categorized as having Definite, Unconfirmed or no CH. We calculated the prevalence of and tested for statistically significant differences of selected comorbid conditions in these populations. RESULTS: An RPDR query identified 170 patients with a free text or ICD diagnosis of cluster headache. 15 records belonging to Partners employees were excluded. 75 patients met diagnostic criteria for CH (Definite CH). 22 had headaches with some features of CH but the diagnosis was uncertain (Unconfirmed CH). In 58 the diagnosis was determined to be inaccurate due to data entry errors. Patients with Definite CH had an average age of 43.4 years; 80% were male. The average time from CH onset to diagnosis was 12.7 years (range 1-51). The average number of yearly emergency department and outpatient visits for the group of Definite CH patients was 4.5 and 25.4, respectively, compared with 1.1 and 6.9 in controls. Of the 55 examined conditions, four were statistically significantly less common in patients with definite CH compared with controls (diabetes, musculoskeletal/orthopaedic problems, "other gastrointestinal diagnoses" and skin conditions) and four were statistically significantly more common (smoking, depression, dental disorders and deviated septum). CONCLUSIONS: In this large population-based study, we identified a surprisingly small number of patients who met strict diagnostic criteria for CH. In these patients, however, we identified a distinct pattern of selected comorbidities. The pattern is somewhat but not entirely consistent with that of the "classic" CH patient depicted in the medical literature. CH patients are frequently diagnosed with sinus or dental problems. Many experience substantial delay in receiving a diagnosis. These things may in part explain the high frequency of medical visits in this population. It is difficult to distinguish conditions that are genuinely comorbid with CH from those that reflect misdiagnoses or medical scrutiny of patients in frequent contact with the healthcare system.

Our Headache Fellowship: a 10-year history.

There has been a clear trend in American medical education after World War II toward training specialization and subspecialization. After some early specialization efforts by the American Board of Psychiatry and Neurology, further efforts were undertaken by the United Council for Neurologic Subspecialties (UCNS), leading to the introduction of the neurologic subspecialty of Headache Medicine in March, 2005. The training program at our center at the Brigham and Women's Hospital Department of Neurology, Harvard Medical School, in Boston, Massachusetts, was accredited in 2008 and has graduated 14 trainees since its inception. Our experience is reviewed.

The evolution and geographic distribution of headache medicine fellowship programs and graduates: an observational study.

OBJECTIVES: We sought to assess the experiences, growth, and distribution of accredited headache medicine fellowships since accreditation began in 2007, and to examine the number and current practice locations of fellows graduated from those programs. BACKGROUND: There are no data on the distribution of headache fellowship programs and their graduates throughout the United States. METHODS: We surveyed directors of Headache Medicine fellowship programs accredited by the United Council of Neurologic Subspecialties as of April 1, 2014. We recorded the geographic locations of accredited programs and fellowship graduates and determined their distribution in relation to the overall and selected minority populations of US census divisions, regions, and states. RESULTS: In early 2014, there were 25 accredited Headache Medicine fellowship programs in the United States. Thirty-two (63%) US states lack a headache fellowship program and 24 (47%) do not have a practicing United Council for Neurologic Subspecialties fellowship graduate. Fifty-two of 96 fellows (54%) entered practice in the same state where they did their training. The northeastern United States has the best ratio of fellowship programs and graduates to population (0.28 and 0.35 per million inhabitants) and land area (6.38 and 8 per 100,000 square miles). The Pacific Northwest has the worst (0.05 and 0.02 fellowship programs and graduates per million inhabitants and 2.3 and 1.1 per 100,000 square miles). Fifty-five percent of the US Hispanic population lives in areas of the country with only 32% of practicing certified headache specialists, 28% of accredited fellowship programs, and which have attracted only 27% of fellowship graduates. Thirty-three percent of the US black population lives in areas with just 8% of fellowship programs and 27% of fellowship graduates. Fellowship directors report that funding for fellowship positions is an important challenge. CONCLUSIONS: The number of fellowship programs has increased dramatically since 2007, but their geographic distribution is uneven and so are the subsequent practice locations of fellow graduates. At present, the distribution of training programs and headache specialists is not well matched to the US population as a whole or to the location of important racial and ethnic minorities. Increasing the overall supply of headache specialists is important, but geographic inequalities in specialist distribution must also be addressed or disparities will increase.