Sex Differences in the Prevalence, Symptoms, and Associated Features of Migraine, Probable Migraine and Other Severe Headache: Results of the American Migraine Prevalence and Prevention (AMPP) Study

Authors


  • Financial Support: The American Migraine Prevalence and Prevention (AMPP) Study was funded through a research grant to the National Headache Foundation from McNeil-Janssen Scientific Affairs LLC, Raritan, NJ. The AMPP database was donated by McNeil-Janssen Scientific Affairs LLC to the National Headache Foundation for use in various projects. Additional funding and support for this manuscript was provided through a grant to the National Headache Foundation by ENDO Pharmaceuticals, Chadds Ford, PA.
  • Conflict of Interest: Dawn C. Buse, PhD, has received grant support and honoraria from Allergan Pharmaceuticals, MAP Pharmaceuticals, Novartis and NuPathe. Elizabeth W. Loder, MD, MPH, reports receiving salary support from the British Medical Journal in exchange for services as a clinical editor. Jennifer A. Gorman, MS, has nothing to disclose. Walter F. Stewart, PhD, received grants from Allergan Pharmaceuticals, Endo Pharmaceuticals, GlaxoSmithKline, Minster, Merck, Inc., Neuralieve, Novartis, OrthoMcNeil, Pfizer, the National Headache Foundation, and the National Institutes of Health. Michael L. Reed, PhD, has received funding for research and data analysis from Allergan Inc., CoLucid, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck, Novartis, NuPathe, Ortho-McNeil, and the National Headache Foundation. Kristina M. Fanning, PhD, has received research support from Allergan Inc., CoLucid, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck & Co., Inc., NuPathe, Novartis, Ortho-McNeil, and the National Headache Foundation. Daniel Serrano, PhD, has received research support from Allergan Inc., CoLucid, Endo Pharmaceuticals, GlaxoSmithKline, MAP Pharmaceuticals, Merck & Co., Inc., NuPathe, Novartis, Ortho-McNeil, and the National Headache Foundation. Richard B. Lipton, MD, receives research support from the NIH [PO1 AG03949 (Program Director, Project and Core Leader), RO1AG025119 (Investigator), RO1AG022374-06A2 (Investigator), RO1AG034119 (Investigator), RO1AG12101 (Investigator), K23AG030857 (Mentor), K23NS05140901A1 (Mentor), and K23NS47256 (Mentor)], the National Headache Foundation, and the Migraine Research Fund; serves on the editorial board of Neurology, has reviewed for the NIA and NINDS, holds stock options in eNeura Therapeutics; serves as consultant, advisory board member, or has received honoraria from: Allergan, American Headache Society, Autonomic Technologies, Boehringer-Ingelheim Pharmaceuticals, Boston Scientific, Bristol Myers Squibb, Cognimed, Colucid, Eli Lilly, ENDO, eNeura Therapeutics, GlaxoSmithKline, Merck, Novartis, NuPathe, Pfizer, and Vedanta.

Address all correspondence to D. Buse, Montefiore Medical Center – Montefiore Headache Center, 1575 Blondell Avenue Suite#225, Bronx, NY 10471, USA, email: dbuse@montefiore.org

Abstract

Background

The strikingly higher prevalence of migraine in females compared with males is one of the hallmarks of migraine. A large global body of evidence exists on the sex differences in the prevalence of migraine with female to male ratios ranging from 2 : 1 to 3 : 1 and peaking in midlife. Some data are available on sex differences in associated symptoms, headache-related disability and impairment, and healthcare resource utilization in migraine. Few data are available on corresponding sex differences in probable migraine (PM) and other severe headache (ie, nonmigraine-spectrum severe headache). Gaining a clear understanding of sex differences in a range of severe headache disorders may help differentiate the range of headache types. Herein, we compare sexes on prevalence and a range of clinical variables for migraine, PM, and other severe headache in a large sample from the US population.

Methods

This study analyzed data from the 2004 American Migraine Prevalence and Prevention Study. Total and demographic-stratified sex-specific, prevalence estimates of headache subtypes (migraine, PM, and other severe headache) are reported. Log-binomial models are used to calculate sex-specific adjusted prevalence ratios and 95% confidence intervals for each across demographic strata. A smoothed sex prevalence ratio (female to male) figure is presented for migraine and PM.

Results

One hundred sixty-two thousand seven hundred fifty-six individuals aged 12 and older responded to the 2004 American Migraine Prevalence and Prevention Study survey (64.9% response rate). Twenty-eight thousand two hundred sixty-one (17.4%) reported “severe headache” in the preceding year (23.5% of females and 10.6% of males), 11.8% met International Classification of Headache Disorders-2 criteria for migraine (17.3% of females and 5.7% of males), 4.6% met criteria for PM (5.3% of females and 3.9% of males), and 1.0% were categorized with other severe headache (0.9% of females and 1.0% of males). Sex differences were observed in the prevalence of migraine and PM, but not for other severe headache. Adjusted female to male prevalence ratios ranged from 1.48 to 3.25 across the lifetime for migraine and from 1.22 to 1.53 for PM. Sex differences were also observed in associated symptomology, aura, headache-related disability, healthcare resource utilization, and diagnosis for migraine and PM. Despite higher rates of migraine diagnosis by a healthcare professional, females with migraine were less likely than males to be using preventive pharmacologic treatment for headache.

Conclusions

In this large, US population sample, both migraine and PM were more common among females, but a sex difference was not observed in the prevalence of other severe headache. The sex difference in migraine and PM held true across age and for most other sociodemographic variables with the exception of race for PM. Females with migraine and PM had higher rates of most migraine symptoms, aura, greater associated impairment, and higher healthcare resource utilization than males. Corresponding sex differences were not observed among individuals with other severe headache on the majority of these comparisons. Results suggest that PM is part of the migraine spectrum whereas other severe headache types are not. Results also substantiate existing literature on sex differences in primary headaches and extend results to additional headache types and related factors.

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