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Chronic Migraine Prevalence, Disability, and Sociodemographic Factors: Results From the American Migraine Prevalence and Prevention Study

Authors

  • Dawn C. Buse PhD,

    Corresponding author
    1. From the Montefiore Medical Center, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Allergan Inc., Irvine, CA, USA (A.N. Manack and C.C. Turkel); Vedanta Research, Chapel Hill, NC, USA (K.M. Fanning, D. Serrano, and M.L. Reed).
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  • Aubrey N. Manack PhD,

    1. From the Montefiore Medical Center, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Allergan Inc., Irvine, CA, USA (A.N. Manack and C.C. Turkel); Vedanta Research, Chapel Hill, NC, USA (K.M. Fanning, D. Serrano, and M.L. Reed).
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  • Kristina M. Fanning PhD,

    1. From the Montefiore Medical Center, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Allergan Inc., Irvine, CA, USA (A.N. Manack and C.C. Turkel); Vedanta Research, Chapel Hill, NC, USA (K.M. Fanning, D. Serrano, and M.L. Reed).
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  • Daniel Serrano PhD,

    1. From the Montefiore Medical Center, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Allergan Inc., Irvine, CA, USA (A.N. Manack and C.C. Turkel); Vedanta Research, Chapel Hill, NC, USA (K.M. Fanning, D. Serrano, and M.L. Reed).
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  • Michael L. Reed PhD,

    1. From the Montefiore Medical Center, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Allergan Inc., Irvine, CA, USA (A.N. Manack and C.C. Turkel); Vedanta Research, Chapel Hill, NC, USA (K.M. Fanning, D. Serrano, and M.L. Reed).
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  • Catherine C. Turkel PhD, PharmD,

    1. From the Montefiore Medical Center, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Allergan Inc., Irvine, CA, USA (A.N. Manack and C.C. Turkel); Vedanta Research, Chapel Hill, NC, USA (K.M. Fanning, D. Serrano, and M.L. Reed).
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  • Richard B. Lipton MD

    1. From the Montefiore Medical Center, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Albert Einstein College of Medicine, Bronx, NY, USA (D.C. Buse and R.B. Lipton); Allergan Inc., Irvine, CA, USA (A.N. Manack and C.C. Turkel); Vedanta Research, Chapel Hill, NC, USA (K.M. Fanning, D. Serrano, and M.L. Reed).
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  • Disclosures: Dawn C. Buse, PhD, has received honoraria and/or research funding from Allergan Pharmaceuticals, ENDO Pharmaceuticals, Iroko Pharmaceuticals, Merck, Inc., MAP Pharmaceuticals, NuPathe, and Novartis. Aubrey N. Manack, PhD, is a full-time employee of Allergan Pharmaceuticals. Kristina M. Fanning, PhD, has provided statistical and consulting support to Allergan, Pfizer, AstraZeneca, Novartis, Merck, GlaxoSmithKline, ENDO Pharmaceuticals, and Ortho-McNeil Neurologics. Daniel Serrano, PhD, has provided statistical and consulting support to Allergan, Merck, GlaxoSmithKline, ENDO Pharmaceuticals, and Ortho-McNeil Neurologics. Michael L. Reed, PhD, received research funding from Ortho-McNeil, GSK, ENDO, Allergan, and MSD. Catherine C. Turkel, PhD, PharmD, is a full-time employee of Allergan Pharmaceuticals. Richard Lipton, MD, has received research support from the NIH (PO1 AG03949 [Program Director], PO1AG027734 [Project 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 boards of Neurology and Cephalalgia and as senior advisor to Headache; has reviewed for the NIA and NINDS; holds stock options in eNeura Therapeutics (a company without commercial products); and serves as consultant, advisory board member, or has received honoraria from Allergan, the American Headache Society, Autonomic Technologies, Boston Scientific, Bristol Myers Squibb, Cognimed, Colucid, Eli Lilly, ENDO, eNeura Therapeutics, GlaxoSmithKline, MAP, Merck, Nautilus Neuroscience, Novartis, NuPathe, and Pfizer.

  • Sponsorship: The American Migraine Prevalence and Prevention Study is funded through a research grant to the National Headache Foundation from Ortho-McNeil Neurologics, Inc., Titusville, NJ, USA. Additional analyses and manuscript preparation were supported by a grant from Allergan Inc., Irvine, CA, USA, to the National Headache Foundation.

D.C. Buse, 1575 Blondell Avenue, Suite 225, Bronx, NY 10461, USA, email: dbuse@montefiore.org

Abstract

Objectives.— To estimate the prevalence and distribution of chronic migraine (CM) in the US population and compare the age- and sex-specific profiles of headache-related disability in persons with CM and episodic migraine.

Background.— Global estimates of CM prevalence using various definitions typically range from 1.4% to 2.2%, but the influence of sociodemographic factors has not been completely characterized.

Methods.— The American Migraine Prevalence and Prevention Study mailed surveys to a sample of 120,000 US households selected to represent the US population. Data on headache frequency, symptoms, sociodemographics, and headache-related disability (using the Migraine Disability Assessment Scale) were obtained. Modified Silberstein–Lipton criteria were used to classify CM (meeting International Classification of Headache Disorders, second edition, criteria for migraine with a headache frequency of ≥15 days over the preceding 3 months).

Results.— Surveys were returned by 162,756 individuals aged ≥12 years; 19,189 individuals (11.79%) met International Classification of Headache Disorders, second edition, criteria for migraine (17.27% of females; 5.72% of males), and 0.91% met criteria for CM (1.29% of females; 0.48% of males). Relative to 12 to 17 year olds, the age- and sex-specific prevalence for CM peaked in the 40s at 1.89% (prevalence ratio 4.57; 95% confidence interval 3.13-6.67) for females and 0.79% (prevalence ratio 3.35; 95% confidence interval 1.99-5.63) for males. In univariate and adjusted models, CM prevalence was inversely related to annual household income. Lower income groups had higher rates of CM. Individuals with CM had greater headache-related disability than those with episodic migraine and were more likely to be in the highest Migraine Disability Assessment Scale grade (37.96% vs 9.50%, respectively). Headache-related disability was highest among females with CM compared with males. CM represented 7.68% of migraine cases overall, and the proportion generally increased with age.

Conclusions.— In the US population, the prevalence of CM was nearly 1%. In adjusted models, CM prevalence was highest among females, in mid-life, and in households with the lowest annual income. Severe headache-related disability was more common among persons with CM and most common among females with CM.

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