Migraine Prevalence Stable, But With Increasing Frequency and Disability

A systematic review suggests that migraine prevalence has remained stable over the last 2 decades, but disability from migraine has increased. This review included only published studies that limited enrollment to people screened for migraine using International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria to define migraine. 

Reported migraine prevalence was 11.6% to 14.7% from 1989 to 2004. Studies included in this systematic review conducted after 2004 did not include prevalence rates because of smaller samples or low response rates. A 2005-2018 US government study that included both severe headache and migraine, however, reports a 12.3% to 16.0% prevalence rate with a similar stable trend; this study included severe headache as well as migraine. Across all these studies, reported prevalence was 2 to 3 times higher in women compared with men.

Prevalence of migraine with moderate and severe disability (Migraine Disability Assessment (MIDAS) questionnaire grade 3 or 4), however, increased by 10% to 20%—from a range of 22% to 30% in 2001 to 2004 to a range of 39% to 43% in 2012 to 2018. For these severe migraine conditions, prevalence in men has been steadily rising from 2004 to 2018, reaching a similar prevalence among women (42.4%) and men (37.2%) in a 2018 study. The proportion of people reporting chronic migraine (15 or more headache days/month) also increased from 6.8% in a 2005 study to 11.7% in a 2018 study.

The authors of this systematic review, presented by Fred Cohen, MD, headache medicine fellow at the Jefferson Headache Center in Philadelphia PA during the American Headache Society Meeting, June 10 in Denver, CO, suggested that the changes in prevalence of severe and chronic migraine may be related to changes in methodology of these studies, changes in treatment patterns including opioid use, employment rates, environmental changes, or cultural changes (eg, stigma and stress being more openly discussed). 

A shift in methodology for these studies, which were initiated between 1989 and 2018, occurred after 2009 when studies that had been completed via phone and mail shifted to online surveys. With that shift, survey response rates dropped from between 33% and 72% to between 12% and 32%. 

Although opioid use increased in these studies, that was primarily from 2016 to 2018 studies. Employment rates in the US were stable from 2004 to 2008 and then decreased but remained relatively stable from 2008 to 2018 studies, suggesting an inverse relationship between migraine prevalence and unemployment. 

For this systematic review, a PRISM search protocol was used to identify 1,609 articles on migraine epidemiology, which were screened based on criteria of including a representative sample of the US population, use of the ICHD3 criteria for identifying migraine, and reporting burden, impact, or prevalence. Review of abstracts eliminated 1,153 articles and review of full text eliminated 430. The remaining 26 articles were from 11 epidemiologic studies. Notably, US government surveys were excluded because these do not use the ICHD-3 criteria for migraine.