Of the 31,126 respondents who completed the NHANES 1999-2004 surveys, we sampled only those adults 20 years of age or older who were asked whether they suffered from severe headaches or migraine during the past three months (Total n=15,332; NHANES 1999-2000: n=4880 out of 9965, NHANES 2001-2001: n= 5411 out of 11,039, NHANES 2003-2004: n=5041 out of 10,122). There were an additional two respondents who had missing values on this question, leaving a sample of 15,330 (n=12,275 with no headache and n=3045 with headache). The three-month prevalence rates of severe headaches or migraine were 27.62% for females, and 14.81% for males, yielding a total prevalence of 22.73% in the general population of U.S. adults.
A comparison of the sociodemographic characteristics of the headache and no headache sample are presented in . In agreement with previous reports, respondents reporting severe headaches or migraine were significantly more likely to be female (adjusted OR=2.32, 95% CI: 2.08, 2.59) and more likely to be young. Adjusted regression analysis showed an association between age group and severe headaches or migraine, and those respondents aged 20-39 years and 40-54 years had 4.52 and 4.33 increased odds of reporting severe headaches or migraine in comparison to respondents aged 75 years or more. Respondents with severe headaches or migraine were also more likely to be separated or divorced (adjusted OR=1.29, 95% CI: 1.13, 1.47), and report an education level of high school (adjusted OR=1.27, 95% CI: 1.09, 1.48) or less than high school (adjusted OR=1.76, 95% CI: 1.50, 2.06). A comparison of ethnicity showed that Mexican-Americans were less likely to report severe headaches or migraine (adjusted OR=0.83, 95% CI: 0.71, 0.98), whereas there were equal prevalence rates among non-Hispanic whites and non-Hispanic blacks.
Three-month weighted prevalence rates and adjusted odds ratios of sociodemographic characteristics by severe headaches/ migraine in the NHANES 1999-2004
The rates and comorbidity of physical disorders in respondents in the headache and no headache sample are presented in . Overall, 84.61% of individuals with severe headaches or migraine had at least one comorbid physical condition, 55.70% had at least two, and 31.77% had at least three comorbid conditions as opposed to the 68.76%, 37.90%, and 19.05%, respectively, in the no headache sample (p<0.001 for all). After Bonferroni correction for multiple comparisons, respondents reporting severe headaches or migraine were significantly more likely (p<0.006) to suffer from a range of physical disorders, including asthma (adjusted OR=1.52, 95% CI: 1.29-1.79), low back pain (adjusted OR=2.77, 95% CI: 2.49-3.09), rheumatoid arthritis (OR=1.95, 95% CI: 1.68-2.25), and a variety of cardiovascular disorders, including angina (OR=2.15, 95% CI: 1.62-2.84) and congestive heart failure (adjusted OR=1.81, 95% CI: 1.36-2.40). In addition, respondents with severe headaches or migraine were more likely to report trouble seeing even with glasses (adjusted OR=2.02, 95% CI: 1.80-2.28), treatment for anemia (adjusted OR=2.11, 95% CI: 1.60-2.78), thyroid problems (adjusted OR=1.39, 95% CI: 1.16-1.67), chronic bronchitis (adjusted OR=2.21, 95% CI: 1.80-2.71), liver problems (adjusted OR=1.69, 95% CI: 1.38-2.07), and being overweight (adjusted OR=1.51, 95% CI: 1.35-1.69). When the frequency of respondents in the headache and no headache sample suffering from two or more conditions within a given physical grouping were compared, we found that respondents with headache were more likely to have at least two comorbid respiratory conditions (5.69% versus 2.65%), and at least two comorbid pain conditions (7.92% vs. 4.51%). Overall, headache sufferers had an increased odds of at least one (OR=2.84), two (OR=2.56) and three (OR=2.69) comorbid conditions.
Rates and adjusted odds ratio of the associations between severe headaches/migraine and physical disorders
There were a total of 598 with headache and 1667 respondents with no headaches among respondents, ages 20-39 years, who completed the WHO-CIDI. As reported in , respondents reporting severe headaches or migraine were significantly more likely to meet criteria for major depression (14.61% vs. 5.42%), panic disorder (5.62% vs. 1.55%), and/or GAD (5.78% vs. 1.97%). After adjusting for age, race, sex, and education, respondents with severe headaches or migraine had 2.84 increased odds of major depression, 3.29 increased odds of panic disorder and 3.03 increased odds of GAD. Overall, individuals with severe headaches or migraine had 2.30 (95% CI: 1.37, 3.85) increased odds of having a single mental disorder, and 6.28 (95% CI: 2.05, 19.26) increased odds of at least two disorders (both p<0.001).
Weighted 12-month month prevalence rates of mental disorders and adjusted odds ratios of association between severe headaches/migraine with mental disorders a.
The association between headache, comorbid mental disorders and comorbid physical disorders on health utilization and general health perception is presented in . As a group, respondents with severe headaches or migraine were less likely to rate their general health condition as excellent (17.54% vs. 27.06), and more likely to rate their health as ‘fair or poor’ (17.87% vs. 6.11%). Respondents with severe headaches or migraine plus at least one comorbid physical disorder were even less likely to rate their health as excellent (13.87% vs. 27.06%) and more likely to rate their health as fair or poor (21.47% vs. 6.11%). It was the addition of a comorbid mental disorder, however, that caused the greatest shift in general health perception; respondents with headache plus at least one mental disorder (n=102) or at least one mental disorder coupled with at least one additional physical disorder (n=79) were less likely to rate their health as excellent (5.81% and 4.59%, respectively, vs. 27.06%) and more likely to rate their health as fair or poor (21.30% and 23.80%, respectively, vs. 6.11%). These differences were all significant at p<0.001.
Health perception and utilization by severe headaches/migraine and comorbid physical and mental disorders a
Similarly, respondents with headache were more likely to endorse physical, mental or emotional problems and confusion or memory problems than their non headache counterparts (19.75% vs. 8.94% and 5.90% vs. 2.53%, respectively). Although these problems were accentuated among those with comorbidity in general, the contribution of mental disorders outweighed that of comorbid physical disorders.
There was a direct association between severe headaches or migraine and use of healthcare four or more times in the past year (43.32% vs. 22.71%), an effect which increased linearly up to 53.45% in the headache group with both a comorbid mental and physical condition. Comorbidity was also associated with an increase in the number of respondents who had visited a mental health professional in the previous year, with the headache plus any comorbid mental disorder group reporting the highest rates (33.42% vs. 6.82% in the no headache sample).