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Interrelations Between Migraine and Tension-Type Headache in the General Population

Interrelations Between Migraine and Tension-Type Headache in the General Population Abstract • In a cross-sectional epidemiological survey of a general population, headache disorders were diagnosed according to a structured interview and a neurological examination using the criteria of the International Headache Society. The prevalences and sex distribution of the primary headache disorders were assessed, and characteristics of and interrelationships between different types of headache were analyzed. Severity and frequency of migraine attacks were not correlated, indicating that the migraine attack is an all-or-none phenomenon triggered with an individually variable threshold. Tension-type headache, in contrast, showed increasing severity with increasing frequency, indicating that it is a graded phenomenon. In the previous year, 6% had migraine without aura (previously called "common migraine") and 4% had migraine with aura (previously called "classic migraine"); 63% had episodic tension-type headache and 3% chronic tension-type headache. In women, migraine without aura was twice as prevalent as migraine with aura; in men, an opposite trend emerged. In migraine without aura, pain was more severe than in migraine with aura. Tension-type headache in migraineurs was not significantly more prevalent than in nonmigraineurs and, except for greater frequency and severity, it did not deviate nosographically from pure tension-type headache. Our results support the contention that migraine and tension-type headache are distinct entities, contradict the so-called continuum-severity model, and indicate that the terms combination headache, mixed headache, and interval headache should be avoided. References 1. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain . Cephalalgia . 1988;8( (suppl 7) )1-96.Crossref 2. Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population: a prevalence study . J Clin Epidemiol . 1991;44:1147-1157.Crossref 3. Rasmussen BK, Olesen J. Symptomatic and non-symptomatic headaches in a general population. Neurology. In press. 4. Hollnagel H, Nrrelund N. Headache among 40 year-olds in Glostrup . Ugeskr Laeger . 1980;142:3071-3077. 5. Post D, Gubbels JW. Headache: an epidemiological survey in a Dutch rural general practice . Headache . 1986;26:122-125.Crossref 6. Srensen PS, Hansen K, Olesen J. A placebo-controlled doubleblind, cross-over trial of flunarizine in common migraine . Cephalalgia . 1986;6:7-14.Crossref 7. Kangasniemi P, Andersen AR, Andersson PC, et al. Classic migraine: effective prophylaxis with metoprolol . Cephalalgia . 1987;7:231-238.Crossref 8. Langemark M, Jensen TS, Olesen J. Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache . Pain . 1989;38:203-210.Crossref 9. Markush RE, Herbert RK, Heyman A, O'Fallon WM. Epidemiologic study of migraine symptoms in young women . Neurology . 1975;25:430-435.Crossref 10. Nikiforow R. Headache in a random sample of 200 persons: a clinical study of a population in northern Finland . Cephalalgia . 1981;1:99-107.Crossref 11. Philips C. Headache in general practice . Headache . 1977;16:322-329.Crossref 12. Waters WE, O'Connor PJ. Epidemiology of headache and migraine in women J Neurol Neurosurg Psychiatry . 1971;34:148-153.Crossref 13. Brewis M, Poskanzer DC, Rolland C, et al. Neurological disease in an English city . Acta Neurol Scand . 1966;42( (suppl 24) ):1-89. 14. Ekbom K, Ahlborg B, Schèle R. Prevalence of migraine and cluster headache in Swedish men of 18 . Headache . 1978;18:9-19.Crossref 15. Waters WE. The Pontypridd headache survey . Headache . 1974;14:81-90.Crossref 16. D'Alessandro R, Benassi G, Lenzi PL, et al. Epidemiology of headache in the Republic of San Marino . J Neurol Neurosurg Psychiatry . 1988;51:21-27.Crossref 17. Manzoni GC, Campari M, Terzano MG, Moretti G, Fanti E. An epidemiological study of headache in a hospital staff . Headache . 1981;21:206-210.Crossref 18. Ogunyemi AO. Prevalence of headache among Nigerian university students . Headache . 1984;24:127-130.Crossref 19. Crisp AH, Kalucy RS, McGuinness B, Ralph PC, Harris G. Some clinical, social and psychological characteristics of migraine subjects in the general population . Postgrad Med J . 1977;53:691-697.Crossref 20. Olesen J, Larsen B, Lauritzen M. Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine . Ann Neurol . 1981a;9:344-352.Crossref 21. Olsen TS, Olesen J. Regional cerebral blood flow in migraine and cluster headache . In: Olesen J, Edvinsson L, eds. Basic Mechanisms of Headache . Amsterdam, the Netherlands: Elsevier Science Publishers; 1988:377-391. 22. Rasmussen BK, Jensen R, Olesen J. A population-based analysis of the diagnostic criteria of the International Headache Society . Cephalalgia . 1991;11:129-134.Crossref 23. Olesen J, Bonica JJ. Headache . In: Bonica JJ, ed. The Management of Pain . Philadelphia, Pa: Lea & Febiger; 1990:687-726. 24. Waters WE. The epidemiological enigma of migraine . Int J Epidemiol . 1973;2:189-194.Crossref 25. Bakal DA, Kaganov JA. Symptom characteristics of chronic and nonchronic headache sufferers . Headache . 1979;19:285-289.Crossref 26. Kaganov JA, Bakal DA, Dunn BE. The differential contribution of muscle contraction and migraine symptoms to problem headache in the general population . Headache . 1981;21:157-163.Crossref 27. Raskin NH. Migraine . Psychosomatics . 1982;23:897-903.Crossref 28. Waters WE. Community studies of the prevalence of headache . Headache . 1970;9:178-186.Crossref 29. Peck DF, Attfield ME. Migraine symptoms on the Waters Headache Questionnaire: a statistical analysis . J Psychosom Res . 1981;25:281-288.Crossref 30. Ziegler DK, Hassanein RS, Couch JR. Headache syndromes suggested by statistical analysis of headache symptoms . Cephalalgia . 1982;2:125-134.Crossref 31. Abramson JH, Hopp C, Epstein LM. Migraine and non-migrainous headaches: a community survey in Jerusalem . J Epidemiol Community Health . 1980;34:188-193.Crossref 32. Arena JG, Blanchard EB, Andrasik F, Dudek C. The headache symptom questionnaire: discriminant classificatory ability and headache syndromes suggested by a factor analysis . J Behav Assess . 1982;4:55-69.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Interrelations Between Migraine and Tension-Type Headache in the General Population

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References (35)

Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1992.00530330036012
Publisher site
See Article on Publisher Site

Abstract

Abstract • In a cross-sectional epidemiological survey of a general population, headache disorders were diagnosed according to a structured interview and a neurological examination using the criteria of the International Headache Society. The prevalences and sex distribution of the primary headache disorders were assessed, and characteristics of and interrelationships between different types of headache were analyzed. Severity and frequency of migraine attacks were not correlated, indicating that the migraine attack is an all-or-none phenomenon triggered with an individually variable threshold. Tension-type headache, in contrast, showed increasing severity with increasing frequency, indicating that it is a graded phenomenon. In the previous year, 6% had migraine without aura (previously called "common migraine") and 4% had migraine with aura (previously called "classic migraine"); 63% had episodic tension-type headache and 3% chronic tension-type headache. In women, migraine without aura was twice as prevalent as migraine with aura; in men, an opposite trend emerged. In migraine without aura, pain was more severe than in migraine with aura. Tension-type headache in migraineurs was not significantly more prevalent than in nonmigraineurs and, except for greater frequency and severity, it did not deviate nosographically from pure tension-type headache. Our results support the contention that migraine and tension-type headache are distinct entities, contradict the so-called continuum-severity model, and indicate that the terms combination headache, mixed headache, and interval headache should be avoided. References 1. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain . Cephalalgia . 1988;8( (suppl 7) )1-96.Crossref 2. Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population: a prevalence study . J Clin Epidemiol . 1991;44:1147-1157.Crossref 3. Rasmussen BK, Olesen J. Symptomatic and non-symptomatic headaches in a general population. Neurology. In press. 4. Hollnagel H, Nrrelund N. Headache among 40 year-olds in Glostrup . Ugeskr Laeger . 1980;142:3071-3077. 5. Post D, Gubbels JW. Headache: an epidemiological survey in a Dutch rural general practice . Headache . 1986;26:122-125.Crossref 6. Srensen PS, Hansen K, Olesen J. A placebo-controlled doubleblind, cross-over trial of flunarizine in common migraine . Cephalalgia . 1986;6:7-14.Crossref 7. Kangasniemi P, Andersen AR, Andersson PC, et al. Classic migraine: effective prophylaxis with metoprolol . Cephalalgia . 1987;7:231-238.Crossref 8. Langemark M, Jensen TS, Olesen J. Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache . Pain . 1989;38:203-210.Crossref 9. Markush RE, Herbert RK, Heyman A, O'Fallon WM. Epidemiologic study of migraine symptoms in young women . Neurology . 1975;25:430-435.Crossref 10. Nikiforow R. Headache in a random sample of 200 persons: a clinical study of a population in northern Finland . Cephalalgia . 1981;1:99-107.Crossref 11. Philips C. Headache in general practice . Headache . 1977;16:322-329.Crossref 12. Waters WE, O'Connor PJ. Epidemiology of headache and migraine in women J Neurol Neurosurg Psychiatry . 1971;34:148-153.Crossref 13. Brewis M, Poskanzer DC, Rolland C, et al. Neurological disease in an English city . Acta Neurol Scand . 1966;42( (suppl 24) ):1-89. 14. Ekbom K, Ahlborg B, Schèle R. Prevalence of migraine and cluster headache in Swedish men of 18 . Headache . 1978;18:9-19.Crossref 15. Waters WE. The Pontypridd headache survey . Headache . 1974;14:81-90.Crossref 16. D'Alessandro R, Benassi G, Lenzi PL, et al. Epidemiology of headache in the Republic of San Marino . J Neurol Neurosurg Psychiatry . 1988;51:21-27.Crossref 17. Manzoni GC, Campari M, Terzano MG, Moretti G, Fanti E. An epidemiological study of headache in a hospital staff . Headache . 1981;21:206-210.Crossref 18. Ogunyemi AO. Prevalence of headache among Nigerian university students . Headache . 1984;24:127-130.Crossref 19. Crisp AH, Kalucy RS, McGuinness B, Ralph PC, Harris G. Some clinical, social and psychological characteristics of migraine subjects in the general population . Postgrad Med J . 1977;53:691-697.Crossref 20. Olesen J, Larsen B, Lauritzen M. Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine . Ann Neurol . 1981a;9:344-352.Crossref 21. Olsen TS, Olesen J. Regional cerebral blood flow in migraine and cluster headache . In: Olesen J, Edvinsson L, eds. Basic Mechanisms of Headache . Amsterdam, the Netherlands: Elsevier Science Publishers; 1988:377-391. 22. Rasmussen BK, Jensen R, Olesen J. A population-based analysis of the diagnostic criteria of the International Headache Society . Cephalalgia . 1991;11:129-134.Crossref 23. Olesen J, Bonica JJ. Headache . In: Bonica JJ, ed. The Management of Pain . Philadelphia, Pa: Lea & Febiger; 1990:687-726. 24. Waters WE. The epidemiological enigma of migraine . Int J Epidemiol . 1973;2:189-194.Crossref 25. Bakal DA, Kaganov JA. Symptom characteristics of chronic and nonchronic headache sufferers . Headache . 1979;19:285-289.Crossref 26. Kaganov JA, Bakal DA, Dunn BE. The differential contribution of muscle contraction and migraine symptoms to problem headache in the general population . Headache . 1981;21:157-163.Crossref 27. Raskin NH. Migraine . Psychosomatics . 1982;23:897-903.Crossref 28. Waters WE. Community studies of the prevalence of headache . Headache . 1970;9:178-186.Crossref 29. Peck DF, Attfield ME. Migraine symptoms on the Waters Headache Questionnaire: a statistical analysis . J Psychosom Res . 1981;25:281-288.Crossref 30. Ziegler DK, Hassanein RS, Couch JR. Headache syndromes suggested by statistical analysis of headache symptoms . Cephalalgia . 1982;2:125-134.Crossref 31. Abramson JH, Hopp C, Epstein LM. Migraine and non-migrainous headaches: a community survey in Jerusalem . J Epidemiol Community Health . 1980;34:188-193.Crossref 32. Arena JG, Blanchard EB, Andrasik F, Dudek C. The headache symptom questionnaire: discriminant classificatory ability and headache syndromes suggested by a factor analysis . J Behav Assess . 1982;4:55-69.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Sep 1, 1992

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