Michael Eller; Peter J Goadsby


Expert Rev Neurother. 2013;13(3):263-273. 

In This Article

Definition & Epidemiology of Common Headache

In order to grasp the wider context and clinical import of MRI in the common headache conditions, it is worth briefly covering relevant epidemiological and clinical details. Headache is a pervasive condition across cultural and geographic boundaries; the world prevalence of active symptoms is estimated to be 46%. The lifetime prevalence is 66% for any headache: 14% for migraine, 46% for tension-type headache (TTH) and 3.4% for chronic headache.[10] A recent large, population-based study demonstrated a cumulative migraine incidence of 43% in women and 18% in men. The median age of onset was 25 years among women and 24 years among men.[11] The associated calculated disability ranks headache among the ten most disabling conditions worldwide according to WHO parameters.[10]

Many people in the community suffer from headache.[12] In Denmark, for example, the lifetime prevalence of TTH has been estimated to be 86%; most patients (59%) only had one headache a month.[13] Within this group, some features that help differentiate migraine are often seen without fulfilling the current diagnostic criteria: more than five episodes; prolonged headache (4–72 h); two of unilateral location, pulsating quality, moderate-to-severe pain intensity and aggravation with routine exercise; one of nausea and/or vomiting or photophobia and phonophobia must also be present; and any other possible cause excluded.[5] Migraine phenotype is further defined by the absence (MO) or presence of aura, or visual aura occurring in up to 40% of migraineurs.[14]

Chronic daily headache (CDH) describes headache of 15 days per month or more for more than 3 months.[15] Medication overuse is a frequent complication.[10,16] Longer duration – generally lasting greater than 4 h – CDH syndromes are: migraine, TTH, NDPH and hemicrania continua. CDH syndromes, in comparison with episodic forms, are associated with greater morbidity and impact on healthcare costs.[17,18] They are overwhelmingly represented by patients with migraine and TTH.[17]