Prevalence and Cost Of Headache

Based on the studies summarised below, we can expect the following statistics to apply to Australia:

• • 4.9 million Australians experience migraine (Migraine in Australia Whitepaper, Deloitte Access Economics Report, 2018).
  • prevalence of migraine increases from 12 years to about 40 years and declines thereafter in both sexes.
  • 23% of households contain at least one person who has migraine.
  • up to seven million tension-type headache sufferers (36% for men and 42% for women[1]).
  • nearly all those with migraine and 60% of those with tension-type headache experience reductions in social activities and work capacity.
  • the direct and indirect costs of migraine alone would be about $35.7 billion pa (Migraine in Australia, Deloitte Access Economics Report, 2018).

Extracts from the studies on which we base this information are included below.

1. World Health Organisation Report

Headache Disorders and Public Health, Education and Management Implications
World Health Organisation, Geneva, WHO/MSD/MBD/00.9, Sept 2000

Headache is a symptom of a range of neurobiological disorders, including some of the most common and ubiquitous. Adults aged 20 – 50 years are the most likely sufferers but children and adolescents are affected too.  The term ‘headache disorder’ encompasses a number of conditions that vary in severity, incidence and duration. As a consequence establishing their overall prevalence has been difficult. There is a lack of worldwide studies on the different headache sub-types. Those carried out have employed different methodologies although headache definitions were standardised by the International Headache Society in 1988.

What is undisputed is that migraine and tension-type headache are the most prevalent headache disorders and, both with disabling potential, they have the greatest impact on public health.

Migraine is the more thoroughly investigated, and better understood.  Onset of migraine is from childhood onwards but most commonly in the 20s and 30s and relatively infrequently after the age of 40 years; therefore, prevalence increases from the first to fourth decades and thereafter declines. Migraine may nevertheless be a significant health issue among children.

Overall, migraine has a variable prevalence worldwide.  In European and American studies the one-year period prevalence of migraine in adults is estimated at 10-15%.

The frequency of migraine attacks is highly variable, from 1/year in some to more than 1/week in as many as 25% of sufferers. The average may be as high as 21 episodes per sufferer per year.

Tension-type headache is the most widespread of headache disorders. Onset is often in the teenage years and prevalence peaks in the fourth decade and then declines. Overall, one-year prevalence may exceed 60% although it is apparently lower in some countries. A large part of the population have mild and infrequent tension-type headache (once monthly or less), with 20-30% experiencing headache episodes more often. Tension-type headache is also more common in women, in a ratio of 1.5:1.

These common neurological complaints impose a significant health burden, with nearly all migraine sufferers and 60% of those with tension-type headache experiencing reductions in social activities and work capacity. Despite this, both the public and the majority of healthcare professionals tend to perceive headache as a minor or trivial complaint. As a result, the physical, emotional, and economic burdens of headache are poorly acknowledged in comparison with those of other, less prevalent, neurological disorders.

2.  Studies Carried Out in the United States

Findings from three major studies involve leading epidemiologist Dr Richard Lipton are summarised below.  Dr Lipton is Professor of Neurology, Epidemiology and Social Medicine at Albert Einstein College, New York and has published over 300 original articles and reviews in the fields of headache, neuroepidemiology and health services research.

Prevalence and Burden of Migraine in the United States: Data from the American Migraine Study II- R.B Lipton MD, W.F Stewart MPH PhD, S. Diamond MD, M.L Diamond MD and M. Reed PhD, reported in Headache 2001;41:646-657.
This study, involving 29,727 age-eligible individuals, found that:

• the prevalence of migraine was 18.2% among females and 6.5% among males, ie prevalent in over 10% of the population
• approximately 23% of households contained at least one member suffering from migraine
• migraine prevalence was inversely related to household income
• prevalence increased from 12 years to about 40 years and declined thereafter in both sexes
• the prevalence and distribution of migraine remained stable cf a previous study (1999 cf 1989) migraine is an important target for public health interventions because it is highly prevalent and disabling
• migraine-associated disability remains substantial and pervasive
• 53% of respondents reported their headaches caused substantial impairment in activities or required bed rest, approximately 31% having had to miss at least one day of work or school in the previous three months, 51% reporting that work or school productivity was reduced by at least 50%.

Migraine Diagnosis and Treatment: Results from the American Migraine Study II- R.B Lipton MD, W.F Stewart MPH PhD, S. Diamond MD, M.L Diamond MD and M. Reed PhD, reported in Headache August 2001; 41:638-645.
This study, involving 3,577 severe headache sufferers meeting the HIS criteria for migraine, found that:

• a physician diagnosis of migraine was reported by 48% of participants compared with 38% in a previous study (1999 cf 1989)
• 41% used prescription drugs for headaches in 1999, compared with 37% in 1989
• 57% used only over-the-counter medications in 1999, compared with 59% in 1989
• 37% of diagnosed and 21% of undiagnosed migraineurs reported 1 to two days of activity restriction per episode
• 38% of diagnosed and 24% of undiagnosed migraineurs missed at least 1 day of work or school in the previous three months
• 57% of diagnosed and 45% of undiagnosed migraineurs experienced at least a 50% reduction in work/school productivity.
  The researchers concluded, “Diagnosis of migraine had increased over the decade but about half of migraineurs remain undiagnosed, and the increased rate of diagnosis of migraine have been accompanied by only a modest increase in the proportion using prescription medicines. Migraine continues to cause significant disability whether or not there has been a physician diagnosis. Given the availability of effective treatments, public health initiatives to improve patterns of care are warranted.”

Disability and economic costs of migraine in the United States: A population-based approach – X. Hu, L. Markson, R.B Lipton et al 1999 Arch.Intern. Med. 159:813-818
This study ‘reported

• direct costs (annual treatment costs): over $1 billion pa
• indirect costs (due to absenteeism and reduced effectiveness at work): $13 billion pa
• ie total costs (direct and indirect): over $14 billion pa.

3.  Studies Carried Out in Australia

Migraine in Australia Whitepaper, Deloitte Access Economics Report, 2018

The socioeconomic burden of migraine in Australia was estimated using best practice cost-of-illness methodology applying a prevalence approach. This approach involves estimating the number of people with migraine in a base period (2018) and the costs attributable to the condition in that period. The analysis was based on the data collected in a targeted data scan and literature review.

Key Findings:

Prevalence of headache and migraine in an Australian city- J. Heywood, T. Colgan, and C. Coffey- Journal of Clinical Neuroscience (1998) 5(4), 485.

This Melbourne study, involving interviewing 1717 individuals, aged 12 and over, from 773 households, found that:

• 87% of subjects had experienced headache in the last year
• the one year prevalence of migraine was 16%, with females at 3 times elevated risk of migraine, age-adjusted
• of those reporting migraine headache in the last year, the commonest medications used were simple analgesics (55%), combination analgesics (34%), anti-inflammatories other than aspirin (4%), and ergotamines (3%). Less than 1% of respondents had used sumatriptan, dihydroergotamine or narcotic analgesics.  2% had used preventative medication for their migraines in the last year.
• they had sought advice from general practitioners (23%), pharmacists (11%), dentists (7%), chiropractors (4%), medical specialists, physiotherapists, eye practitioners, and masseurs (each 2%).
• headache and migraine are common disorders in Australia, and migraineurs may not regularly seek professional advice regarding treatment.

Prevalence and vascular associations with migraine in older Australians – P. Mitchell, J.J Wang, J. Currie, R.G Cumming and W. Smith – ANZ Journal of Medicine Vol 28 No 5 October 1998

This 1992- 1994 Blue Mountains NSW study, involving 3654 residents of two postcode areas aged 49 or older, found that:

• a lifetime past history of typical migraine was given by 17% of participants including 22% of women and 10% of men, a ratio of 2.3:1.
• a marked trend for declining migraine frequency with increasing age was found for both sexes.

The Prevalence and Costs of Migraine in Australia – T.G Parry, School of Economics, University of New South Wales 1990-91.

This study summarised estimates of the major direct and indirect costs of migraine in Australia:

* Total productivity losses from days away from work plus productivity losses while at work subject to a migraine episode.

1 Wolff’s Headache And Other Head Pain 7th ed – S.D Silberstein, R.B Lipton, D.J Dalession 2001