Elsevier

Journal of the Neurological Sciences

Volume 372, 15 January 2017, Pages 307-315
Journal of the Neurological Sciences

Review Article
Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants

https://doi.org/10.1016/j.jns.2016.11.071Get rights and content

Highlights

  • Global migraine prevalence is 11.6%; Africa 10.4%, Asia 10.1%, Europe 11.4%, North America 9.7%, and South America 16.4%.

  • Prevalence is 13.8% in females, 6.9% in males, 11.2% in urban residents, 8.4% in rural residents, and 12.4% in students.

  • There was a pattern of rising global migraine prevalence.

  • Higher student and urban affliction can lower academic and economic performance.

  • Improving awareness, early treatment, research, training, and healthy urban lifestyles may tackle this costly prevalence.

Abstract

Objective

To study the weighted average global prevalence of migraine at the community level.

Study design and setting

A systematic review using advanced search strategies employing PubMed/MEDLINE, Scopus, and Web of Science was conducted for community-based and non-clinical studies by combining the terms “migraine”, “community-based”, and names of every country worldwide spanning all previous years from January 1, 1920 until August 31, 2015. Methods were in accordance with PRISMA and MOOSE guidelines. A meta-analysis with subgroup analysis was performed to identify pooled migraine prevalence and examine cohort heterogeneity.

Results

A total of 302 community-based studies involving 6,216,995 participants (median age 35 years, male-to-female ratio of 0.91) were included. Global migraine prevalence was 11.6% (95% CI 10.7–12.6%; random effects); 10.4% in Africa, 10.1% in Asia, 11.4% in Europe, 9.7% in North America, 16.4% in Central and South America. When the pooled cohort was stratified, the prevalence was 13.8% among females, 6.9% among males, 11.2% among urban residents, 8.4% among rural residents, and 12.4% among school/college students. Our result showed a pattern of rising global migraine prevalence.

Conclusion

Migraine affects one in ten people worldwide featuring recent rise. Higher prevalence was found among females, students, and urban residents.

Introduction

Community-based and centralized population-based neuroepidemiological studies are an accurate representation of estimating true incidence and prevalence of public health burdens [1]. Such studies serve as a crucial source of information for planning, policy-making, and research prioritization in health care [1]. Neuroepidemiological studies can enhance understanding, identify risk and prognostic factors, identify comorbidities and correlates, and stratify phenotyping [2], [3]. These studies allow sociodemographic subanalysis of population characteristics such as age-group, gender, and area of residency (urban or rural) [2], [4]. Socioeconomic impact of headache disorders has been assessed utilizing neuroepidemiological studies [5]. Capturing such big data allows researchers to conduct longitudinal prospective studies to identify causal factors. While longitudinal prospective studies provide the best evidence base for data accrual, repeated cross-sectional studies can be regarded as quasilongitudinal providing less costly but useful epidemiologic clues [6].

Migraine is a common cause of public health and socioeconomic burden worldwide; it is under- or misdiagnosed and under- or mistreated [7], [8], [9]. It can negatively affect quality of life and productivity both at work and at home [5]. When not appropriately managed, migraine is a progressive neurological disorder that has the potential to chronify [5]. Migraine is more common among the productive workforce segment of the population [4], [10]. Many countries in the Global South are at the crossroads of rapidly improving socioeconomic mobility and shifting disease epidemiology; mortality from communicable diseases is either declining or stabilizing, and greater numbers of people are living longer [1], [4]. Thus, morbidity and disability causing disorders such as migraine have become important causes of global health burden [1], [4], [11]. However, in developing countries, the health care delivery system is designed to tackle infectious diseases, and has not yet adapted to accommodate the growing health demands of chronic conditions such as migraine [11], [12].

Since the 1930s, beginning with classic studies by Balyeat [13] and later by Valqhuist [14], large number of community-based studies have been conducted in different countries worldwide to study migraine prevalence. The 2010 Global Burden of Disease (GBD) Study revealed that global years lived with disability (YLD) for migraine has steadily increased since 1990, making primary headache disorders the leading causes of sequelae of up to 35.5% (10.7% in males, 18.8% in females for migraine) [1], [11]. However, to the best of our knowledge, there is no study that combined data from all community-based studies to present a weighted average global migraine prevalence. We are now able to analyze these accruing results and identify important time series trends. Using a comprehensive systematic review and meta-analysis, we studied the global migraine prevalence at the community level, examine population cohorts with varying prevalences, and study inter-generational variations.

Section snippets

Screening and inclusion

A combination of the following search strategies using different search databases was employed to capture our topic of interest, i.e. community- or population-based or non-clinical studies on migraine prevalence. Clinical or healthcare facility-based studies were excluded because clinical population is made of convenience sampling where cohorts are created by recruiting only those patients presenting at clinical facilities [15].

  • 1.

    A PubMed/MEDLINE® search was employed for Clinical Studies

Results

302 studies involving 6,216,995 participants were included (Fig. 1b, Appendix B). Median age was 35 years (Interquartile Range or IQR 30.2–38.9). Male-to-female ratio among total number of participants was 0.91 (47.6% males, 52.4% females); male-to-female ratio among non-responders was not available. The geographic distribution of the studies was as follows: 33 (10.9%) studies were from Africa involving combined sample size of 178,382, 63 (20.9%) from Asia involving combined sample size of

Discussion

Overall, migraine affects 11.6% people worldwide. When this crude estimate was stratified to different sociodemographic cohorts, female gender, school/college goers and urban residents decreasingly were more affected compared to male gender, rural residents and the overall population. Urban residents were 1.3 times more likely to have migraine compared to rural residents. Migraine was twice as common among females compared to males. These results were in agreement with most previous studies on

Conclusions

Migraine affects one in ten people worldwide; it is twice common in females. Geographical variations were observed with Central and South American region featuring higher prevalence compared to other regions with comparable prevalence; however, this has to be interpreted within the context of lower combined sample size within this region compared to other regions. It can be deduced that rapid urbanization is associated with the recent rise in migraine prevalence. The significance of these and

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interest

None declared.

Acknowledgements

The authors are indebted to Associate Professor Tomomi Kawakami and Dr. Yuko Nakamura, from Department of Pediatric Dentistry, The Nippon Dental University School of Life Dentistry at Tokyo for assistance in Japanese translation.

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