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NEUROLOGY 2004;62:2065-2069
© 2004 American Academy of Neurology

The relative influence of environment and genes in episodic tension-type headache

Vibeke Ulrich, MD PhD, Morten Gervil, MD PhD and Jes Olesen, MD DrMedSci

From the Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.

Address correspondence and reprint requests to Dr. Vibeke Ulrich, Glostrup Hospital, Department of Neurology, DK-2600 Glostrup, Copenhagen, Denmark; e-mail: ulrich{at}post1.tele.dk

Objective: To examine the relative importance of genetic and environmental influence for the development of tension-type headache by analyses of twins.

Methods: The authors screened by questionnaire a population of 5,360 twins born during 1953 to 1960 from the general population for migraine and headache symptoms. The response rate of the questionnaire was 87%. All twin pairs with at least one twin of the pair reporting migraine or headache symptoms were interviewed by telephone by a physician. Correlation of liability and structural equation modeling were applied on tension-type headache.

Results: A total of 1,417 subjects had tension-type headache equivalent to a 1-year prevalence of 62%. The male: female ratio was 1:1.24. Chronic tension-type headache was found in 49 twins corresponding to a prevalence of 2% with a male:female ratio of 1:1.21. The prevalence, pain characteristics, frequency, and duration of tension-type headache were similar to what has been found in the general Danish population. The correlation of liability of tension-type headache was low and not significantly different in monozygotic and dizygotic twin pairs: 0.21 (0.03 to 0.39), 0.08 (0 to 0.24). The best fitting model of phenotypic variation consisted of 81% non-shared environmental effects and of 19% additive genetic effects.

Conclusions: Environmental influence is of major importance for episodic tension-type headache and a genetic factor, if it exits, is minor. In chronic tension-type headache the genetic factor may be more important. These data clearly separate episodic tension-type headache from migraine without aura where the phenotypic variation consists of non-shared environmental effects of 39% and of 61% additive genetic effects.

Received September 13, 2003. Accepted in final form February 10, 2004.






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