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Age-dependent prevalence and clinical features of migraine

From the Departments of Neurology (M.E.B., R.B.L.) and Epidemiology and Population Health (R.B.L.), Albert Einstein College of Medicine, and Montefiore Headache Unit (M.E.B., R.B.L.), Bronx, NY; Caremark Inc. (J.N.L.), Hunt-Valley, MD; and New England Center for Headache (M.E.B.), Stamford, CT.

Address correspondence and reprint requests to Dr Bigal, Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Ave., Bronx, NY; e-mail: mbigal{at}aecom.yu.edu

Background: Available data suggest two seemingly opposite trends with regard to the natural history of migraine. Migraine prevalence decreases with age. In some individuals, migraine progresses to chronic daily headache.

Objective: To contrast the clinical features of migraine across the life span.

Methods: A validated computer-assisted telephone interview (CATI) was used to identify a population sample in three urban centers in the United States. Eligible participants were older than 18 years. The CATI covered the International Classification of Headache Disorders criteria for migraine and probable migraine (PM). Prevalence and clinical features of migraine and PM were examined by age.

Results: This sample consists of 145,335 participants. The overall prevalence of migraine was 15%, whereas the overall prevalence of PM was 14.6%. Migraine prevalence was highest between ages 30 and 39 years. In older ages, PM was more prevalent than migraine. Among those with migraine, the prevalence of unilateral and throbbing pain peaked at intermediate ages and declined after that. The prevalence of photophobia and phonophobia related to the attacks declined with ages, whereas the prevalence of aura increased. The proportion of those with 10 to 14 headache days per month also increased, from 12.5% in those ages 18 to 29 to 41.0% (odds ratio = 4.8, 95% CI = 3.9 to 7.1) in those older than 70.

Conclusion: The profile of migraine changes over the life span and suggests three nonexclusive profiles. In many, migraine remits. In some patients with migraine, attacks get less typical, resembling probable migraine instead of full migraine. In some, migraine progresses.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the July 25 issue to find the title link for this article.

Disclosure: The authors report no conflicts of interest.

Received September 19, 2005. Accepted in final form March 29, 2006.

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