Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Abstract

Background: Through the Global Burden of Diseases, Injuries, and Risk Factors (GBD) studies, headache has emerged as a major global public health concern. We aimed to use data from the GBD 2016 study to provide new estimates for prevalence and years of life lived with disability (YLDs) for migraine and tension-type headache and to present the methods and results in an accessible way for clinicians and researchers of headache disorders.

Methods: Data were derived from population-based cross-sectional surveys on migraine and tension-type headache. Prevalence for each sex and 5-year age group interval (ie, age 5 years to ≥95 years) at different time points from 1990 and 2016 in all countries and GBD regions were estimated using a Bayesian meta-regression model. Disease burden measured in YLDs was calculated from prevalence and average time spent with headache multiplied by disability weights (a measure of the relative severity of the disabling consequence of a disease). The burden stemming from medication overuse headache, which was included in earlier iterations of GBD as a separate cause, was subsumed as a sequela of either migraine or tension-type headache. Because no deaths were assigned to headaches as the underlying cause, YLDs equate to disability-adjusted life-years (DALYs). We also analysed results on the basis of the Socio-demographic Index (SDI), a compound measure of income per capita, education, and fertility.

Findings: Almost three billion individuals were estimated to have a migraine or tension-type headache in 2016: 1·89 billion (95% uncertainty interval [UI] 1·71-2·10) with tension-type headache and 1·04 billion (95% UI 1·00-1·09) with migraine. However, because migraine had a much higher disability weight than tension-type headache, migraine caused 45·1 million (95% UI 29·0-62·8) and tension-type headache only 7·2 million (95% UI 4·6-10·5) YLDs globally in 2016. The headaches were most burdensome in women between ages 15 and 49 years, with migraine causing 20·3 million (95% UI 12·9-28·5) and tension-type headache 2·9 million (95% UI 1·8-4·2) YLDs in 2016, which was 11·2% of all YLDs in this age group and sex. Age-standardised DALYs for each headache type showed a small increase as SDI increased.

Interpretation: Although current estimates are based on limited data, our study shows that headache disorders, and migraine in particular, are important causes of disability worldwide, and deserve greater attention in health policy debates and research resource allocation. Future iterations of this study, based on sources from additional countries and with less methodological heterogeneity, should help to provide stronger evidence of the need for action.

Funding: Bill & Melinda Gates Foundation.

Figure 1

Age-standardised prevalence of migraine per 100 000 population by location for both sexes, 2016 ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. LCA=Saint Lucia. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.

Figure 2

Age-standardised prevalence of tension-type headache per 100 000 population by location for both sexes, 2016 ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. LCA=Saint Lucia. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.

Figure 3

Global prevalence of (A) migraine and (B) tension-type headache by age and sex, 2016 Prevalence is expressed as the percentage of the population that is affected by the disease. Shaded areas show 95% uncertainty intervals. Values are plotted at the midpoint of 5-year age categories.

Figure 4

Global years of life lived with disability (YLD) rate per 100 000 population due to migraine and tension-type headache by age, 2016 Shaded areas show 95% uncertainty intervals. Values are plotted at the midpoint of 5-year age categories.

Figure 5

Age-standardised disability-adjusted-life-years (DALY) rates for (A) migraine and (B) tension-type headache by 21 Global Burden of Disease regions by Socio-demographic Index (SDI), 1990–2016 The solid black line represents expected values based on SDI from a regression of all location data over the entire 1990 to 2016 estimation period.