tension type headache

27 April 2022

Massive Study on Headache Statistics

Just how common are headache disorders? This is an extremely difficult question, in spite of the statistics that are thrown around as if they’re certain.

A new study out of Norway, published in The Journal of Headache and Pain, is giving us a new way to look at headaches and migraine from a global perspective.

Researchers took 357 publications, not just adding up the numbers, but looking carefully at how the study was done, to come up with some new estimates for 1961-2020.

Age & Gender

Here is just a sample of the findings of the study. First, 52% of the global population has suffered from a headache disorder of some kind this past year. Here’s what that looks like:

Global headache statistics — Global Headache Statistics

What I call “chronic headache” here is defined as a headache more than 15 days a month (H15+ in the study).

In agreement with many other studies, headaches are more common in women than in men. The difference is significant, if not huge, until you get to migraine. In migraine, about twice as many women had migraine than men (~~which means of course that we should ignore men’s migraine~~). Another interesting migraine fact was that, unlike many other headache disorders, it does tend to be lower if you’re under the age of 10 or over 65.

Geography

The study also looked at geographical location. A possible limitation of the study was that most of the research has been done in wealthier countries. However, from what this study could tell, Southeast Asia, East Asia and Oceania was the best place to be, with lowest headache prevalence.

Headache is generally more common in the North Africa/Middle East region. Migraine, however, was most common in South Asia, as was chronic headache. Tension-type headache peaked in high income countries.

Headache today?

Do you have a headache today? On any given day, about 15.8% of the world population have a headache of some kind. Almost half of these – 7%, are migraine.

Progress through the years?

There hasn’t been a huge change overall in the prevalence of headache over the past few decades, which is not particularly encouraging. But there’s worse news. Migraine actually seems to be increasing.

Why would that be? Is it just that we are more aware of migraine, and so are diagnosing it more often? Or are there environmental factors (technology, pollution, change of diet, et cetera) that are making a difference?

The researchers did discuss this question, extensively. As with all of these statistics, in spite of careful research, it is very difficult to say with certainty exactly what the numbers are. But thanks to a lot of hard work, we do have some clues to help us more forward, and keep fighting back against headache. We still have a long way to go.

For more, you can read the abstract and the complete study here: The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates

A quicker summary can be found in ScienceDaily: Global estimates of headaches suggest disorder impacts over 50 percent of the population

10 April 2020

“Just a Headache” – Even Less Common Than We Thought

James Discoveries & Stats 0

Of course most of us know by now that migraine is not “just a headache”. In fact, it’s not “just migraine” either – there are many different types of migraine, and knowing the type of migraine you have may help you with treatment.

A recent study out of Spain is suggesting that the problem of the “just a headache” diagnosis may be even worse that we thought.

Imagine getting a headache diagnosis in the emergency department of your local hospital. If a doctor has to “guess” about what kind of headache you have, a good guess would be tension-type headache, right? Very common. Or is it?

The study took 2132 patients who had visited emergency, who had all been diagnosed with tension-type headache (TTH) (which isn’t caused by tension, by the way – hence the addition of the word “type”). Then the researchers used the criteria in the International Classification of Headache Disorders (ICHD) – the standardized way to diagnose headaches.

Out of over 2000 patients who were told they had TTH, guess how many probably actually did have TTH? 2.4%!

Really? Yep. “Take an aspirin, and call me in the morning – it’s just a headache.” But – what kind of headache? And is aspirin the best treatment? And what is the underlying cause?

A few simple questions can be used to better diagnose headaches. Are doctors not educated? Is there some laziness here? Are some just assuming that “chances are” it’s TTH? But what if the statistics are skewed just because we’re assuming it’s so common?

These patients were actually suffering from quite a variety of headaches, all with different treatments.

You can check out the ICHD classifications for yourself, right here. If your doctor gives you a diagnosis, it can at least get you started (although it can be tricky if you don’t have a wider knowledge of why various headaches are diagnosed as they are). Don’t settle for an off-the-cuff diagnosis – it could mean that you will suffer much longer than you need to.

13 September 2019

Veterans Affairs: Biofeedback for Migraine/Headache a Useful Tool

James Discoveries & Stats, Treatments 0

A recent study done by Veterans Affairs in the USA has confirmed again the value of biofeedback as a migraine and headache treatment.

Biofeedback for veterans — Original photo thanks to Army Medicine

We have actually talked about biofeedback here frequently. Biofeedback is a treatment that helps the patient take control of some normally “involuntary” processes in the body, such as heart rate and breathing patterns. Sometimes this is done using technology, other times without.

Veterans Affairs is very interested in the headache field for obvious reasons. But in this case, the research was a little bit wider. They wanted to find out which conditions were effectively treated by biofeedback, according to previous clinical trials. A study like this involves searching for past trials, as well as evaluating whether or not the trials were done properly.

The study found that biofeedback was indeed effective for migraine and headache conditions (more on that in a moment), and also for incontinence (both urinary and fecal). For other conditions there was less evidence, however, that’s at least partly because not many studies have been done for many other conditions.

So what did the researchers find? Biofeedback was effective in treating both tension-type headache and migraine. Specific types of biofeedback were especially effective. EMG (electromyogram) in biofeedback is used for muscle function. Measuring and controlling skin temperature and blood pressure were also helpful for migraine and headache.

Biofeedback decreased frequency, duration, and intensity of attacks – a very encouraging result. Interestingly, the most evidence of all was that it helps with the frequency of headaches. Helping with the headache/migraine attacks themselves, biofeedback also helped fight related issues, such as muscle tension, anxiety, and depression. It also helped decrease medication use.

Biofeedback has always been one of the treatments with the most good evidence behind it. It’s non-invasive and doesn’t involve medication, making it excellent for anyone but an especially valuable choice for children and pregnant women, where more caution is required for many other treatments.

For more information, listen to this Biofeedback for Migraine and Headache podcast. The study abstract is available here: Efficacy of Biofeedback for Medical Conditions: an Evidence Map

For an excellent overview of the study, see Review: Biofeedback could help treat a number of conditions from ScienceDaily.

14 December 2018

Fascinating (and disturbing) New Migraine and Headache Statistics

James Information, News 0

Last month, The Lancet (a world-renown medical journal) published an article with some new statistics about migraine and headache, from 1990 to 2016. The statistics are troubling as the fight to stop migraine and headache disorders continues around the world.

Researchers used the Global Burden of Disease Study 2016 (GBD 2016) to gain new insights into migraine and tension-type headache in particular. The advantage of using this study is that it has a global focus. It’s true that not every country has equally useful information, but it’s the best estimate we have today.

According to the new study, almost 3 billion people suffered from migraine or tension headache in 2016 (2.93 billion, to be more exact). That’s almost 40% of the world.

Of those, 1.89 had tension-type headache (over 25% of the world’s population) and 1.04 billion had migraine (about 14% of the world’s population).

Statistically, women are more likely to have headaches than men, but they’re a serious problem for everyone. People 15-49 are also at highest risk.

Now, here’s where things get interesting. Researchers had to calculate just how disabling these headaches were, on average. We’ve talked about this before – how both tension-type headaches and migraine are on a scale (it is possible to have a “mild” migraine attack, and a fairly “disabling” tension-type headache. And the two types may have a lot more in common than we once believed.).

But here’s a chart showing the difference.

Headache disability As you can see, migraine is generally significantly more disabling than tension-type headache (no surprise there). Here’s what the numbers mean – during an attack, someone with migraine loses 43.4% of their health on average (I know, at times during many attacks it’s much higher – remember, this is an average). For tension-type headache, patients lose 3.7% of their health.

But look at it this way – what if you lost that much productivity every day? What if you lose that % of your pay each month, or missed that % of your major family events? Even tension-type headache can be quite serious.

Researchers stretched this into YLDs, or years lived with disability (it’s a technical calculation used to estimate the affects of disability – don’t get caught up in the details right now). But first, how much time are people living with these attacks?

Patients who experience tension-type headaches tend to spend 4.7% of an average year with a headache, migraine patients 8.5% of a year.

So, worldwide, migraine caused 45.1 million YLDs in 2016, and tension-type headaches 7.2 million YLDs. That’s a total of 52.3 million YLDs worldwide – accounting for 6.5% of all YLDs from any cause!

If you’re head is spinning from all this, here’s the bottom line. These two issues alone – not even taking into consideration headaches of other types – leads to 6.5% of the world’s disability. That is a huge number, when you think about all the other causes.

Out of the full list, tension-type headache and migraine were both in the top 10 most prevalent concerns (tension-type headache third after after cavities and latent tuberculosis infection). Migraine especially is one of the main causes of disability worldwide. Migraine is among the top causes of YLDs.

The researchers said “any improvements in the efficacy of headache treatments during this period (which saw the introduction of triptans for migraine) have had no detectable effect”. That’s right – no change. (They suggest that one reason is because of lack of worldwide availability of treatments, and the inability to measure lengths of attacks in this study. Fair enough to some extent, especially the second point. If stopping a migraine after 10 minutes is measured the same as 3 hours of agony, we can see how it would be hard to measure the benefits of triptans in this study. Still – no improvement??)

The researchers suggest that treatment of such a huge population will be a massive job – and that perhaps our focus should be on reducing risk.

Researchers also recommend an increased focus on headache care in health care systems, a focus on simple remedies, more resources given to research, and the development of better cost-effective treatments.

There’s a lot to discuss here, and you can read more for yourself in the links below.

I have seen many people helped by quality information, which is why this blog is here. So I know that change and improvement is possible. But there are many, many, who are still not being helped. As the authors of this study put it: Headache is not limited to the high-income part of the world and, unless action is taken, it is here to stay…

News summary: Migraines and tension headaches are more prevalent and debilitating than we thought
Full study: Global, regional, and national burden of migraine and tension-type headache, 1990–2016

29 November 2018

The “10-Second Tension Headache Remedy”

James Tips, Treatments 0

At least a couple of articles have been circulating promoting a tension headache remedy that is quick, and free. And certainly worth a try.

Tension headaches are, as you may know, now commonly called “tension-type headaches”. Why? Because doctors now know that these headaches aren’t simply caused by tension. Your muscles can be very tense, and you may not have any symptoms whatsoever. And – the reverse can also be true. (For more, see Just what is the “Common Headache”?)

Superficial chewing muscles — Diagram thanks to OpenStax Anatomy and Physiology

With that important caveat in place, the fact remains that, in certain cases, muscle tension is related to headaches. For example, muscle tension can trigger headache and/or migraine attacks in certain people.

That may be one reason why quitting chewing gum seems to help many people lessen headaches.

The “10-second remedy” is similar – it involves massage of the masseter muscle, a muscle used when you chew food – or clench your teeth at night. There are a few ways to massage here. One is using your fingers to put pressure on the front of the muscle (toward your mouth), then push back (up toward your ear).

Another method, the one you’ll read about in the following article, is to let the jaw do the movement.

Try it next time you feel a headache coming on. If it works, it may mean that jaw issues such as TMD are contributing to your headache symptoms.

The 10-Second Tension Headache Remedy a Physical Therapist Swears By (from Prevention)