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