Prevalence of migraine in the Canadian household population
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Pamela L. Ramage-Morin and Heather Gilmour
Migraine can be a debilitating disorder characterized by pulsating headaches lasting from a few hours to several days, accompanied by nausea, vomiting, and/or sensitivity to light and sound. It is exacerbated by and tends to interfere with physical activity. Migraine usually occurs on one side of the head, although in children and youth it tends to be bilateral.Note1
An estimated 14% of the world’s population have suffered from migraine at some point in their life.Note2 Studies consistently show that women are more likely than men to experience migraine.Note2,Note3
Migraine is recognized as a major cause of disability.Note2 A global study ranked migraine eighth in years lived with disability, a measure of the burden of disease.Note4 The cost to individuals, their families and the community is high in terms of quality of life, absenteeism from school and work, lost productivity, and medication expenses.Note5,Note6
Using data for 2010/2011, this study provides up-to-date estimates of the prevalence of migraine diagnosed by a health professional, as well as estimates of migraine burden (see The data). Gaps addressed in this analysis include the prevalence among children younger than 12 and impacts on usual activities. Migraine diagnosed by a health professional is henceforth referred to simply as “migraine”; those diagnosed with migraine are referred to as “migraineurs.” Note7
Prevalence of migraine
In 2010/2011, an estimated 8.3% of Canadians (2.7 million) reported that they had been diagnosed with migraine (Table 1). This likely underestimates migraine prevalence. Research indicates that some people who experience migraine do not seek professional help, and therefore, would not have a diagnosis to report.Note8,Note9
To identify migraineurs, most studies employ the International Classification of Headache Disorders (ICHD) criteria, rather than self-reported diagnosis (Appendix Table A). However, even among studies that used ICHD criteria, prevalence estimates vary widely—from 2.4% to 27.5% in some American and European studies.Note10-15 The prevalence in the present study (Table 1) is below estimates based on results of three population surveys in the United States: 22.7% in the National Health and Nutrition Examination Survey; 16.6% in the National Health Interview Survey; and 11.7% in the American Migraine Prevalence and Prevention study. Stovner et al. Note15 note that differences in methodologies used by population-based studies have made comparisons difficult and point to the need to standardize methodological guidelines for migraine studies.
Females were more than twice as likely as males to report migraine (11.8% versus 4.7%), a pattern that prevailed among all age groups except children younger than 12 (Figure 1). Fewer than 1% of children had migraine, and no significant difference emerged between boys and girls. For both sexes, prevalence was highest at ages 30 to 49; the mean age for women was 43, slightly older than for men (40) (p < 0.01).
On average, migraine was diagnosed at 26.2, 3.6 years after symptoms were first experienced (p < 0.01). There was no significant difference by sex, contrary to earlier findings that onset peaks earlier for men than women.Note4
Compared with the national figure, migraine prevalence was lower in Quebec (6.8%) and higher in Manitoba (9.5%), Nova Scotia (9.1%) and Ontario (8.8%). These differences persisted even after age-standardization (data not shown). An earlier Canadian studyNote8 also reported lower migraine prevalence in Quebec. Studies in GermanyNote14 and SpainNote13 have observed differences within regions of the same country.
Most migraineurs reported migraine as their only neurological condition (Table 1). Nonetheless, they were more likely than non-migraineurs to report that they had also been diagnosed with a brain or spinal cord injury, epilepsy, or the effects of a stroke (Appendix Table B).
The majority of migraineurs reported symptoms of depression—63% were classified with minimal or mild depression, and 20% had moderate to severe depression. The relationship of these two disorders is well established in epidemiological literature: migraine increases the risk of depression, and depression increases the risk of migraine.Note20-25
Fewer than half of migraineurs (42%) reported that they had taken prescription medication for the condition in the past three months (Table 2). Migraineurs aged 50 or older were more likely than those aged 15 to 49 to have taken prescription medication (57% versus 35%; p ≤ 0.01).
Given that migraineurs, as defined in this study, must have reported a diagnosis, the low percentage taking prescription medication was not due to under-diagnosis. The percentage using medication would likely be much higher if non-prescribed products had been included in survey questions.Note26,Note27
Among migraineurs not taking prescription medication, the most frequent reasons were that they did not need it (35%), it had not been prescribed (25%), and they did not want it (14%). More than half (56%) of migraineurs reported incurring out-of-pocket medication expenses in the past 12 months for which they would not be reimbursed.
Impact on usual activities
About one-quarter of migraineurs experienced pain that prevented activities (26%) or felt left out of things because of their condition (26%). More than half (53%) reported that migraine had prevented them from driving, at least for a short time. Migraine limited getting a good night’s sleep for three-quarters of migrainerus (76%). Almost a third (30%) reported limitations in educational opportunities.
About one-third of migraineurs reported limitations in job opportunities (34%), although the majority were currently employed (70%). Over one-third of those currently working (36%) reported missing at least one day of work in the past three months owing to migraine. Nearly one in five (18%) who had previously been employed reported that they had changed their work activities (hours, type of work, or stopped work) for at least three months because of migraine. Previous studies indicate that migraine is strongly associated with lost productive time, most of which is linked to presenteeism (reduced productivity) rather than absenteeism.Note21,Note28
This study presents the most current estimates of the prevalence and impact of migraine in Canada. In 2010/2011, an estimated 2.7 million Canadians had migraine headaches. Many of them reported that migraine affected their daily life, including work and educational opportunities. The disorder was associated with medication use, pain, depression, difficulty sleeping, and the ability to drive.
Statistics Canada thanks all participants for their input and advice during the development of the neurological content for the Canadian Community Health Survey (CCHS) and the Survey on Living with Neurological Conditions in Canada (SLNCC). The content was developed jointly by the Health Statistics Division at Statistics Canada and the Public Health Agency of Canada (PHAC), with input from PHAC’s expert advisory group members who specialize in the study of neurological conditions. Content selection was based on objectives and data requirements specified by PHAC. Sponsorship was provided by PHAC as part of the National Population Health Study of Neurological Conditions.