Diagnosing Headache: Clinical Clues and Clinical Rules

The vast majority of people worldwide experience headache at least once during a lifetime. Several international studies have shown that the lifetime prevalence of headache ranges from 60% to 93% in men and from 82% to 99% among women. One-year prevalence rates by gender vary greatly by country, ranging from 40% to 91% for women and 19% to 84% for men. These dramatic variations in headache prevalence may reflect racial differences. For example, one study found the prevalence of migraine in the United States was highest in Caucasians, intermediate in African Americans, and lowest in Asian Americans. Although headache and migraine are more common among adults, children are not immune. Investigators have reported that headache occurs in 4% of 3-year-olds. By 5 years of age, as many as 20% of children experience a headache, and the incidence increases to 47% among children 6 to 7 years of age. Between 7 and 15 years of age, 57% of children have had a headache and, in the same age group, the percentage of migraine sufferers approaches 10%, which is comparable to the percentage of adult migraine sufferers. In addition, the incidence of migraine among children has markedly increased during the past 3 decades. The burden of headache is significant, especially among those with primary headache disorders such as migraine. Studies using the Health-Related Quality of Life and the Short Form-12 assessments reveal a substantially reduced quality of life among migraine patients compared to controls. Pooled data from studies conducted in the United States and United Kingdom have documented that the median pain A M B U L A T O R Y M E D IC IN E Diagnosing Headache: Clinical Clues and Clinical Rules