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Prevention of headache in adolescents: population-attributable risk fraction for risk factors amenable to
Lucia Albers1, Astrid Milde-Busch, Otmar Bayer
1Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany. lucia.albers@med.uni-muenchen.de
Introduction:
Several risk factors for headache have been identified, some of which are potentially amenable to interventions. The potential effect of such interventions can be predicted by the population-attributable risk fraction (PARF). We assessed PARFs of the the following risk factors: neck muscle pain, chronic stress, alcohol consumption, smoking, coffee consumption, and physical inactivity. We studied the maximal possible effect achievable by avoidance of these risk factors.
Methods:
Two approaches to estimate PARFs are compared, which assess their cumulative and individual impact of risk factors by age: the Levin formula and the average attributable fraction.
Results:
The overall impact for removal of all six risk factors amounts to 19.7% for the average attributable fraction. Neck tension and consumption of alcohol ranked as the strongest population-attributable risk factor for any headache. The potential impact for migraine was considerably higher (43.8%). With increasing age, the overall impact of risk factors on headache increases by 18.9%.
Conclusion:
Based on the estimations of the most appropriate approach, up to 20% of headaches in general and up to 43% of migraine in adolescents might be preventable by removing risk factors amenable to intervention, with increasing proportions by age.
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