Factors Associated with Primary Headache According to Diagnosis, Sex, and Social Group

We previously showed that migraine and tension-type headache (TTH) have a high prevalence that differs markedly between social groups. Here, we aim to identify factors associated with migraine and TTH (possible risk factors) in three social groups to better understand the difference in prevalence between sexes, between different headache diagnoses, and between different social groups.

The study included 3124 persons: 1007 blood donors (484 females, mean age 34.1), 1075 workers in an oil and gas factory (146 females, mean age 40.4), and 1042 medical students (719 females, mean age 20.6). Headache diagnoses and associated factors were identified by direct or telephone interview using a semistructured, validated form. It was administered by a neurologist or by specially trained senior medical students under supervision of a neurologist.

We report factors associated with headache according to diagnosis, sex, and social group using multivariate logistic regression analysis. (1) According to diagnosis. Many associated factors were common for migraine and TTH: female sex, arterial hypertension, history of head trauma, and consumption of light alcoholic beverages. To be a student was associated with the highest risk of migraine (OR 6.6; 95% CI 4.2-10.4) and TTH (OR 3.6; 95% СI 2.7-4.8). Low physical activity (OR 1.6; 95% CI 1.0-2.4) and family history of headache (OR 2.1; 95% CI 1.5-2.9) were associated only with migraine. Current smoking and BMI > 25 were negatively associated with migraine and TTH. (2) According to sex. Common factors associated with migraine and TTH in both sexes included history of head trauma, family history of headache, and arterial hypertension. Use of alcohol was different between sexes: in males consumption of strong alcoholic beverages was associated with TTH (OR 1.5; 95% CI 1.0-2.0) and in females consumption of light alcoholic beverages was associated with migraine (OR 3.49; 2.03-6.02) and TTH (OR 3.0; 95% CI 1.93-4.66). Low physical activity was associated with migraine in females (OR 1.9; 95% CI 1.1-3.2). (3) According to social group. Common factors associated with headache in all groups included female sex, family history of headache, history of head trauma, and arterial hypertension. Consumption of light alcoholic beverages was associated with migraine and TTH in blood donors and students. Only two factors were specific to a social group: consumption of strong alcoholic beverages was associated with TTH in blood donors (OR 1.5; 95% CI 1.1-2.1), low physical activity was associated with migraine in students (OR 1.98; 95% CI 1.04-3.74) and with TTH in workers (OR 2.1; 95% CI 1.2-3.7).

Most of the associated factors were shared by the sexes. The associated factors varied somewhat more between migraine and TTH and between social groups. To be a student was associated with the highest risk of headache. Factors different from those in the present and previous studies should be studied in the future in order to better understand the differences in associated factors according to diagnosis, sex, and social group.