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Global epidemiology of migraine and its implications for public health and health policy

Nature Reviews Neurology volume 19, pages 109–117 (2023)Cite this article

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Abstract

Migraine is one of more than 200 headache disorders but stands out among these as a major cause of population ill health. In migraine epidemiology, the key variable is prevalence, but, from the perspective of public health, prevalence is uninformative without burden estimates. Here, we discuss how migraine epidemiology, from a quite recent start, has evolved into the respectable though imperfect science of today, but with the legacy that much of the large corpus of older literature is of questionable reliability. Newer studies have benefited from a universally accepted definition of migraine, while methodological developments have broadened the scope of migraine caseness, and published guidelines address important methodological issues. In the light of these developments, we question the apparent increase in migraine prevalence over time, offering explanations as to why this may be illusory. We suggest that the current best estimates are that global migraine prevalence is 14–15%, and that migraine accounts for 4.9% of global population ill health quantified in years lived with disability (YLDs). These evaluations are probably under-quantified rather than over-quantified, and YLDs are not a comprehensive measure of migraine-attributed burden. Despite these uncertainties, such high estimates of population ill health have clear implications for health policy.

Key points

  • Migraine is one of more than 200 recognized headache disorders but, as a major cause of global population ill health, stands out from all others in the context of public health.

  • Although prevalence is the key variable in migraine epidemiology, prevalence estimates, from the perspective of public health, are uninformative without associated burden estimates.

  • Migraine epidemiology is a young and evolving science, and, with an accepted definition of migraine available only since 1988, much in the large corpus of older literature is of questionable reliability.

  • Accordingly, the apparent increase in migraine prevalence over the past three decades may be illusory.

  • The current best estimate of global migraine prevalence is 14–15%, and, in terms of burden, migraine accounts for 4.9% of global ill health, quantified as years lived with disability.

  • These evaluations are still attended by uncertainty and are probably under-quantified rather than over-quantified.

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Fig. 1: Waypoints in the evolutionary progress of migraine epidemiology.
Fig. 2: Estimated global migraine prevalence from 1990 to 2019.

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Authors and Affiliations

  1. NorHEAD, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway

    Timothy J. Steiner & Lars Jacob Stovner

  2. The Norwegian Advisory Unit on Headaches, St. Olavs Hospital, Trondheim, Norway

    Lars Jacob Stovner

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  1. Timothy J. Steiner
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Correspondence to Timothy J. Steiner.

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Both authors are directors and trustees of Lifting The Burden. T.J.S. has no other competing interests. L.J.S. has received lecture fees and research contributions from Allergan, Lilly, Lundbeck, Novartis and Teva during the last 3 years.

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Nature Reviews Neurology thanks Min Kyung Chu, Matilde Leonardi, Jes Olesen and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Related links

GBD interactive website: https://vizhub.healthdata.org/gbd-compare/

Glossary

Caseness

Whether or not an individual has the condition of interest.

Cluster-sampling

A method of probability sampling in which a population is divided into smaller groups, or clusters. Clusters are then randomly selected to form a sample.

Retropolations

Backward extrapolations.

Secular trends

Long-term trends.

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Steiner, T.J., Stovner, L.J. Global epidemiology of migraine and its implications for public health and health policy. Nat Rev Neurol 19, 109–117 (2023). https://doi.org/10.1038/s41582-022-00763-1

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