Monitoring chronic headache and medication-overuse headache prevalence in Denmark

Abstract

Objectives To study chronic headache and medication-overuse headache (MOH) prevalence; to identify groups with high prevalence of these conditions; and to identify the most frequently used pain medications among respondents with chronic headache. Background Chronic headache and MOH prevalence in Denmark were last estimated in 2010. Methods In this cross-sectional study, 104,950 individuals aged ≥16 years were randomly sampled for the 2017 Danish Capital Region Health Survey. Responses to questions about headache and use of acute pain medications were linked to demographic registries. MOH was defined as headache ≥15 days/month plus self-report of use of pain medications ≥10 or 15 days/month, in the last three months. Weighted prevalence proportions were calculated. Results Among 55,185 respondents, chronic headache prevalence was 3.0% (95% CI: 2.3–3.2) and MOH prevalence was 2.0% (95% CI: 1.8–2.1). Both conditions were more common among females and the middle-aged. Respondents on social welfare or receiving early retirement pensions had the highest prevalences. Among those with chronic headache, 44.7% overused over-the-counter analgesics for headache; paracetamol 41.5%; a combination of different pain relievers 25.3%; ibuprofen 21.9%; opioids 17.0%; combination preparations 14.3%; and triptans 9.1%. Conclusions The highest prevalence of chronic headache and MOH was seen among people with low socioeconomic position. Overuse of paracetamol was most common. Reported opioid use was higher than expected. Groups with high prevalence of MOH should be the focus of public health interventions on rational use of OTC and prescription pain medications.

Time trends of major headache diagnoses and predictive factors. Data from three Nord-Trøndelag health surveys

“…Conceivably, individuals who at baseline in HUNT2 already had experienced that alcohol causes headache may tend to avoid it [28]. In previous prospective HUNT studies, we have found that physical activity gave lower risk of headache and migraine compared to physical inactivity [25,32]. Contrary to these results, in the present study physical inactivity was associated with lower risk of having stable headache.…”

“…More speculatively, the difference could also in part be related to differences in prescription of analgesics and/or genetic, psychosocial, behavioral factors and ethnicity. Among participants in the HUNT studies, there is a relatively low proportion of immigrants [16], whereas in the Danish study the highest MOH prevalence was found among non-Danish, non-western participants [25].…”

“…With this method, we captured 2/3 of patients with MOH trough the information about OCTs, and only 1/3 were identified through the NPD, overusing triptans and/or opioids [24]. Similarly, the vast majority with MOH overused over-the-counter analgesics in a recent large population-based study from Denmark, whereas only 12% overused triptans and 23% opioids [25]. Interestingly, the prevalence of MOH was munch higher in the Danish study (2.0%) than in the present study (0.4%).…”

The Many Faces of Medication‐Overuse Headache in Clinical Practice

“…The prevalence of MOH is estimated between 1% and 3%, making it one of the most common secondary headache disorders 12‐16 . In tertiary headache clinics, about 50% of patients also have medication overuse 17 .…”

Medication overuse headache: The trouble with prevalence estimates

“…In this issue of Cephalalgia, Westergaard et al present an epidemiological study of medication overuse headache (MOH) in Denmark. The authors used the results of a 2017 survey of 104,950 Danish adults to update estimates of the prevalence of chronic headache (CH) and MOH in Denmark, and to identify the most commonly overused medications (2). The response rate was modest, at 52.6%, but weighting techniques were used to compensate for the potential effects of differential non-response.…”