Interrelations between migraine and tension-type headache in the general population
B. K. Rasmussen, R. Jensen, M. Schroll and J. Olesen
Department of Internal Medicine C, Glostrup Hospital, Denmark.
In a cross-sectional epidemiological survey of a general population,
headache disorders were diagnosed according to a structured interview and a
neurological examination using the criteria of the International Headache
Society. The prevalences and sex distribution of the primary headache
disorders were assessed, and characteristics of and interrelationships
between different types of headache were analyzed. Severity and frequency
of migraine attacks were not correlated, indicating that the migraine
attack is an all-or-none phenomenon triggered with an individually variable
threshold. Tension-type headache, in contrast, showed increasing severity
with increasing frequency, indicating that it is a graded phenomenon. In
the previous year, 6% had migraine without aura (previously called "common
migraine") and 4% had migraine with aura (previously called "classic
migraine"); 63% had episodic tension-type headache and 3% chronic
tension-type headache. In women, migraine without aura was twice as
prevalent as migraine with aura; in men, an opposite trend emerged. In
migraine without aura, pain was more severe than in migraine with aura.
Tension-type headache in migraineurs was not significantly more prevalent
than in nonmigraineurs and, except for greater frequency and severity, it
did not deviate nosographically from pure tension-type headache. Our
results support the contention that migraine and tension-type headache are
distinct entities, contradict the so-called continuum-severity model, and
indicate that the terms combination headache, mixed headache, and interval
headache should be avoided.
