Prevalence and comorbidity of migraine headache: results from the Singapore Mental Health Study 2016

DOI: https://doi.org/10.1007/s00127- 019- 01755- 1

Abstract-Summary Migraine is a highly prevalent and disabling neurological disorder associated with a wide range of psychiatric comorbidities.

Studies have revealed that those with migraine headache and coexisting psychi-

atric disorders have poorer treatment outcomes and increased disability.

The study aims to establish the prevalence, correlates, and comorbidities of

migraine headache among the multi-ethnic Asian population in Singapore.

The lifetime prevalence for migraine headache in the Singapore general popula-

tion was 8.2%.

Participants belonging to the older age group (65  years and above versus 18–34 years of age), and those who were economically inactive (versus employed) were less likely to experience migraine headache.

Poisson regression analyses showed that migraine headache was also signifi- cantly associated with psychiatric conditions such as major depressive disorder (MDD) (prevalence ratio (PR), 1.80; 95% CI, 1.25–2.58), bipolar disorder (BD)

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(PR, 3.55; 95% CI, 2.29–5.51), generalized anxiety disorder (GAD) (PR, 2.04; 95% CI, 1.12–3.69), obsessive compulsive disorder (OCD) (PR, 2.20; 95% CI, 1.49–3.26), and alcohol use disorder (AUD) (PR, 1.93; 95% CI, 1.20–3.08).

Those with migraine headache were significantly associated with poor function-

ing and disability compared to those without migraine headache.

Our study showed significant associations between migraine headache and psy-

chiatric disorders, as well as with role functioning and disability.

Extended: Studies have revealed that patients with migraine headache and with coexisting psychiatric disorders are associated with poorer treatment outcomes and increased disability as compared to migraine headache without comorbid psychiat- ric conditions [56–58].

Those with migraine were two times more likely to have major depressive disor- der (MDD) and alcohol use disorder (AUD), and three times more likely to have generalized anxiety disorder (GAD) [58].

These findings can help to create awareness and encourage holistic coordinated

approaches to the management of migraine in health care settings.

Introduction Studies have revealed that patients with migraine headache and with coexisting psy- chiatric disorders are associated with poorer treatment outcomes and increased dis- ability as compared to migraine headache without comorbid psychiatric conditions [56–58].

A population-wide epidemiological study conducted

in Singapore—the Singapore Mental Health Study (SMHS 2010)—was the first to establish the life- time prevalence of migraine headache as 5.6% and that migraine was significantly associated with psychiatric disorders.

The aims of the current article were to (1) establish the prevalence, correlates and comorbidity of migraine headache among the general population of Singapore, (2) examine changes, if any, in the prevalence of migraine since the last survey—SMHS 2010, (3) assess the extent of role disability among individuals with migraine head- ache, and finally, (4) examine the comorbidity of common psychiatric disorders with migraine headache in this population.

Methods Singapore is a multi-ethnic country in South-East Asia, with a resident population of 3.8 million [59] of which 74.2% are Chinese, 13.3% are Malays, 9.1% are Indians, and 3.3% belong to other ethnic groups.

The SMHS 2016 was a cross-sectional epidemiological household survey con- ducted among Singapore citizens and permanent residents, aged 18 years and above who were living in Singapore between 2016 and 2017, and randomly selected from an administrative database.

Participants living outside Singapore, those who were unable to be contacted due to an incomplete or incorrect address, those residents who were incapable of doing an interview due to severe physical and mental conditions, and those who were unable to complete the interview in one of the specified languages were excluded from the survey.

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Epidemiology

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Face-to-face interviews were conducted at the respondents’ homes or another preferred location and respondents completed the interviewer—administered ques- tionnaire in English, Chinese, and Malay according to their preference.

Assessments In accordance with McWilliams et al’s methodology, to elucidate the relationship between migraine headache, significant socio-demographic variables and comorbid psychiatric disorders while accounting for other variables that may have indepen- dent effects on psychopathology, three series of Poisson regression models were used [60].

In the first Poisson model, prevalence ratios (PRs) for the association between migraine headache and psychiatric disorders were adjusted for socio-demographic variables such as age, gender, ethnicity, education level, and employment status.

The second Poisson regression model was adjusted for the significant socio- demographic variables (such as age, gender, ethnicity, education level, and employ- ment status) and presence of other chronic physical conditions.

The third Poisson regression model was adjusted for the significant socio- demographic variables, other chronic physical conditions, and psychiatric disorders. The mean score of role functioning and disability among individuals with migraine headache and individuals without migraine headache were assessed using a linear regression model after controlling for significant socio-demographic vari- ables including age, gender, ethnicity, education level, and employment status.

Results The first model of Poisson regression analysis adjusting for socio-demographic variables shows that those with migraine headache were significantly associated with all psychiatric disorders compared with those without migraine headache.

The second model of Poisson regression used to examine the association, adjusted for significant socio-demographic variables, and the presence of any of the 17 other chronic physical conditions revealed that those with migraine headache remained significantly associated with all psychiatric disorders compared with those not having migraine headache.

The third model of Poisson regression, adjusted for significant socio- demographic variables, 17 chronic physical conditions, and psychiatric disorders, revealed that those with migraine headache remained significantly associated with MDD (PR, 1.60; 95% CI, 1.08–2.37), BD (PR, 2.70; 95% CI, 1.70–4.29), and OCD (PR, 1.72; 95% CI, 1.15–2.55) compared with those not having migraine headache.

Discussion The increase in the prevalence of migraine could be due to more individuals seeking treatment for headaches and receiving a diagnosis of migraine as compared to the previous study.

Similar findings have been reported in various studies, where individuals with

migraine headache were more likely to be female [58, 61, 62].

Ethnicity also appears to play a role in migraine headache; while individuals of Malay ethnicity were more likely than those of Chinese ethnicity to experience

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migraine in the current study, these findings are consistent with a previous study conducted in 2010 among Singapore’s general population [58] as well as in the clinical population by Tai and others [63].

Our findings are in agreement with the previous population-based studies con- ducted in China [64], Italy [65], United States [66], and Japan [67] that have found migraine headache prevalence to decrease significantly with increasing age.

Consistent with various research findings, our study also found an association of migraine headache with psychiatric disorders, including MDD, GAD, BD and OCD [58, 61, 68–71].

Conclusions The present study established that migraine headache is prevalent in Singapore with 1 in 12 people in the population having lifetime migraine headache.

The study found a significant association between migraine headache and psy- chiatric disorders and established its negative impact on functioning and disability.

Acknowledgement A machine generated summary based on the work of Jeyagurunathan, Anitha; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Chua, Boon Yiang; Shafie, Saleha; Chang, Shi Hui Sherilyn; James, Lyn; Tan, Kelvin Bryan; Basu, Sutapa; Chong, Siow Ann; Subramaniam, Mythily. 2019  in Social Psychiatry and Psychiatric Epidemiology.

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