Chronic headache and comorbidities: a two-phase, population-based, cross-sectional study.
BACKGROUND
Studies using resources of a public family health program to estimate the prevalence of chronic daily headaches (CDH) are lacking.


OBJECTIVE
To estimate the 1-year prevalence of CDH, as well as the presence of associated psychiatric and temporomandibular disorders (TMD) comorbidities, on the entire population of a city representative of the rural area of Brazil.


METHODS
This was a cross-sectional, population-based, 2-phase study. In the first phase, health agents interviewed all individuals older than 10 years, in a rural area of Brazil. In the second stage, all individuals who reported headaches on 4 or more days per week were then evaluated by a multidisciplinary team. CDH were classified according to the second edition of the International Classification of Headache Disorders (ICHD-2). Medication overuse headache was diagnosed, as per the ICHD-2, after detoxification trials. Psychiatric comorbidities and TMD were diagnosed based on the DSM-IV and on the Research Diagnostic Criteria for Temporomandibular Disorders criteria, respectively.


RESULTS
A total of 1631 subjects participated in the direct interviews. Of them, 57 (3.6%) had CDH. Chronic migraine was the most common of the CDH (21, 36.8%). Chronic tension-type headache (10, 17.5%), medication overuse headache (13, 22.8%) and probable medication overuse headache (10, 17.5%) were also common. Psychiatric disorders were observed in 38 (67.3%) of the CDH subjects. TMD were seen in 33 (58.1)% of them.


CONCLUSIONS
The prevalence of CDH in the rural area of Brazil is similar to what has been reported in previous studies. A significant proportion of them have psychiatric comorbidities and/or TMD. In this sample, comorbidities were as frequent as reported in convenience samples from tertiary headache centers.
da Silva
Ariovaldo
A
UFMG - Headache Clinic, Belo Horizonte, Brazil.
Costa
Esther Coelho
EC
Gomes
João Bosco
JB
Leite
Frederico Motta
FM
Gomez
Rodrigo Santiago
RS
Vasconcelos
Luiz Paulo
LP
Krymchantowski
Abouch
A
Moreira
Pedro
P
Teixeira
Antonio Lucio
AL
D000293:Adolescent; D000328:Adult; D001938:Brazil; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D020773:Headache Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult