title: Prevention of headache in adolescents: population-attributable risk fraction for risk factors amenable to intervention.
abstract: BACKGROUND
  Several risk factors for headache have been identified, some of which are potentially amenable to interventions. The potential effect of such interventions can be predicted by the population-attributable risk fraction (PARF). We assessed PARFs of the the following risk factors: neck muscle pain, chronic stress, alcohol consumption, smoking, coffee consumption, and physical inactivity. We studied the maximal possible effect achievable by avoidance of these risk factors.
  
  
  METHODS
  Two approaches to estimate PARFs are compared, which assess their cumulative and individual impact of risk factors by age: the Levin formula and the average attributable fraction.
  
  
  RESULTS
  The overall impact for removal of all six risk factors amounts to 19.7% for the average attributable fraction. Neck tension and consumption of alcohol ranked as the strongest population-attributable risk factor for any headache. The potential impact for migraine was considerably higher (43.8%). With increasing age, the overall impact of risk factors on headache increases by 18.9%.
  
  
  CONCLUSIONS
  Based on the estimations of the most appropriate approach, up to 20% of headaches in general and up to 43% of migraine in adolescents might be preventable by removing risk factors amenable to intervention, with increasing proportions by age.
authors.affiliation: Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany. lucia.albers@med.uni-muenchen.de
authors.forename: Lucia
authors.initials: L
authors.lastname: Albers
authors.forename: Astrid
authors.initials: A
authors.lastname: Milde-Busch
authors.forename: Otmar
authors.initials: O
authors.lastname: Bayer
authors.forename: Steffi
authors.initials: S
authors.lastname: Lehmann
authors.forename: Christina
authors.initials: C
authors.lastname: Riedel
authors.forename: Michaela
authors.initials: M
authors.lastname: Bonfert
authors.forename: Florian
authors.initials: F
authors.lastname: Heinen
authors.forename: Andreas
authors.initials: A
authors.lastname: Straube
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Kries
mesh_terms: D000293:Adolescent; D020773:Headache Disorders / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D011159:Population Surveillance / Q000379:methods; D012307:Risk Factors