ISSN 0017-8748

Headache doi: 10.1111/head.12482

© 2015 American Headache Society Published by Wiley Periodicals, Inc.

Feature Article
The Prevalence and Burden of Migraine and Severe Headache
in the United States: Updated Statistics From Government
Health Surveillance Studies
Rebecca C. Burch, MD; Stephen Loder, BA; Elizabeth Loder, MD, MPH; Todd A. Smitherman, PhD

Background and Objectives.—The US National Center for Health Statistics, which is part of the Centers for Disease
Control, conducts ongoing public health surveillance activities. The US Armed Forces also maintains a comprehensive database
of medical information. We aimed to identify the most current prevalence estimates of migraine and severe headache in the
United States adult civilian and active duty service populations from these national government surveys, to assess stability of
prevalence estimates over time, and to identify additional information pertinent to the burden and treatment of migraine and
other severe headache conditions.
Methods.—We searched for the most current publicly available summary statistics from the National Ambulatory Medical
Care Survey, the National Hospital Ambulatory Medical Care Survey, and the National Health Interview Survey (NHIS).
Summary data from the Defense Medical Surveillance System were also obtained, and PubMed was also searched for
publications reporting summary statistics based on these studies. Data were abstracted, double-checked for accuracy, and
summarized over time periods and as a function of demographic variables.
Results.—14.2% of US adults 18 or older reported having migraine or severe headache in the previous 3 months in the 2012
NHIS. The overall age-adjusted 3-month prevalence of migraine in females was 19.1% and in males 9.0%, but varied substan-
tially depending on age. The prevalence of migraine was highest in females 18-44, where the 3-month prevalence of migraine or
severe headache was 23.5%. The 3-month prevalence of migraine or severe headache has remained relatively stable over the
period of 2005-2012, with an average prevalence of 20.2% in females, 9.4% in males, and 20.2% overall. During this time, the
average female to male sex ratio for migraine or severe headache was 2.17. The unadjusted 1-year prevalence of migraine in
active duty US military service members varied from 1% to 1.9% between 1998 and 2010, ranging from 0.7% to 1.2% in males
and 3.5% to 6% in females. The 1-year prevalence of “other headache” in this military population ranged from a low of 1.9%
in 2003 to a high of 3% in 2010. Headache or pain in the head was the fourth leading cause of visits to the emergency department
(ED) in 2009-2010, accounting for 3.1% of all ED visits. Across all ambulatory care settings, migraine accounted for 0.5% of all
visits and other headache presentations for 0.4% of all ambulatory care visits. 52.8% of all visits for migraine occurred in
primary care settings, 23.2% in specialty outpatient settings, and 16.7% in EDs. In 2010, opioids were administered at 35% of
ED visits for headache, while triptans were administered in only 1.5% of visits.
Conclusions.—This report summarizes the most recent government statistics on the prevalence and burden of migraine and
severe headache in the US civilian and active duty military populations. The prevalence of migraine headaches is high, affecting
roughly 1 out of every 7 Americans annually, and has remained relatively stable over the last 8 years. Migraine and headache
are leading causes of outpatient and ED visits and remain an important public health problem, particularly among women
during their reproductive years.

From the Graham Headache Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (R.C. Burch);
Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, MA, USA (S. Loder); Division of
Headache and Pain, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (E. Loder); Department of
Psychology, University of Mississippi, Oxford, MS, USA (T.A. Smitherman).
Address all correspondence to R.C. Burch, 1153 Centre Street – Suite 4970, Boston, MA 02130, USA.

Accepted for publication September 23, 2014.

21
22
Key words: headache, migraine, prevalence, epidemiology, military
(Headache 2015;55:21-34)
Migraine and other recurrent headache disorders
are prominent causes of personal suffering and
decreased economic productivity. It is therefore
important to have an accurate picture of the preva-
lence, burden, and treatment of migraine and severe
headache in the United States. In a previous report, we
summarized data from nationally representative epi-
demiologic studies to characterize the prevalence and
burden of headache in the United States.1 In this
paper, we sought to identify the most recent statistics
on the prevalence and burden of migraine in adults
from large, nationally representative government
health surveillance studies. Our aims were to update
prior national prevalence estimates, to evaluate the
stability of migraine and severe headache prevalence
estimates over time, and to identify other information
relevant to the burden and treatment of these
disorders.
METHODS
We searched the National Center for Health Sta-
tistics and Medical Surveillance Monthly Report
websites using the term “migraine” to identify reports
of summary data from nationally representative or
other population-based surveillance studies con-
ducted by the US government in the last 5 years.To be
eligible for inclusion, studies had to report US-wide
data on the prevalence or burden of migraine or
severe headache in adults. For each source of infor-
mation, we identified the most recent available statis-
tics. In selected cases, we abstracted data from
previous years to evaluate the stability of estimates
over time. Data sources included in this review were
the National Health Interview Survey (NHIS),
the National Ambulatory Medical Care Survey
(NAMCS), the National Hospital Ambulatory
Medical Care Survey (NHAMCS), and the Defense
Medical Surveillance System (DMSS). The National
Health and Nutrition Examination Survey stopped
collecting information about migraine and severe
headache in 2004, so no statistics from that study are
January 2015
included in this paper. The key characteristics of these
studies are described in Table 1 and a brief descrip-
tion of each is presented below.
The NHIS.—NHIS has been conducted every year
since 1957. It produces cross-sectional information on
the US population based on structured interviews
conducted with adults drawn from a representative
sample of households and “non-institutional group
quarters” (eg, dormitories) across the geographical
regions of the United States. Racial and ethnic
minorities are oversampled to compensate for histori-
cally lower rates of response. All adult members of
selected households available at the time of the inter-
view are asked to complete the Family Core compo-
nent of the interview, and an adult selected at random
is chosen to answer the Sample Adult Questionnaire.
This includes the question “During the past 3 months,
did you have . . . severe headache or migraine?” The
survey also obtains standardized information about
sociodemographic details and healthcare use.2
The DMSS.—DMSS is a comprehensive database
of medical surveillance information for the US mili-
tary, and is thus a population-based national database.
Each individual active duty armed services member
has a longitudinal record in the database, which is
updated with information from each healthcare
encounter in the military healthcare system.The data-
base includes data for current and previous diagnoses
and medical events as well as longitudinal data on both
medical history and deployment history. Data for out-
patient encounters are collected for active duty service
members, activated Reserves and National Guard, and
other beneficiaries of the military healthcare system.
Diagnoses are categorized by International Classifica-
tion of Disease (ICD) codes in use at the time of the
encounter. All codes for 346 (“migraine”) were con-
sidered diagnoses of migraine, and all other diagnostic
codes that specified non-migraine headache were con-
sidered “other headache.”A patient who received any
diagnosis of migraine was considered to have
migraine, even if other headache diagnoses had been
Headache 23

Table 1.—Data Sources and Characteristics

Survey and Year (URL) Sample and Size Design Headache-Relevant Data

NHIS, 2012 Adults 18 years of age or Multistage cluster sample of US “During the past 3 months did you
(http://www.cdc.gov/nchs/ older; households; data collected via have severe headache or
data/series/sr_10/ n = 27,157, response rate structured interview at the level migraine?” Respondents were
sr10_252.pdf) 60.8% of individual respondents. instructed to report pain that
had lasted a whole day or more
and not to report fleeting or
minor aches or pains.
NAMCS, 2010 1,482 physicians Sampling of visits to office-based Principal reason for visit and
(http://www.cdc.gov/nchs/ participated, with physician settings (including medications given. Headache-
ahcd.htm) 31,229 patient record community health centers but relevant reasons for a visit are
forms completed excluding anesthesiologists, limited to: S210 Headache, pain
pathologists, and radiologists). in head; S410.1 Sinus headache;
Physicians provide data on up and D365.0 Migraine.
to 30 patient visits during a Headache-relevant diagnoses are
randomly assigned 1-week ICD-9 CM 784.0 (headache) and
period. Data collected are a 346.0 (migraine).
sample of visits, not patients.
NHAMCS, 2010 357 hospitals Sampling of visits to hospital Data captured include
(http://www.cdc.gov/nchs/ participated, with settings (outpatient, emergency, patient-stated reasons for visits,
ahcd.htm) 34,936 patient record and surgery centers) across physician diagnoses, and
forms completed geographic regions. Medical testing and medications used.
staff provide data on a random Headache-relevant reasons
sample of patient visits during for a visit are limited to: S210
a randomly selected 4-week Headache, pain in head; S410.1
period. Data collected are a Sinus headache; and D365.0
sample of visits, not patients. Migraine. Headache-relevant
diagnoses are ICD-9 CM 784.0
(headache) and 346.0 (migraine).
DMSS 9.9 million past and Central repository for medical Data are captured using ICD-9
(http://www.afhsc.mil/ present active duty encounter, diagnosis, deployment codes for various types of
dmss) service members in the information. Information is headaches.
US armed forces updated with each encounter.

recorded. Summary data were initially reported in the
Medical Surveillance Monthly Report in February
2012.3 As access to the database itself is restricted to
Department of Defense researchers, we contacted the
authors and were given access to their extracted
summary data.
The NAMCS.—NAMCS began in 1973 and has
been conducted yearly since 1989. It produces cross-
sectional information on outpatient visits to non-
federally employed, office-based physicians providing
direct patient care (excluding anesthesiologists,
pathologists, and radiologists). Trained interviewers
visit physicians to train them in survey procedures
and the use of data collection forms. Physicians
provide data for a randomly assigned 1-week report-
ing period. Data collected include symptoms, diagno-
ses, medication prescriptions, and other treatments.
Patient-reported principal reasons for visits are cat-
egorized using the “Reason for Visit Classification” of
the American Medical Records Association, and phy-
sician diagnoses are classified according to the ICD,
Ninth Revision, Clinical Modification (ICD-9_CM).
The NHAMCS.—NHAMCS produces cross-
sectional information on services provided in
hospital-based ambulatory care settings including
emergency departments (EDs), hospital outpatient
departments and clinics, and, since 2009, ambulatory
surgery centers. Like NAMCS, NHAMCS produces
information on visits rather than patients. The survey
is designed to obtain a geographically representative
24
sample of hospitals in the 50 states and District of
Columbia, excluding Federal, military, or Veterans
Administration hospitals. Trained interviewers visit
selected facilities to train staff in data collection pro-
cedures using the Patient Record form. Data on a
random sample of patient visits over a 4-week period
is collected, including chief medical complaint, diag-
noses, testing/procedures, medications administered,
and demographic information. The patient-reported
reasons for visit and physician diagnoses are classi-
fied, as in NAMCS, using the “Reason for Visit Clas-
sification” and ICD-9_CM. A dynamic search tool for
both the NAMCS and NHAMCS is available at
http://www.cdc.gov/nchs/hdi.htm.
The main outcome measures were: self-reported
prevalence of migraine or severe headache in the pre-
ceding 3 months (NHIS); 1-year period prevalence
for migraine or other headache diagnoses, and
encounter rates for these diagnoses (DMSS); fre-
quency of outpatient visits for headache, sinus head-
ache, or migraine, and medications prescribed at
those visits (NAMCS); and frequency of ED visits for
headache, sinus headache, migraine, and testing and
medications associated with those visits (NHAMCS).
Unless otherwise specified, reported estimates have
been age and sex standardized to the US population.
Trends in prevalence data over time were examined
using 8 consecutive years of survey data from NHIS.
RESULTS
The NHIS.—The most recent NHIS data are from
2012 and are summarized in Table 2.2 These show
that, overall, 14.1% of those interviewed reported
experiencing migraine or severe headache during the
3 months before the interview. Pain elsewhere in the
head or neck region was also commonly reported,
with 14% of adults reporting neck pain and 5%
reporting pain in the face or jaw area in the last 3
months. When examined across various demographic
variables, migraine was roughly twice as common in
women as men, and was more common in whites and
blacks than Asians. Respondents who were unem-
ployed or employed only part time were more likely
to report headaches than those working full time.
Migraine prevalence was inversely related to income,
and also varied according to insurance status.
January 2015
Figure 1 shows the age-adjusted 3-month popula-
tion prevalence overall and by sex for migraine or
severe headache from 2005 to 2012. For the popula-
tion overall, 3-month prevalence ranged from a low of
12.3% in 2007 to a high of 16.6% in 2010. For women,
it ranged from 17.2% in 2007 to 22.1% in 2011, and
for men from 7.3% in 2007 to 11.0% in 2010. Figure 2
shows the 2005-2012 average age-adjusted 3-month
prevalence of migraine or severe headache in the
population overall and by sex.
Figure 3 displays the female to male sex ratio for
migraine or severe headache from 2005 to 2012
(ie, headache prevalence in females divided by head-
ache prevalence in males). This varied from a low of
2.0 in 2010 to a high of 2.36 in 2007, but never fell
below 2.
The DMSS.—Data were reported for active com-
ponent service members on active duty at the begin-
ning of each year from 1998 to 2010.3 Detailed data,
provided by Armed Forces Health Surveillance
Center staff, are available in Appendix A. Figure 4
shows the unadjusted 1-year prevalence of migraine
in active duty service members from 1998 to 2010.
One percent of active duty service members in 1998
were diagnosed with migraine, including 0.7% of
males and 3.5% of females. The most recent 1-year
prevalence data were reported for 2010, when 1.9%
of service members received a diagnosis of migraine,
including 1.2% of males and 6% of females. Figure 5
demonstrates that the prevalence of migraine in both
sexes increased over the study period, with a slightly
greater increase in males (84.9% increase vs 73.6%
increase in females.) One-year prevalence did not
differ meaningfully by age in 1998, but increases in
migraine prevalence were greatest in the 25 to
44-year-old and over 44-year-old age groups. The
most recent prevalence data show that migraine
among active duty military personnel is most
common in the 35 to 44-year-old age group (2.45%)
and least common in the 17 to 24-year-old age group
(1.4%).
Both the number of encounters for both migraine
and other headache diagnoses and the encounter
rates per 10,000 person-years increased over the
study period. Encounter rates were much lower in
males than females (Fig. 6). Males were evaluated for
Headache 25

Table 2.—Summary Data From the National Health Interview Study

Migraine/Severe
Headache % Pain in Neck† % Pain in Face or Jaw‡ %
Selected Characteristic (Standard Error) (Standard Error) (Standard Error)

Total 3-month prevalence (age-adjusted) 14.1 (0.26) 13.9 (0.25) 4.8 (0.15)
Male 9.0 11.3 3.2
Female 18.9 16.3 6.3
Education
Less than a high school diploma 16.6 16.7 5.1
High school diploma or GED 12.9 15.2 4.7
Some college 16.5 17.4 6.1
Bachelor’s degree or higher 11.0 12.2 3.8
Employment status
Employed 11.8 11.5 3.7
Full-time 11.4 11.1 3.4
Part-time 13.6 12.1 4.6
Not employed, worked previously 20.1 18.9 7.6
Not employed, never worked 15.7 10.4 4.3
Income level
<$35,000 17.8 17.0 6.5
$35,00 or more 12.5 12.6 4.1
$35,000-49,999 14.5 14.8 4.9
$50,000-74,000 13.3 13.4 4.6
$75,000-99,999 12.3 11.6 3.8
≥$100,000 10.7 11.2 3.6
Poverty status
Poor 20.5 18.3 7.6
Near poor 16.4 16.8 7.6
Not poor 12.2 12.6 4.0
Under 65 by insurance status
Private 13.8 12.3 4.2
Medicaid 25.0 21.0 8.9
Other 25.8 21.4 8.3
Uninsured 16.6 14.0 5.2

†Respondents were asked “During the past three months, did you have neck pain?” (lasting a whole day or more).
‡Respondents were asked “During the past three months, did you have facial ache or pain in the jaw muscles or the joint in front
of the ear?” (lasting a whole day or more).

migraine at a rate of 106.5/10,000 person-years in
1998 compared with 276.1 in 2010. Females were seen
for a diagnosis of migraine at a rate of 600/10,000
person-years in 1998, and this rose to 1366 in 2010. In
2010, the encounter rate for females was 5 times that
of males. During the study period, 57.5% of males
diagnosed with migraine were seen only once, and 3%
were seen more than 10 times. For females, 46.2%
were seen only once for migraine, while 6% had more
than 10 visits.
The prevalence of “other headache” decreased
slightly over the first half of the study period and
then increased after 2005 (Fig. 7). The most recent
unadjusted 1-year prevalence was 3.1%, including
2.7% of males and 5.3% of females. In contrast to
the prevalence of migraine, diagnoses of other head-
ache were most common in the 17 to 24-year-old age
group, including 3.5% of this group in 2010, and
least common in service members over 35 (2.6%).
70.5% of males and 66.5% of females had just a
single medical encounter for headache, while fewer
than 1% of each sex had more than 10 encounters
for this reason.
The NAMCS and NHACMS.—The most current
summary NAMCS and NHAMCS results are from
the 2010 surveys of each study, collected from Decem-
ber 2009 to December 2010.4,5 In the NAMCS,
“headache/pain in the head” was the 20th most
26 January 2015

Fig 1.—Age-adjusted 3-month prevalence of migraine and severe headache in the US population. National Health Interview
Survey 2005-2012.

common patient-reported reason for outpatient visits
(1.2% of visits) in the 2009 survey, but headache was
not among the top 20 reasons for outpatient visits in
the 2010 survey. In combined 2009-2010 NAMCS and
NHAMCS physician diagnosis data (reviewed in
more detail below), migraine accounted for 0.5% of
all ambulatory care visits, and other headache presen-
tations accounted for 0.4%. In the 2010 NAMCS,
analgesics were the most commonly mentioned drugs,
accounting for 10.9% of all drugs prescribed, pro-
vided, or continued at the visit.
The most recent summary NHAMCS data are
from the 2010 survey, collected from December 2009
to December 2010.5 Data from the NHAMCS survey
showed that overall, headache or pain in the head
was the fourth leading cause of visits to the ED as

Fig 2.—The 3-month prevalence of migraine and severe headache in the US population National Health Interview Survey (averages
over 2005-2012).
Headache 27

Fig 3.—Female to male 3-month prevalence ratio – migraine and severe headache. NHIS 2005-2012.

Fig 4.—The prevalence* of migraine in active duty US Armed Forces members. Defense Medical Surveillance System (*unadjusted
1-year prevalence).
28
Fig 5.—The prevalence* of migraine in active duty US Armed Forces members by age. Defense Medical Surveillance System
(*unadjusted 1-year prevalence).
reported by patients, accounting for 3.1% (standard
error [SE] 0.1) of all ED visits. Only stomach/
abdominal pain, chest pain, and fever accounted for
more visits than headache. When examined by age
and sex, headache was the third leading patient-
reported reason for ED visits in women 15-64,
accounting for 2.5% of ED visits in this population; in
men in that age group, it was the 10th leading reason
(1.2%). Though most common among young and
middle-aged adults, headache ranked as the 9th and
10th most common reason for ED visits among
females and males under age 15, respectively (0.9%
among girls, 1.2% among boys). Although not as
common a reason for outpatient hospital visits as ED
visits, headache was the 19th most common reason all
patients gave for seeking outpatient hospital care
(0.9%).
Regarding ED diagnoses provided by physicians
in the NHAMCS,“headache” (ICD-9 CM code 784.0)
was the 16th most common assigned diagnosis
January 2015
(1.5%). Among women 15-64, “headache” ranked as
the 8th most common diagnosis (1.4%) and
“migraine” (ICD-9 CM code 346) as the 15th most
common ED diagnosis (0.9%). Headache was the
18th most commonly diagnosed condition among
men 15-64 (0.6%).
NHAMCS also provides data on medications dis-
pensed or prescribed at the ED, as well as data on
various diagnostic procedures. Analgesics were the
most mentioned class of drug, being dispensed or pre-
scribed for 34.9% of ED visits. Mazer-Amirshahi et al
evaluated NHAMCS data from 2001 to 2010 to iden-
tify trends in ED treatment for headaches.6 Their
analyses were based on the “reason for visit” rather
than on the final diagnosis. As depicted in Figure 8,
they found that the proportion of ED visits for head-
ache during which any opioid was used increased
from 20.6% in 2001 to 35% in 2010. The estimated
annual number of ED visits for headache also
increased over this period, from 5.5 million in 2001 to
Headache 29

Fig 6.—Prevalence* and encounter rates for migraine in active duty US service members (*unadjusted 1-year prevalence).
(Reproduced [Adapted] with permission from Armed Forces Health Surveillance Center: Outpatient encounters associated with
diagnostic codes for migraine and other types of headaches, active component service members, 1998-2010. MSMR 2012;19:12-17.)

7.7 million in 2010. They noted no substantial change
over this period in the use of triptans, butalbital com-
bination products, or acetaminophen. The use of anti-
emetic agents decreased slightly and the use of
intravenous fluids and NSAIDs increased. Computed
tomography scans of the head were ordered for 8.0%
of ED visits assessed via the NHAMCS, and although
the data collection methods preclude determination
of the proportion of these scans ordered for head-
ache, likely a significant proportion of these scans
were ordered in patients presenting with headache.
Combined data from the 2009-2010 NAMCS and
NHAMCS provide information on the distribution of
visits for migraine across hospital and non-hospital
ambulatory care settings. Migraine accounted for an
estimated 6,223,000 (0.5%) of all ambulatory care
visits, or 1 in every 200 outpatient visits; other head-
ache presentations accounted for 0.4% of visits. As
depicted in Figure 9, just over half of all visits for
migraine occurred in primary care settings (52.8%),
and roughly a quarter (23.2%) in specialty outpatient
settings, presumably neurology or headache specialty
clinics. A sizeable proportion of visits, however,
occurred in EDs (16.7%). Figure 10 shows that the
visit rate for migraine and headache among females
was highest among 25 to 44-year-old females. In this
group, migraine accounted for 455 visits and head-
ache for 123 visits per 10,000 females. Visits in the
combined 2009-2010 NAMCS/NHAMCS were classi-
fied based on the physician diagnosis recorded at the
end of the visit, which sometimes differed from
the patient-reported reason for visit (recorded at the
beginning of the visit).
DISCUSSION
This report summarizes the most current preva-
lence data on migraine and severe headache from
large-scale US government studies, including detailed
data from the US military medical surveillance data-
base. Despite differing methodologies and sampling
strategies, the 3 population-based studies confirm that
migraine remains a highly prevalent medical condi-
tion, affecting approximately 1 out of every 7 Ameri-
cans annually (14.9% on average). This 3-month
30 January 2015

Fig 7.—The prevalence* of headache other than migraine in active duty US Armed Forces members Defense Medical Surveillance
System (*unadjusted 1-year prevalence).

prevalence is similar to but slightly higher than the
11.7% 1-year prevalence of migraine observed in
the American Migraine Prevalence and Prevention
(AMPP) study.7 The AMPP study assigned a diagno-
sis of migraine based on assessment for many of the
specific International Classification of Headache Dis-
orders (ICHD-II) diagnostic criteria, which likely
accounts for the somewhat lower prevalence
observed in that study.
Consistent with prior studies, we found that
migraine disproportionately affects vulnerable popu-
lations.8,9 There is a higher burden of migraine in those
who work part time or are unemployed, those with low
socioeconomic status, and the uninsured. These popu-
lations likely have reduced access to health care, sug-
gesting a possible avenue for intervention.
Three-month prevalence estimates of migraine or
severe headache from the NHIS have been relatively

Fig 8.—Medications administered for headache in the emergency department. Data based on Mazer-Amirshahi M, Dewey K,
Mullins PM, et al. Trends in opioid analgesic use for headaches in US EDs. Am J Emerg Med 2014;32:1068-1073.
Headache 31

Fig 9.—Ambulatory care visits for migraine. Percentage by setting. 2009-2010 NHAMCS/NAMCS.

stable over time. The drop in prevalence seen in 2007-
2008 may be attributable to methodological changes
and budgetary limitations that reduced the sample
size during those years. This may have led to reduced
accuracy of the estimates and contributed to lower
estimated prevalence during those years.
Similar to the stability of overall prevalence, the
female to male prevalence ratio also stayed relatively
stable between 2005 and 2012. The prevalence ratio
fluctuated between 2.0 and 2.36 and averaged 2.17.
Fluctuations in the ratio inversely mirror fluctuations
in overall prevalence estimates, such that the ratio
increases when overall prevalence estimates are
lower and decreases when they are higher. This may
be due to the fact that changes in prevalence are
proportionally larger for men given the much lower
prevalence of migraine in this population.
The high frequency of healthcare use for
migraine across all settings is evident from the
NAMCS and NHAMCS study results. Although most
migraineurs present to their primary care physicians
for evaluation and treatment, roughly 1 of out every 6
(16.7%) visits across hospital and non-hospital ambu-
latory care settings occurred in the ED. This is unfor-
tunate, because management of migraine in the ED is
often suboptimal. Patients may be prescribed non-
migraine-specific medications such as opioids, which
have been associated with dependence and overuse
syndromes.10 Use of opioids to treat migraine in the
ED is increasing, however.6 Exposure to radiation

Fig 10.—Ambulatory care* visit rate for migraine and headache in females by age. NAMCS/NHAMCS 2008-2010 *physician office
and hospital outpatient and ED visits.
32
through unnecessary computed tomography (CT)
scans is another potential harm for migraineurs in the
ED. We report data showing that head CT scans are
ordered in 8% of ED visits, and it seems likely that a
significant proportion of these are for headache. CT
scans are often unnecessary for patients with typical
migraine symptoms and a normal neurological
exam.11,12 Given these concerns, continued efforts are
needed to reduce the use of EDs for evaluation and
treatment of migraine. Considered in conjunction
with AMPP data indicating that roughly a third of
migraineurs eligible for preventive pharmacotherapy
do not receive it, much work is clearly needed to
increase awareness and ensure proper diagnosis and
treatment of this common disorder.13
The DMSS database includes every active duty
service member and medical encounter, as well as
actual (vs estimated) 1-year prevalence data and is
thus quite comprehensive and precise. Interestingly,
rates of migraine in active duty US military person-
nel are lower than those for the general population.
This difference is likely attributable to the significant
disability associated with migraine, so that individu-
als with migraine may be less likely to enroll in the
military due to migraine-related disability. Another
possible explanation is that a diagnosis of migraine
was only recorded in this database for individuals
who sought medical attention. This estimate there-
fore does not include individuals who may have
had milder phenotypes of migraine or well-
controlled migraine. Interestingly, in contrast to the
stable prevalence of migraine in the general popu-
lation, the prevalence of migraine in military person-
nel increased over the 12-year surveillance period. It
is unclear whether this is the result of a true increase
in prevalence, increased specificity of headache diag-
noses by providers, or increased use of healthcare
resources by persons with migraine. However,
the growth in encounter rates for migraine was
larger than the increase in migraine prevalence for
both men and women, suggesting increased use of
healthcare resources for migraine. The 1-year preva-
lence of non-migraine headaches also increased
after 2005. We speculate that this could be related
to an increase in post-traumatic headache coinci-
ding with military deployment, but an examination
January 2015
of that possibility is beyond the scope of this
paper.
Potential limitations of our report include differ-
ent survey methods, questions and recall intervals, our
reliance on previously reported data, and unclear
generalizability of the estimates to population sub-
groups. Additionally, criteria used for assessment of
migraine and severe headache were not validated for
any of the data sources used in this report. Consider-
ing the consistency of the reported data, however, the
data appear reliable and support the overall conclu-
sions that migraine is highly prevalent, migraine
prevalence has been relatively stable over time, and
migraine remains a leading cause of outpatient and
ED visits. As such, migraine remains an important
public health problem, particularly among women
during their reproductive years.
CONCLUSIONS
In this review, we update past prevalence esti-
mates and summarize the most current information
about migraine prevalence among the US population.
These are the best and most current government-
collected data available, including nationwide
population-based data sources likely to provide rela-
tively accurate estimates of migraine prevalence. The
consistency of prevalence estimates across parallel
studies with different methodologies suggests that
these estimates are accurate and stable over time.
FAST FACTS
1. Migraine or severe headache affects roughly 1 out
of every 7 Americans annually.
2. Migraine is 2-3 times more common among
women than men.
3. Migraine prevalence is higher than average in
certain vulnerable or underserved populations
(low socioeconomic status, uninsured, unem-
ployed, or employed part time).
4. 1 of every 6 outpatient visits for migraine takes
place in the ED.
5. Migraine is less frequently diagnosed among
active duty US Armed Forces personnel than the
general population, but 1-year prevalence is
increasing.
Headache 33

REFERENCES 7. Lipton RB, Bigal ME, Diamond M, et al. Migraine

1. Smitherman TA, Burch R, Sheikh H, Loder E. The
prevalence, impact, and treatment of migraine and
severe headaches in the United States: A review of
statistics from national surveillance studies. Head-
ache. 2013;53:427-436.
2. National Health Interview Survey, 2005-2010, Avail-
able from: http://www.cdc.gov/nchs/nhis.htm.
Accessed August 10, 2014.
3. Armed Forces Health Surveillance Center. Outpa-
tient encounters associated with diagnostic codes
for migraine and other types of headaches, active
component service members, 1998-2010. MSMR.
2012;19:12-17.
4. National Center for Health Statistics. National
Ambulatory Medical Care Survey, 2010. Available
from: http://www.cdc.gov/nchs/ahcd.htm. Accessed
August 10, 2014.
5. National Hospital Ambulatory Care Survey, 2010.
Available from: http://www.cdc.gov/nchs/ahcd.htm.
Accessed August 10, 2014.
6. Mazer-Amirshahi M, Dewey K, Mullins PM, et al.
Trends in opioid analgesic use for headaches
in US EDs. Am J Emerg Med. 2014;32:1068-
1073.
prevalence, disease burden, and the need for preven-
tive therapy. Neurology. 2007;68:343-349.
8. Winter AC, Berger K, Buring JE, Kurth T. Associa-
tions of socioeconomic status with migraine and
non-migraine headache. Cephalalgia. 2012;32:159-
170.
9. Stewart WF, Roy J, Lipton RB. Migraine preva-
lence, socioeconomic status, and social causation.
Neurology. 2013;81:948-955.
10. Colman I, Rothney A, Wright SC, et al. Use of nar-
cotic analgesics in the emergency department treat-
ment of migraine headache. Neurology. 2004;62:
1695-1700.
11. Detsky ME, McDonald DR, Baerlocher MO,
Tomlinson GA, McCrory DC, Booth CM. Does this
patient with headache have a migraine or need
neuroimaging? JAMA. 2006;296:1274-1283.
12. Loder E, Weizenbaum E, Frishberg B, Silberstein S.
Choosing wisely in headache medicine. Headache.
2013;53:1651-1659.
13. Diamond S, Bigal ME, Silberstein S, Loder E, Reed
M, Lipton RB. Patterns of diagnosis and acute and
preventive treatment of migraine in the United
States: Results of the American migraine prevalence
and prevention study. Headache. 2007;47:355-363.

APPENDIX A: RAW DATA FROM THE DEFENSE MEDICAL SURVEILLANCE SYSTEM

One-year prevalence of migraine in active duty service members in the US Armed Forces

All figures are percentages.

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Overall 1.05 1.27 1.30 1.28 1.33 1.41 1.54 1.56 1.63 1.64 1.74 1.79 1.91
Males 0.67 0.82 0.80 0.77 0.79 0.83 0.9 0.93 0.97 1.02 1.09 1.12 1.23
Female 3.46 4.07 4.3 4.26 4.41 4.71 5.19 5.23 5.53 5.38 5.68 5.83 6
Age
17-24 0.99 1.26 1.25 1.18 1.24 1.34 1.43 1.38 1.46 1.43 1.46 1.46 1.43
25-34 1.02 1.26 1.32 1.36 1.4 1.47 1.63 1.67 1.72 1.78 1.88 1.95 2.12
35-44 1.18 1.3 1.33 1.3 1.37 1.43 1.58 1.7 1.75 1.82 2.04 2.14 2.45
>44 1.26 1.4 1.38 1.35 1.47 1.55 1.66 1.77 1.86 1.7 1.9 1.92 2.17

One-year prevalence of “other headache” in active duty service members in the US Armed Forces.
34 January 2015

All figures are percentages.

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Overall 2.14 2.29 2.28 2.05 2 1.92 1.95 1.79 1.99 2.26 2.6 2.79 3.06
Males 1.73 1.88 1.87 1.68 1.66 1.59 1.62 1.5 1.69 1.99 2.31 2.46 2.68
Females 4.69 4.81 4.69 4.18 4 3.81 3.86 3.5 3.74 3.86 4.34 4.79 5.34
Age
17-24 2.74 2.93 2.97 2.59 2.48 2.34 2.33 2.11 2.41 2.73 3.07 3.28 3.47
25-34 1.79 1.95 1.86 1.75 1.7 1.67 1.72 1.57 1.77 2.02 2.39 2.56 2.87
35-44 1.73 1.82 1.76 1.58 1.6 1.53 1.59 1.56 1.59 1.8 2.11 2.27 2.66
>44 1.9 1.88 1.83 1.59 1.59 1.51 1.76 1.66 1.69 1.91 2.12 2.4 2.67

Encounter rates for migraine by sex and year.

Rates are per 10,000 person-years.

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Male 106.5 131.2 132.8 135.5 143 175.1 181 188.1 201.3 221.3 242.7 245 276.1
Female 600 722.9 792.9 815.6 874.1 1034.9 1109.8 1105.5 1143.8 1158.4 1261.2 1303 1366.6

APPENDIX B: NHIS 2012 ADDITIONAL DATA

Migraine/Severe
Headache % Pain in Neck† % Pain in Face or Jaw‡ %
Selected characteristic (Standard Error) (Standard Error) (Standard Error)

Total 3 month prevalence (age-adjusted) 14.1 (0.26) 13.9 (0.25) 4.8 (0.15)
65 and over by insurance status
Private 4.7 14.5 3.4
Medicare and Medicaid 9.7 22.3 7.9
Medicare only 5.8 12.4 3.6
Other 7.3 13.4 3.2
Uninsured 21.3 19.6 –
Marital status
Married 13.1 13.5 4.1
Widowed 21.6 18.7 9.8
Divorced or separated 19.3 19.0 9.8
Never married 13.5 11.8 4.4
Living with a partner 16.9 17.2 6.3

†Respondents were asked “During the past three months, did you have neck pain?” (lasting a whole day or more). ‡Respondents
were asked “During the past three months, did you have facial ache or pain in the jaw muscles or the joint in front of the ear?”
(lasting a whole day or more).