Abstract
Headache epidemiological studies aiming to detect causes of headaches are quite rare compared with those that measure prevalence and burden. The Nord-Trøndelag Health Survey (Helseundersøkelsen i Nord-Trøndelag: HUNT) is a large health survey of all inhabitants in one county, performed in adults in four waves (HUNT1-4) from 1985 to 2019, and in adolescents (Young-HUNT) from 1995. A wide array of health-related data and risk factors have been collected. Questions about headache (migraine and tension-type headache) have been included since HUNT2 in 1995, allowing estimates of associations between headache and putative risk factors both cross-sectionally (in the same study) and longitudinally (in follow-up studies).
Interesting associations have been found with socioeconomic factors, comorbid conditions (anxiety, depression, sleep problems, musculoskeletal pain, gastrointestinal problems, asthma, hay fever, diabetes and dementia), blood analyses (haemoglobin and thyroid-stimulating hormone), blood pressure and other vascular risk factors, behavioural factors (smoking, alcohol consumption, use of analgesics and physical exercise/peak oxygen uptake), female hormonal factors and life events (oestrogen-containing drugs, age at menarche, pregnancy and parity), head injuries, intracranial infections and white matter hyperintensities in magnetic resonance imaging.
Findings are mainly hypothesis generating, but may be of value for understanding causes and mechanisms of headache, which may itself give rise to better treatment and/or prevention.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Stovner LJ, Al Jumah M, Birbeck GL, Gururaj G, Jensen R, Katsarava Z, Queiroz LP, Scher AI, Tekle-Haimanot R, Wang SJ, Steiner TJ. The methodology of population surveys of headache prevalence, burden and cost: principles and recommendations from the Global Campaign against Headache. J Headache Pain. 2014;15:5.
Bradford-Hill A. The environment and disease: association or causation? Proc Roy Soc Med. 1965;58:295–300.
Sheikh HU, Pavlovic J, Loder E, Burch R. Risk of stroke associated with use of estrogen containing contraceptives in women with migraine: a systematic review. Headache. 2018;58:5–21.
Monteith T, Gardener H, Rundek T, Dong C, Yoshita M, Elkind MS, DeCarli C, Sacco RL, Wright CB. Migraine, white matter hyperintensities, and subclinical brain infarction in a diverse community: the northern Manhattan study. Stroke. 2014;45:1830–2.
Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice? J Headache Pain. 2018;19:17.
Hagen K, Zwart JA, Vatten L, Stovner LJ, Bovim G. Prevalence of migraine and non-migrainous headache—head-HUNT, a large population-based study. Cephalalgia. 2000;20:900–6.
Holmen J, Midthjell K, Krüger Ø, Langhammer A, Holmen TL, Brattberg GH. The Nord-Trøndelag Health Study 1995–97 (HUNT 2): objectives, contents, methods and participation. Nor J Epidemiol. 2003;13:19–32.
Linde M, Stovner LJ, Zwart JA, Hagen K. Time trends in the prevalence of headache disorders. The Nord-Trondelag Health Studies (HUNT 2 and HUNT 3). Cephalalgia. 2011;31:585–96.
Zwart JA, Dyb G, Holmen TL, Stovner LJ, Sand T. The prevalence of migraine and tension-type headaches among adolescents in Norway. The Nord-Trondelag Health Study (Head-HUNT-Youth), a large population-based epidemiological study. Cephalalgia. 2004;24:373–9.
Hagen K, Zwart JA, Vatten L, Stovner LJ, Bovim G. Head-HUNT: validity and reliability of a headache questionnaire in a large population-based study in Norway. Cephalalgia. 2000;20:244–51.
Zwart JA, Dyb G, Stovner LJ, Sand T, Holmen TL. The validity of ‘recognition-based’ headache diagnoses in adolescents. Data from the Nord-Trondelag Health Study 1995–97, Head-HUNT-Youth. Cephalalgia. 2003;23:223–9.
Hagen K, Zwart JA, Aamodt AH, Nilsen KB, Brathen G, Helde G, Stjern M, Tronvik EA, Stovner LJ. The validity of questionnaire-based diagnoses: the third Nord-Trondelag Health Study 2006–2008. J Headache Pain. 2010;11:67–73.
Hagen K, Åsberg AN, Uhlig BL, Tronvik E, Brenner E, Stjern M, Helde G, Gravdahl GB, Sand T. The epidemiology of headache disorders: a face-to-face interview of participants in HUNT4. J Headache Pain. 2018;19:25.
Hagen K, Åsberg AN, Uhlig BL, Tronvik E, Brenner E, Sand T. The HUNT4 study: the validy of questionnaire-based diagnosis. J Headache Pain. 2019;20:70.
Hagen K, Zwart JA, Aamodt AH, Nilsen KB, Brathen G, Helde G, Stjern M, Tronvik EA, Stovner LJ. A face-to-face interview of participants in HUNT 3: the impact of the screening question on headache prevalence. J Headache Pain. 2008;9:289–94.
Hagen K, Stovner LJ, Vatten L, Holmen J, Zwart JA, Bovim G. Blood pressure and risk of headache: a prospective study of 22685 adults in Norway. J Neurol Neurosurg Psychiatry. 2002;72:463–6.
Tronvik E, Stovner LJ, Hagen K, Holmen J, Zwart JA. High pulse pressure protects against headache: prospective and cross-sectional data (HUNT study). Neurology. 2008;70:1329–36.
Tronvik E, Zwart JA, Hagen K, Dyb G, Holmen TL, Stovner LJ. Association between blood pressure measures and recurrent headache in adolescents: cross-sectional data from the HUNT-Youth study. J Headache Pain. 2011;12:347–53.
Fagernaes CF, Heuch I, Zwart JA, Winsvold BS, Linde M, Hagen K. Blood pressure as a risk factor for headache and migraine: a prospective population-based study. Eur J Neurol. 2015;22:156–62.
Stovner LJ, Hagen K. Hypertension-associated hypalgesia: a clue to the comorbidity of headache and other pain disorders. Acta Neurol Scand Suppl. 2009;189:46–50.
Hagen K, Zwart JA, Holmen J, Svebak S, Bovim G, Stovner LJ. Does hypertension protect against chronic musculoskeletal complaints? The Nord-Trondelag Health Study. Arch Intern Med. 2005;165:916–22.
Winsvold BS, Hagen K, Aamodt AH, Stovner LJ, Holmen J, Zwart JA. Headache, migraine and cardiovascular risk factors: the HUNT study. Eur J Neurol. 2011;18:504–11.
Hagen K, Asberg AN, Stovner L, Linde M, Zwart JA, Winsvold BS, Heuch I. Lifestyle factors and risk of migraine and tension-type headache. Follow-up data from the Nord-Trondelag Health Surveys 1995–1997 and 2006–2008. Cephalalgia. 2018;38:1919–26.
Aamodt AH, Stovner LJ, Hagen K, Brathen G, Zwart J. Headache prevalence related to smoking and alcohol use. The Head-HUNT study. Eur J Neurol. 2006;13:1233–8.
Hagen K, Wisloff U, Ellingsen O, Stovner LJ, Linde M. Headache and peak oxygen uptake: the HUNT3 study. Cephalalgia. 2016;36:437–44.
Hagen K, Asvold BO, Midthjell K, Stovner LJ, Zwart JA, Linde M. Inverse relationship between type 1 diabetes mellitus and migraine. Data from the Nord-Trondelag Health Surveys 1995–1997 and 2006–2008. Cephalalgia. 2017;38:417–26.
Aamodt AH, Stovner LJ, Midthjell K, Hagen K, Zwart JA. Headache prevalence related to diabetes mellitus. The Head-HUNT study. Eur J Neurol. 2007;14:738–44.
Antonazzo IC, Riise T, Cortese M, Berge LI, Engeland A, Bernt Fasmer O, Lund A, Joachim Odegaard K, Poluzzi E, Bjornevik K. Diabetes is associated with decreased migraine risk: a nationwide cohort study. Cephalalgia. 2018;38:1759–64.
Zwart JA, Dyb G, Hagen K, Odegard KJ, Dahl AA, Bovim G, Stovner LJ. Depression and anxiety disorders associated with headache frequency. The Nord-Trondelag Health Study. Eur J Neurol. 2003;20:147–52.
Blaauw BA, Dyb G, Hagen K, Holmen TL, Linde M, Wentzel-Larsen T, Zwart JA. Anxiety, depression and behavioral problems among adolescents with recurrent headache: the Young-HUNT study. J Headache Pain. 2014;15:38.
Blaauw BA, Dyb G, Hagen K, Holmen TL, Linde M, Wentzel-Larsen T, Zwart JA. The relationship of anxiety, depression and behavioral problems with recurrent headache in late adolescence—a Young-HUNT follow-up study. J Headache Pain. 2015;16:10.
Aamodt AH, Stovner LJ, Langhammer A, Hagen K, Zwart JA. Is headache related to asthma, hay fever, and chronic bronchitis? The Head-HUNT study. Headache. 2007;47:204–12.
Odegard SS, Sand T, Engstrom M, Stovner LJ, Zwart JA, Hagen K. The long-term effect of insomnia on primary headaches: a prospective population-based cohort study (HUNT-2 and HUNT-3). Headache. 2011;51:570–80.
Hagen K, Einarsen C, Zwart JA, Svebak S, Bovim G. The co-occurrence of headache and musculoskeletal symptoms amongst 51 050 adults in Norway. Eur J Neurol. 2002;9:527–33.
Hagen K, Linde M, Steiner TJ, Zwart JA, Stovner LJ. The relationship between headache and chronic musculoskeletal complaints: an 11-year follow-up in the Nord-Trondelag Health Study (HUNT). Eur J Neurol. 2012;19:1447–54.
Aamodt AH, Stovner LJ, Hagen K, Zwart JA. Comorbidity of headache and gastrointestinal complaints. The Head-HUNT study. Cephalalgia. 2008;28:144–51.
Zwart JA, Dyb G, Hagen K, Svebak S, Holmen J. Analgesic use: a predictor of chronic pain and medication overuse headache: the Head-HUNT study. Neurology. 2003;61:160–4.
Hagen K, Linde M, Steiner TJ, Stovner LJ, Zwart JA. Risk factors for medication-overuse headache: an 11-year follow-up study. The Nord-Trondelag Health Studies. Pain. 2012;153:56–61.
Hagen K, Kristoffersen ES, Winsvold BS, Stovner LJ, Zwart JA. Remission of chronic headache: an 11-year follow-up study. Data from the Nord-Trondelag Health Surveys 1995–1997 and 2006–2008. Cephalalgia. 2018;38:2026–34.
Aamodt AH, Borch-Iohnsen B, Hagen K, Stovner LJ, Asberg A, Zwart JA. Headache prevalence related to haemoglobin and ferritin. The HUNT study. Cephalalgia. 2004;24:758–62.
Hagen K, Stovner LJ, Asberg A, Thorstensen K, Bjerve KS, Hveem K. High headache prevalence among women with hemochromatosis: the Nord-Trøndelag health study. Ann Neurol. 2002;51:786–9.
Hagen K, Bjoro T, Zwart JA, Vatten L, Stovner LJ, Bovim G. Low headache prevalence amongst women with high TSH values. Eur J Neurol. 2001;8:693–9.
Hagen K, Bjoro T, Zwart JA, Svebak S, Bovim G, Stovner LJ. Do high TSH values protect against chronic musculoskeletal complaints? The Nord-Trondelag Health Study (HUNT). Pain. 2005;113:416–21.
Aegidius K, Zwart JA, Hagen K, Schei B, Stovner LJ. Oral contraceptives and increased headache prevalence: the Head-HUNT study. Neurology. 2006;66:349–53.
Aegidius KL, Zwart JA, Hagen K, Schei B, Stovner LJ. Hormone replacement therapy and headache prevalence in postmenopausal women. The Head-HUNT study. Eur J Neurol. 2007;14:73–8.
Aegidius K, Zwart JA, Hagen K, Stovner L. The effect of pregnancy and parity on headache prevalence: the Head-HUNT study. Headache. 2009;49:851–9.
Aegidius KL, Zwart JA, Hagen K, Dyb G, Holmen TL, Stovner LJ. Increased headache prevalence in female adolescents and adult women with early menarche. The Head-HUNT studies. Eur J Neurol. 2011;18:321–8.
Hagen K, Vatten L, Stovner LJ, Zwart JA, Krokstad S, Bovim G. Low socio-economic status is associated with increased risk of frequent headache: a prospective study of 22718 adults in Norway. Cephalalgia. 2002;22:672–9.
Fiane I, Haugland M, Stovner L, Zwart JA, Bovim G, Hagen K. Sick leave is related to frequencies of migraine and non-migrainous headache-The HUNT Study. Cephalalgia. 2006;26:960–7.
Linde M, Langnes HA, Hagen K, Bergh K, Stovner LJ. No increase in headache after previous intracranial infections: a historical cohort study (HUNT). Eur J Neurol. 2012;19:324–31.
Hoem Nordhaug L, Vik A, Hagen K, Stovner LJ, Pedersen T, Gravdahl GB, Linde M. Headaches in patients with previous head injuries: a population-based historical cohort study (HUNT). Cephalalgia. 2016;36:1009–19.
Nordhaug LH, Hagen K, Vik A, Stovner LJ, Follestad T, Pedersen T, Gravdahl GB, Linde M. Headache following head injury: a population-based longitudinal cohort study (HUNT). J Headache Pain. 2018;19:8.
Honningsvag LM, Linde M, Haberg A, Stovner LJ, Hagen K. Does health differ between participants and non-participants in the MRI-HUNT study, a population based neuroimaging study? The Nord-Trondelag health studies 1984–2009. BMC Med Imaging. 2012;12:23.
Haberg AK, Hammer TA, Kvistad KA, Rydland J, Muller TB, Eikenes L, Garseth M, Stovner LJ. Incidental intracranial findings and their clinical impact; the HUNT MRI study in a general population of 1006 participants between 50–66 years. PLoS One. 2016;11:e0151080.
Honningsvag LM, Hagen K, Haberg A, Stovner LJ, Linde M. Intracranial abnormalities and headache: a population-based imaging study (HUNT MRI). Cephalalgia. 2016;36:113–21.
Honningsvag LM, Haberg AK, Hagen K, Kvistad KA, Stovner LJ, Linde M. White matter hyperintensities and headache: a population-based imaging study (HUNT MRI). Cephalalgia. 2018;38:1927–39.
Husoy AK, Indergaard MK, Honningsvag LM, Haberg AK, Hagen K, Linde M, Garseth M, Stovner LJ. Perivascular spaces and headache: a population-based imaging study (HUNT-MRI). Cephalalgia. 2016;36:232–9.
Hansen AG, Stovner LJ, Hagen K, Helvik AS, Thorstensen WM, Nordgard S, Bugten V, Eggesbo HB. Paranasal sinus opacification in headache sufferers: a population-based imaging study (the HUNT study-MRI). Cephalalgia. 2017;37:509–16.
Asberg AN, Stovner LJ, Zwart JA, Winsvold BS, Heuch I, Hagen K. Migraine as a predictor of mortality: the HUNT study. Cephalalgia. 2016;36:351–7.
Hagen K, Stordal E, Linde M, Steiner TJ, Zwart JA, Stovner LJ. Headache as a risk factor for dementia: a prospective population-based study. Cephalalgia. 2014;34:327–35.
Rottereng AK, Bosnes O, Stordal E, Zwart JA, Linde M, Stovner LJ, Hagen K. Headache as a predictor for dementia: the HUNT study. J Headache Pain. 2015;16:89.
Ioannidis JP. Why most published research findings are false. PLoS Med. 2005;2:e124.
Ioannidis JP. Exposure-wide epidemiology: revisiting Bradford Hill. Stat Med. 2016;35:1749–62.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Hagen, K., Stovner, L.J. (2019). Headache in the HUNT Study: Analytical Headache Epidemiology as a Source of Added Knowledge. In: Steiner, T., Stovner, L. (eds) Societal Impact of Headache. Headache. Springer, Cham. https://doi.org/10.1007/978-3-030-24728-7_10
Download citation
DOI: https://doi.org/10.1007/978-3-030-24728-7_10
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-24726-3
Online ISBN: 978-3-030-24728-7
eBook Packages: MedicineMedicine (R0)