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The Environment and Headache: a Narrative Review

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Abstract

Purpose of Review

In this narrative review, we summarize the peer-reviewed literature published between 2017 and 2022 that evaluated ambient environmental risk factors for primary headache disorders, which affect more than half of the population globally. Primary headache disorders include migraine, tension-type headache (TTH), and trigeminal and autonomic cephalalgias (TAC).

Recent findings

We identified 17 articles that met the inclusion criteria via PubMed or Google Scholar. Seven studies (41%) relied on data from US populations. The remaining studies were conducted in China, Taiwan, Germany, Ghana, Japan, the Netherlands, South Korea, and Turkey. Air pollution was the most frequently assessed environmental risk factor. Most studies were cross-sectional and focused on all-cause or migraine headaches; one study included TTH, and none included TAC. Short-term exposure to fine particulate matter (PM2.5) was not consistently associated with headache endpoints, but long-term exposure to PM2.5 was associated with migraine headache prevalence and severity across multiple studies. Elevated ambient temperature, changes in weather, oil and gas well exposure, and less natural greenspace, but not noise pollution, were also associated with headache. No studies considered water pollution, metal exposure, ultrafine particulate matter, or wildfire smoke exposure.

Summary

There is a need for ongoing research focused on headache and the environment. Study designs with the greatest explanatory power may include longitudinal studies that capture the episodic nature of headache and case-crossover analysis, which control for time-invariant individual-level confounders by design. There is also a clear need for research that considers comorbid psychiatric illness and socioeconomic position as powerful modifiers of the effect of the environment on headache.

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Data Availability

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Acknowledgements

The editors would like to thank Molly Kile for handling the review of this manuscript.

Funding

J.A.C. was supported by the National Institute of Environmental Health Sciences grant R00-ES0207023. The conclusions expressed are solely those of the authors.

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H.C.E. and J.A.C. conceptualized this narrative review. H.C.E. and C.F.G.K. wrote the main manuscript text. H.C.E. prepared Fig. 1, and J.A.C. prepared Fig. 2. All authors reviewed and critically revised the manuscript.

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Correspondence to Holly Elser.

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Elser, H., Kruse, C.F.G., Schwartz, B.S. et al. The Environment and Headache: a Narrative Review. Curr Envir Health Rpt 11, 184–203 (2024). https://doi.org/10.1007/s40572-024-00449-4

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