Skip to main content

Headache in the HUNT Study: Analytical Headache Epidemiology as a Source of Added Knowledge

  • Chapter
  • First Online:
  • 327 Accesses

Part of the book series: Headache ((HEAD))

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.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bradford-Hill A. The environment and disease: association or causation? Proc Roy Soc Med. 1965;58:295–300.

    Article  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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.

    Article  CAS  PubMed  Google Scholar 

  7. 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.

    Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  CAS  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Google Scholar 

  14. 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.

    Google Scholar 

  15. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. 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.

    Article  CAS  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 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.

    Article  CAS  PubMed  Google Scholar 

  20. 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.

    Article  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  CAS  PubMed  Google Scholar 

  25. Hagen K, Wisloff U, Ellingsen O, Stovner LJ, Linde M. Headache and peak oxygen uptake: the HUNT3 study. Cephalalgia. 2016;36:437–44.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  CAS  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  Google Scholar 

  30. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. 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.

    Article  CAS  PubMed  Google Scholar 

  35. 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.

    Article  CAS  PubMed  Google Scholar 

  36. Aamodt AH, Stovner LJ, Hagen K, Zwart JA. Comorbidity of headache and gastrointestinal complaints. The Head-HUNT study. Cephalalgia. 2008;28:144–51.

    CAS  PubMed  Google Scholar 

  37. 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.

    Article  PubMed  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  CAS  PubMed  Google Scholar 

  41. 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.

    Article  PubMed  Google Scholar 

  42. 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.

    Article  CAS  PubMed  Google Scholar 

  43. 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.

    Article  CAS  PubMed  Google Scholar 

  44. 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.

    Article  CAS  PubMed  Google Scholar 

  45. 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.

    Article  CAS  PubMed  Google Scholar 

  46. 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.

    Article  PubMed  Google Scholar 

  47. 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.

    Article  CAS  PubMed  Google Scholar 

  48. 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.

    Article  CAS  PubMed  Google Scholar 

  49. 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.

    Article  CAS  PubMed  Google Scholar 

  50. 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.

    Article  CAS  PubMed  Google Scholar 

  51. 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.

    Article  PubMed  Google Scholar 

  52. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  54. 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  55. 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.

    Article  PubMed  Google Scholar 

  56. 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.

    Article  PubMed  Google Scholar 

  57. 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.

    Article  PubMed  Google Scholar 

  58. 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.

    Article  PubMed  Google Scholar 

  59. 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.

    Article  PubMed  Google Scholar 

  60. 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.

    Article  PubMed  Google Scholar 

  61. 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.

    Article  PubMed Central  Google Scholar 

  62. Ioannidis JP. Why most published research findings are false. PLoS Med. 2005;2:e124.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Ioannidis JP. Exposure-wide epidemiology: revisiting Bradford Hill. Stat Med. 2016;35:1749–62.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Knut Hagen .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

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)

Publish with us

Policies and ethics