Abstract
Physical and psychological measures across the lifespan were used to determine which factors could differentiate between migraine and tension-type headache in a representative birth cohort (Dunedin Multidisciplinary Health and Development Study). Over one-third of the study members suffered from frequent headache during childhood. Of these children, over one quarter were later diagnosed with primary headache in adulthood. The 1-year prevalence was 11.1% for tensiontype headache and was 11.6% for migraine. Migraine at age 26 was predicted by maternal headache, anxiety disorders in childhood and adolescence, and stress reactivity and harm avoidance personality traits. In contrast, tension-type headache was characterised by childhood neck or back injury, moderate childhood anxiety, and adolescent aggression. Perinatal complications, neurological disorders or concussion did not predict headache status. While migraineurs had the most severe impairment in work and social-related activities, all study members diagnosed with primary headache disorder reported their physical, emotional and mental health to be worse than headache-free controls and comparable to individuals currently receiving treatment for asthma. The pervasive impairment reported across multiple life domains among young headache sufferers illustrates the significant burden of illness associated with headache disorders. These results also confirm that migraine and tension-type headache are distinct disorders with different defining characteristics.