Jump to ContentJump to Main Navigation
Show Summary Details

International Journal of Occupational Medicine and Environmental Health

IMPACT FACTOR 2014: 0.695
5-year IMPACT FACTOR: 1.332

SCImago Journal Rank (SJR) 2014: 0.370
Source Normalized Impact per Paper (SNIP) 2014: 0.554
Impact per Publication (IPP) 2014: 1.071

Open Access
See all formats and pricing

Emergency department visits for migraine and headache: a multi-city study

Mieczysław Szyszkowicz1 / Gilaad Kaplan1 / Eric Grafstein1 / Brian Rowe1

Canada Population Studies Division, Health Canada, Ottawa, ON, Canada1

Canada Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB2

Canada Department of Emergency Medicine, Providence Health Care and St. Paul's Hospital, Vancouver, BC3

Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, AB, Canada4

This content is open access.

Citation Information: International Journal of Occupational Medicine and Environmental Health. Volume 22, Issue 3, Pages 235–242, ISSN (Online) 1896-494X, ISSN (Print) 1232-1087, DOI: https://doi.org/10.2478/v10001-009-0024-5, October 2009

Publication History

Published Online:

Emergency department visits for migraine and headache: a multi-city study

Objectives: We set out to examine associations between ambient air pollution concentrations and emergency department (ED) visits for migraine/headache in a multi-city study. Materials and Methods: We designed a time-series study of 64 839 ED visits for migraine (ICD-9: 346) and of 68 495 ED visits for headache (ICD-9: 784) recorded at hospitals in five different cities in Canada. The data (days) were clustered according to the hierarchical structure (location, year, month, day of week). The generalised linear mixed models technique was applied to fit the logarithm of clustered daily counts of ED visits for migraine, and separately for headache, on the levels of air pollutants, after adjusting for meteorological conditions. The analysis was performed by sex (all, male, female) and for three different seasonal periods: whole (January—December), warm (April—September), and cold (October—March). Results: For female ED visits for migraine, positive associations were observed during the warm season for sulphur dioxide (SO2), and in the cold season for particulate matter (PM2.5) exposures lagged by 2-days. The percentage increase in daily visits was 4.0% (95% CI: 0.8-7.3) for SO2 mean level change of 4.6 ppb, and 4.6% (95% CI: 1.2,-8.1) for PM2.5 mean level change of 8.3 μg/m3. For male ED visits for headache, the largest association was obtained during the warm season for nitrogen dioxide (NO2), which was 13.5% (95% CI: 6.7-20.7) for same day exposure. Conclusions: Our findings support the associations between air pollutants and the number of ED visits for headache.

Keywords: Air pollution; Migraine; Headache; Emergency department visit; Urban

  • Prince PB, Rapaport AM, Sheftell FD, Tepper SJ, Bigal ME. The effect of weather on headache. Headache 2004;44: 596-602. [PubMed] [Crossref]

  • Chabriat H, Danchot J, Michel P, Joire JE, Henry P. Precipitating factors of headaches. A perspective study in a national control-matched survey in migraineurs and non-migraineurs.Headache 1999;39:335-8. [Crossref]

  • Farrow A, Taylor H, Northstone K, Golding J. Symptoms of mothers and infants related to total volatile organic compounds in household products. Arch Environ Health 2003;58:633-41. [Crossref] [PubMed]

  • Panzmolhave L, Kjaergaard SK. Effects on eyes and nose in humans after experimental exposure to airborne office dust. Indoor Air 2000;10:237-45.

  • Wargocki P, Lagercrantz L, Witterseh T, Sundell J, Wyon DP, Fanger PO. Subjective perceptions, symptom intensity and performance: A comparison of two independent studies, both changing similarly the pollution load in an office. Indoor Air 2002;12:74-80. [Crossref]

  • Schiffman SS, Studwell CE, Landerman LR, Berman K, Sundy JS. Symptomatic effects of exposure to diluted air sampled from a swine confinement atmosphere on healthy human subjects. Environ Health Perspect 2005;113:567-76.

  • Nattero G, Enrico A. Outdoor pollution and headache. Headache 1996;36:243-5. [PubMed] [Crossref]

  • Partti-Pellinen K, Marttila O, Vikka V, Jaakkola JJ, Jappinen P, Haahtela T. The South Karelia air pollution study: Effects of low-level exposure to malodorous sulfur compounds on symptoms. Arch Environ Health 1996;51:315-20. [Crossref]

  • Szyszkowicz M, Stieb D, Rowe B. Air pollution and daily ED visits for headache in Edmonton, Canada. Am J Emerg Med 2009;27:391-6. [Web of Science] [Crossref] [PubMed]

  • Szyszkowicz M, Rowe B, Kaplan G. Ambient Sulphur Dioxide Exposure and Emergency Department Visits for Migraine in Vancouver, Canada. Int J Occup Med Environ Health 2009;(1);22:1-6. DOI 10.2478/v1001-009-0006-7 [Web of Science] [Crossref]

  • Villeneuve PJ, Szyszkowicz M, Stieb D, Bourque DA. Weather and emergency room visits for migraine headaches in Ottawa, Canada. Headache 2006;46:64-72. [Crossref] [PubMed]

  • Szyszkowicz M. Ambient Air Pollution and Daily Emergency Department Visits for Headache in Ottawa, Canada. Headache 2008;48:1076-81. [Crossref] [PubMed] [Web of Science]

  • World Health Organization. The International Classification of Diseases, 9th Revision. Geneva: WHO; 1997.

  • Mukamal KJ, Wellenius GA, Suh HH, Mittleman MA. Weather and air pollution as triggers of severe headaches. Neurology 2009;72:922-7. [Web of Science] [Crossref] [PubMed]

  • R Development Core Team. A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna, Austria: R Development Core Team; 2008. Available from: URL: http://www.R-project.org

  • Szyszkowicz M. Use of generalized linear mixed models to examine the association between air pollution and health outcomes. Int J Occup Med Environ Health 2006;19(4):224-7. DOI 10.2478/v1001-006-0032-7 [Crossref] [PubMed]

  • Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol 1991;133:144-53.

  • Janes H, Sheppard L, Lumley T. Case-crossover analyses of air pollution exposure data: referent selection strategies and their implications for bias. Epidemiology 2005;16:717-26. [PubMed] [Crossref]

  • Gelman A, Stern H. The difference between "significant" and "not significant" is not itself statistically significant. The American Statistician 2006;60:328-31. [Crossref]

  • DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88. [Crossref] [PubMed]

  • Meggs WJ. Neurogenic inflammation and sensitivity to environmental chemicals. Environ Health Perspect 1993;103(3): 234-8.

  • Tornqvist H, Mills NL, Gonzalez M, Miller MR, Robinson SD, Megson IL, et al. Persistent endothelial dysfunction in humans after diesel exhaust inhalation. Am J Respir Crit Care Med 2007;176:395-400.

Comments (0)

Please log in or register to comment.