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Weather and air pollution as triggers of severe headaches

From the Department of Medicine (K.J.M., G.A.W., M.A.M.), Beth Israel Deaconess Medical Center, Boston; and Departments of Environmental Health (H.H.S.) and Epidemiology (M.A.M.), Harvard School of Public Health, Boston, MA.

Address correspondence and reprint requests to Dr. Kenneth J. Mukamal, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 kmukamal{at}bidmc.harvard.edu

Background: The roles of weather conditions and air pollution as triggers of headache have been inconsistent in previous, generally small studies.

Methods: We performed a case-crossover study of 7,054 patients seen in a single emergency department between May 2000 and December 2007 with a primary discharge diagnosis of headache. We compared levels of temperature, barometric pressure, humidity, fine particulate matter, black carbon, and nitrogen and sulfur dioxides during the three 24-hour periods preceding presentation with corresponding levels on the remaining occurrences of that day of the week in a given month, using local meteorologic and pollutant monitors.

Results: Higher mean ambient temperature in the 24 hours preceding hospital presentation positively and linearly increased the acute risk of headache (odds ratio [OR] for a 5°C increment 1.075; 95% confidence interval [CI], 1.021–1.033; p = 0.006). Higher risk was observed for cases with and without a discharge diagnosis of migraine and for cases between October and March or between April and September. Lower barometric pressure also increased the risk of nonmigraine cases in the 48 to 72 hours before hospitalization (OR 0.939 per 5 mm Hg; 95% CI, 0.902–0.978; p = 0.002). Current levels of pollutants did not influence the risk of headache.

Conclusions: Higher ambient temperature and, to a lesser degree, lower barometric pressure led to a transient increase in risk of headache requiring emergency department evaluation. We did not find clear association of air pollutants with risk, but cannot exclude effects of air pollution of the magnitude previously observed for stroke and other cardiovascular events.

BC = black carbon; BIDMC = Beth Israel Deaconess Medical Center; CI = confidence interval; OR = odds ratio; PM_2.5 = fine particulate matter with aerodynamic diameter 2.5 µm.

Supported in part by grants ES015774 and ES009825 from the National Institute of Environmental Health Sciences and R827353 and R832416 from the US Environmental Protection Agency.

Disclosure: The authors report no disclosures.

Received October 9, 2008. Accepted in final form December 15, 2008.

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