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However, future studies focusing on this topic should use prospective headache diaries and should include assessments for measurement of psychiatric comorbidity (especially depression and anxiety disorder) as these diseases may influence headache frequency as well as adherence to treatment recommendations.
These databases lack personal information that may influence headache, but these factors would not be expected to confound the observed relation.
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We did not include potentially relevant variables, such as physical activity, income, sleep quality, body mass index, which may influence primary headache prevalence and symptoms.
However, migraine without aura is 2.2 times more prevalent in women than migraine with aura, which seldom occurs in relation to menstruation [2, 25] We do not have information about the use of oral contraception, other hormonal treatment and pregnancy, which may influence the headache pattern of these women.
Caffeine has a wide range of physiologic effects that are unrelated to the direct treatment of headache pain but may influence improvement in headache symptoms.
Several factors are likely to influence headache progression: genetic predisposition, persistent (or recurring) noxious stimuli, trigeminal or cervical pathology, dysfunctional descending modulation of nociception, and repetitive headache attacks that may lead to persistent central sensitization which is directly related to age, duration of illness and migraine attack frequency [ 15– 17].
Additionally, studies indicate that being diagnosed with migraine at baseline may influence the course of headache and the headache frequency at a later time point.
The bidirectional link between headache and EVT has thus far never been investigated, hence it is unknown whether history of headache may influence the endovascular procedure due to vascular complications such as distal embolization or dissection (Additional file 1: Table S2), and vice versa whether a complicated procedure may affect headache patterns after EVT.
These events may influence the occurrence of headache quite strongly especially in case of migrainers and the subjects who believe they are MSG-sensitive.
However, we cannot rule out that other unmeasured factors related to sleep disturbance may influence the association with chronic headache.
While, ideally, these data will reflect all factors that may influence prevalence and/or burden of headache, this objective is necessarily limited by the availability of data characterizing the entire population.
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