Geographical patterns and determinants of migraine in persons aged ten years or older living in Sweden from 2015 to 2023: a nationwide cross-sectional study

Migraine is a major cause of disability affecting a person’s health, well-being, working life and social relationships. In Sweden, it was previously estimated that approximately one in eight people experience migraine with lower socioeconomic groups disproportionately affected. Yet there is a lack of recent evidence on the burden and geographic distribution of migraine within Sweden including by small-area deprivation. A nationwide register-based cross-sectional study was conducted of persons ten years or older in Sweden on 31 December 2023 and who were diagnosed with or prescribed drugs for migraine during the study period (2015–2023). Crude and age-standardized migraine rates per 1,000 persons were tabulated nationally and sub-nationally by region and small-area deprivation measured using the Index for Multiple Deprivation in Sweden (IMDIS). Logistic regression models quantified the association between small-area deprivation level and other covariates (age, sex, area of residence, birthplace) on migraine. Among migraine patients, the healthcare source for the first recorded diagnosis was compared at national and regional levels as well as by patient characteristics. A total of 372,926 people aged ten years or older had recorded migraine during the study period corresponding to a rate of 43.7 cases per 1,000 persons. Higher migraine occurrence was found in the least versus the most deprived areas (OR: 1.05, 95% CI: 1.04–1.06). Among migraine patients, the first diagnosis occurred in primary (27.2%), specialized outpatient (13.9%), or inpatient (3.8%) care while 55.2% were prescribed drugs without a recorded diagnosis in the study period. There was significant variation in the source of the first migraine diagnosis across regions and by the patient’s age, birthplace and area of residence. We found low migraine rates using administrative healthcare registry data compared to higher estimates reported in previous population surveys in Sweden. The higher prevalence of migraine among people in better-resourced areas compared to more deprived areas suggests potential healthcare gaps for migraine patients across socioeconomic contexts. Significant variation in the source of the first migraine diagnosis by region and patient characteristics merits further investigation. Overall findings suggest healthcare gaps for migraine patients in Sweden with uneven practices across regions and socioeconomic contexts.