What question did this study set out to answer?

This study aims to assess the prevalence of headaches and identify associated risk factors among middle-aged and older adults with hypertension.

March 8, 2026Open Access

Prevalence and risk factors of headaches in middle-aged and older Chinese adults with hypertension: a cross-sectional study based on CHARLS

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Middle-aged and older Chinese adults (≥45 years) with self-reported physician-diagnosed hypertension (n=2186). Primary outcome: Prevalence of headache among hypertensive individuals.

Key Result

Headache prevalence was 32.0% among middle-aged and older Chinese adults with hypertension.

Key Points

This study aims to assess the prevalence of headaches and identify associated risk factors among middle-aged and older adults with hypertension.
Analyzed data from the 2018 China Health and Retirement Longitudinal Study (CHARLS).
Included 2,186 middle-aged and older adults with hypertension.
Headache status was assessed through self-reported questionnaires.
Factors were examined using the Health Ecology Model framework.
Multivariable logistic regression analyses identified associations with headache.
The prevalence of headache in hypertensive individuals was found to be 32.0%.
Factors associated with increased headache odds included female sex, fair or poor self-assessed health, shorter nighttime sleep, poor sleep quality, history of falls, and non-clean household fuel use.
Increasing age was inversely associated with headache prevalence.
Significant variation in effects was noted based on residence location.

Study Design

Type

Cross-Sectional (n=2,186)

Multicenter

Yes

Structured PICO

Population

2,186 middle-aged and older Chinese adults (aged ≥45 years) with self-reported physician-diagnosed hypertension, mean age 63.06, 51.01% male.

Outcome

Prevalence of headache assessed through self-reported questionnairespatient reported

Headache is highly prevalent (32.0%) among middle-aged and older Chinese adults with hypertension, and is strongly associated with female sex, poor sleep quality, and poor self-assessed health.

Main Result

Absolute Event Rate: 32% vs 68%

Limitations

Cross-sectional design limits causal inference.
Self-reported headache status based on questionnaire may introduce reporting bias.
Study population limited to Chinese adults, potentially limiting generalizability.

Abstract

Headache among individuals with hypertension warrants considerable clinical attention, yet evidence regarding its prevalence and associated factors in this population remains limited. Using data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), this cross-sectional study included 2,186 middle-aged and older adults with hypertension. Headache status was assessed through self-reported questionnaires, and potential associated factors were examined across five dimensions of the Health Ecology Model. Multivariable logistic regression analyses were performed to identify factors associated with headache. The prevalence of headache among hypertensive individuals was 32.0%. Female sex, self-assessed fair or poor health, shorter nighttime sleep duration, poor sleep quality, a history of falls, and the use of non-clean household fuels were associated with higher odds of reporting headache, whereas increasing age was inversely associated with headache. In addition, significant effect modification by residence location was observed for self-assessed health. These findings indicate that headache among middle-aged and older adults with hypertension is associated with a combination of physiological, behavioral, and environmental factors, highlighting the importance of targeted and context-specific strategies for headache prevention and management in this population.

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