This study using the entire national data aimed to investigate migraine incidence and its trend among women of childbearing age over three decades from 1990 to 2019, and to make a prediction of migraine incidence to the next decade in China. It was observed that, from 1990 to 2019, there was an increasing trend in all migraine cases, CIR and ASIR among overall study population. Moreover, although the number of migraine cases is predicted to decrease from 2020 to 2030, the CIR and ASIR of migraine will remain rapidly rising among women of childbearing age in China. Additionally, the predicted CIR of migraine will be higher among women aged 15–29 years than that for their counterparts of other ages, with the highest among women aged 15–19 years in the year of 2030.

The trend in migraine cases and ASIR examined in our study was in line with that observed among not only the general Chinese population [16] but also the global population [24]. Migraine is a physiological and psychological problem associated with some environmental, social, behavioral, physical and psychological factors, including air pollution [25], unexpected body weight status [26], frequent use of electronic products [27], physical inactivity [28], anxiety/stress[29] and sleep disorders [30]. These influencing factors of migraine were shared by people worldwide, which might, at least partially, explain the consistent findings regarding migraine cases and ASIR between our study and the previous investigations. However, the trend of migraine CIR in this study was inconsistent with that observed in the general population in China [16]. This may be due to that the proportion of women of childbearing age within the total population of China decreased from 26.79% in 1990 to 22.86% in 2020 [31].

The values of CIR and ASIR in women of childbearing age in our study were higher than those in either the general population or the overall women in China. Such an inconsistency might be attributed to biological, emotional state or/and lifestyle factors. From a biological point of view, it was assumed that sex hormones, especially fluctuations in estrogen and progesterone, might play a key role in the pathogenesis of migraine [12]. Since the pain threshold was lower for women than men, women might be more vulnerable to migraine [32]. Additionally, stress, lifestyle and behavioral patterns were also well-known triggers for migraine [33], and women tended to be physically inactive and to experience stress due to the complicated pressure from work and family life [34].

Another interesting finding in our study was that the risk of migraine varied for participants within different age-groups from 1990 to 2019. Based on the age-period-cohort analysis, the highest risk of experiencing migraine due to age effect was identified in the group aged 25–29 years, followed by those aged 35–39 years over the past three decades. For females aged 25–29 years, they are at the stage of transition from school to work and face complex work and social relationships, economic pressures, stress and anxiety [35]. Similarly, women aged 35–39 years may be experiencing the midlife crises, and have to play dual roles of working and caring for family and children [36]. Under such a situation, they need to maintain highly energetic and positive emotional states all the time, which may have them to feel tired and/or anxious [36].

Moreover, the highest migraine CIR for 2030 is predicted in young women aged 15–19 years. This may be due to the highly competitive pressures faced by Chinese children/adolescents and traditional parenting style in China [36]. Participants aged 15–19 years have to face pressures of curricula study, physical and mental development challenges, particularly, during the period of puberty and menarche. These individuals have to do their best to obtain excellent academic performance as possible under a highly competitive situation, and, meanwhile, to face hormonal fluctuations [37].

In this study, either the birth cohort or period was examined to be associated with incidence of migraine. The relative risk for cohort effect increased monotonically from the 1940–1949 birth cohorts to the 1995–2004 cohorts. There are several factors that may contribute to the cohort effect on migraine incidence. It has been examined that environmental pollution, stress, physical inactivity, overuse of medications and electronic devices are all in negative relation to migraine [29, 32]. In recent years, due to rapid economic and social development, these risk factors of migraine have been becoming more prevalent in China [38, 39]. Thus, compared to earlier-born participants, later-born subjects are more likely to be exposed to these risk factors. Consequently, coupled with the cumulative effect of time, people born later tend to suffer from migraine.

Moreover, the period-specific relative risk continued increasing over the 30 years except for the period of 1994–1999. This might be explained by the following two reasons. On the one hand, more risk factors associated with migraine emerged in the century in China, e.g., negative life events (SARS endemic, earthquakes, etc.), social competition, and unhealthy behaviors and/or lifestyles (staying up late, lack of exercise, addiction to electronic products, etc.) [16], which might increase the risk for residents to experience migraine. On the other hand, with the rapid development of medical technology and elevated health consciousness of participants, the identification rate of migraine might be consequently improved [40].

Additionally, a constantly increasing trend was predicted in CIR and ASIR of migraine in the next decade from 2020 to 2030, while the number of migraine cases was projected to decrease by 4.55% over the same period. This may be due to the changes in Chinese population structure in the next 10 years. China has been under a way to rapidly-aging society. It has been estimated that the proportion of residents aged 65 + years will increase from 12.06% in 2020 to 18.21% in 2030 [41]. Contrarily, the proportion of women of childbearing age will decrease in the next decade in China [42].

For women of childbearing age in China, the burden caused by migraine was very heavy during 1990 and 1999 and such a situation would remain for 2030. Meanwhile, women within this age-group tends to experience migraine due to complicated biological (e.g., female sex hormone fluctuation), emotional (e.g., anxiety, depression), lifestyle factors (e.g., sleep) or/and social factors (e.g., career competitiveness, family and child care) [12, 32,33,34,35,36]. Moreover, women of childbearing age also play critical and multiple roles not only in a society but also in each single family. The health state of each woman of childbearing age is really crucial for herself, her family and the society. Therefore, it is of particular importance and urgent necessity to initiate precision interventions on migraine among women of childbearing age in China.

This is the first study to comprehensively assess the incidence of and trend in migraine among women of childbearing age over a 30-year period using nationwide data in China. There were several strengths in this study. First, the definition and identification approach of migraine were adopted from those in GBD, which warranted the data regarding migraine were comparable across GBD-related studies [22]. Second, participants were the vulnerable sub-population for this disease, nationwide women of childbearing age. Third, the trend in migraine incidence over the past three decades was examined and a prediction for the next 10 years was projected. The last, the effects of age, period, and cohort on migraine incidence from a historical epidemiological perspective were estimated using the APC model among participants in the study.

However, limitations are also worthy of attention. Firstly, the definition and identification of migraine in our study were directly derived from GBD study, implying that the potential bias in GBD study also existed in our study [1, 19]. Secondly, very few influencing factors were included in GBD study, which did not allow us further identifying more factors in relation to the trend in migraine over the 30 years. Thirdly, data on migraine incidence were available only at national level, thus we had to just present the nationwide trend in migraine incidence. In future, well-designed population-level epidemiological surveys are encouraged to collect data on migraine, including its risk factors and participant’s personal characteristics, from a representative population.