Facts of Life

Facts of Life:
Issue Briefings for Health Reporters
Vol. 10, No. 8
August 2005

Migraine: A Major Headache

The Issue

The Facts

Hidden Migraines

Expert Sources

References

The Issue:

Migraine is the “queen” of headaches and the bane of its sufferers, a disabling condition with no cure. Migraine is usually characterized by throbbing pain on one side of the head, accompanied by nausea and sensitivity to light. Genetics appears to play a significant but still mysterious role in migraine, but other environmental and behavioral triggers including diet, exercise, sleep patterns, hormonal fluctuations and even social relationships can affect the severity and frequency of migraine.

Crippling Costs

According to the National Headache Foundation, nearly 30 million Americans have migraines.¹ In June 2005, the foundation released results from the latest American Migraine Prevalence and Prevention (AMPP) Study, which documented the effects of migraine across a sample of 162,576 Americans ages 12 and older. The study found that three of ten people with migraines retreat to their beds on the days of an attack, and that more than 25 percent missed at least one day of work over the past three months due to a migraine.¹ Families with at least one person suffering from migraines spend about 70 percent more each year on medical costs than other families, according to a 2004 study.²

Preventive Measures

Medications and nondrug measures such as relaxation techniques, biofeedback and heat application can all reduce the frequency of migraines, but the AMPP survey suggests that only one in five migraine sufferers use preventive therapy. Over half use only over-the-counter medications, such as ibuprofen and naproxen, or no medicines at all to treat their severe headaches.¹

The Facts:

• In the United States, the prevalence of migraine is highest among women, people ages 25 to 55 and individuals from low-income households.³

• Only 42 percent of internal medicine and 62 percent of family practice residency graduates say they are “very prepared” to treat patients with headaches.⁴

• Recent brain imaging studies suggest that migraines, once thought to be caused by blood flow abnormalities in the brain, may originate in brain tissue itself.⁵

• People with migraines may have twice the risk of certain types of stroke as non-migraine patients, according to a 2005 systematic review.⁶

• Drugs called triptans are effective medications against acute migraine attacks, according to recent reviews of several brands of triptans.^7,8,9

• Studies suggest that patients taking migraine-specific triptan drugs are more satisfied with their care than those taking over-the-counter painkillers such as ibuprofen or naproxen.¹⁰

• Anticonvulsant drugs, such as those used to treat epileptic seizures, can reduce the frequency of migraines in adults, according to a 2005 systematic review.¹¹

• Studies of drugs used to treat migraine in children are generally very small and of poor quality, according to a 2005 review.¹²

• In an analysis of randomized clinical trials of painkillers for migraine patients, 30 percent of the patients reported a reduction in migraine symptoms after taking a placebo.¹³

• Feverfew, a popular herbal remedy for migraine, is no more effective than a placebo for preventing migraine attacks, a 2005 review concludes.¹⁴

• A systematic review of studies suggests that doses of niacin may help migraine sufferers, but the studies do not resolve how niacin may act in the body to alleviate migraines.¹⁵

• A 2005 review suggests there is some evidence that spinal manipulation, such as that practiced by a chiropractor, can prevent migraines as well as amitriptyline, an antidepressant used to treat migraine.¹⁶

• Patients who received acupuncture treatments for three months used 15 percent less migraine medication and made 25 percent fewer visits to their primary care physicians, according to a 2004 systematic review.¹⁷

Hidden Migraines

Americans — nearly 45 million of them, according to the National Headache Foundation¹ — live with their headaches, blaming them on sinus troubles or stress. Few people believe that their headaches are severe enough to call them migraines, but they and their doctors may be setting their thresholds too high when it comes to diagnosing migraine, according to several prominent researchers.

“Everybody has this idea that migraine has to be this throwing up over the toilet problem,” says Frederick Taylor, M.D., a migraine specialist at the Park Nicollet Headache Clinic and Research Center in Minneapolis. “Anyone who has an intermittent headache and any functional limitations from it may be a migraineur.”

Robert Kaniecki, M.D., director of the Headache Research Center at the University of Pittsburgh Medical Center, agrees that migraine “remains underdiagnosed and undertreated.” In a 2003 article in the Journal of the American Medical Association, Kaniecki suggested that patients’ own mistaken perceptions about their headaches were probably the most significant factor in the misdiagnosis of migraine.¹⁸

“Even migraineurs say most of their headaches aren’t migraines,” Taylor says, “A lot of it has to do about how you ask the question, and what the person has decided in their head that they have.”

Taylor and Kaniecki say many headaches sufferers would be surprised to hear their symptoms described as migraine. Physicians should diagnosis migraine by asking their patients if they have had any headaches in the past three months that caused “any disability or limitation in function,” which could include things such as skipping a usual morning jog or not driving the kids to soccer practice, Taylor says.

Disability along with more familiar symptoms such as nausea and light sensitivity are the hallmarks of migraine, Taylor says. “If you have all three of these, there is a 98 percent likelihood that you have migraines. Even if you just have two of these symptoms, there is a 93 percent likelihood of migraine.”

Migraine patients who think their headaches are stress- or sinus-related rely on over-the-counter medications to treat themselves, which can aggravate the problem by causing medication overuse or “rebound headaches,” according to Taylor, who says “at least half” of those who have headaches more than 15 days a month are probably over-medicating themselves.

Kaniecki and Taylor’s research is supported in part by GlaxoSmithKline, AstraZeneca and other pharmaceutical companies that sell prescription migraine medications. Taylor says it is important to treat migraine aggressively and as early as possible, since small headaches often give way to more severe migraine and it is difficult to tell which patients will progress to this point. There is also some evidence that untreated migraines can cause abnormalities such as brain lesions over time ¹⁹. Even without considering those dire outcomes, however, Taylor says most headache patients should recognize the daily disability caused by any headache.

Expert Sources:

References

1. National Headache Foundation (2005) American Migraine Prevalence and Prevention Study. (AMPP) Fact Sheet. Last accessed 7/15/05 at http://www.headaches.org/consumer/AMPP/AMPPFactSheet.pdf.

2. P.E. Stang et al. (2004) The family impact and costs of migraine. The American Journal of Managed Care, 10, 313-320.

3. M.E. Bigal et al. (2004) The epidemiology and impact of migraine. Current Neurology and Neuroscience Reports, 4, 98-104.

4. F.C. Wiest et al. (2002) Preparedness of internal medicine and family practice residents for treating common conditions. Journal of the American Medical Association, 288, 2609-2614.

5. A.S. Cohen and P.J. Goadsby (2005) Functional neuroimaging of primary headache disorders. Current Pain and Headache Reports, 9, 141-146.

6. M. Etminan et al. (2005) Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies. British Medical Journal, 330, 63-66.

7. D.C. McCrory and R.N. Gray (2005) Oral sumatriptan for acute migraine. (Review) The Cochrane Database of Systematic Reviews, Issue 2.

8. L.A. Smith et al. (2005) Eletriptan for acute migraine. (Review) The Cochrane Database of Systematic Reviews, Issue 2.

9. A.D. Oldman et al. (2005) Rizatriptan for acute migraine. (Review) The Cochrane Database of Systematic Reviews, Issue 2.

10. M. Diamond and R. Cady (2005) Initiating and optimizing acute therapy for migraine: the role of patient-centered stratified care. American Journal of Medicine, 118 Suppl 1, 18S-27S.

11. E. Chronicle and W. Mulleners (2005) Anticonvulsant drugs for migraine prophylaxis. (Review) The Cochrane Database of Systematic Reviews, Issue 2.

12. S. Victor and S.W. Ryan (2005) Drugs for preventing migraine headaches in children. (Review) The Cochrane Database of Systematic Reviews, Issue 2.

13. L. Bendtsen et al. (2003) Placebo response in clinical randomized trials of analgesics in migraine. Cephalalgia, 23, 487-490.

14. M.H. Pittler and E. Ernst (2005) Feverfew for preventing migraine. (Review) The Cochrane Database of Systematic Reviews, Issue 2.

15. G. Bronfort et al. (2005) Non-invasive physical treatments for chronic/recurrent headache. (Review) The Cochrane Database of Systematic Reviews, Issue 2.

16. J. Prousky and D. Seely (2005) The treatment of migraines and tension-type headaches with intravenous and oral niacin (nicotinic acid): systematic review of the literature. Nutrition Journal, 4, 3-11.

17. A.J. Vickers et al. (2004) Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis. Health Technology Assessment., 48, 1-35.

18. R. Kaniecki (2003) Headache assessment and management. Journal of the American Medical Association, 289, 1430-1433.

19. M.C. Kruit et al. (2004). Migraine as a risk factor for subclinical brain lesions. Journal of the American Medical Association, 291, 427-434.

The Center for the Advancement of Health is an independent nonprofit organization that promotes greater recognition of how psychological, social, behavioral, economic and environmental factors influence health and illness. The Center advocates the highest quality research and communicates it to the medical community and the public. The fundamental aim of the Center is to translate into policy and practice the growing body of evidence that can lead to the improvement and maintenance of the health of individuals and the public. The Center was founded by the John D. and Catherine T. MacArthur Foundation and the Nathan Cummings Foundation, which continue to provide core funding. Funding for this series was provided by the Robert Wood Johnson Foundation.

For Information Contact:
Lisa Esposito
Editor, Health Behavior News Service
Center for the Advancement of Health
2000 Florida Ave., NW, Suite 210
Washington, DC 20009
p. 202.387.2829 / f. 202.387-2857
press@cfah.org
http://www.cfah.org

© Copyright 2005, Center for the Advancement of Health

PDF Version