| Migraine Treatment Gets a Report Card | |
Results From the American Migraine Study II
| "The
economic and public health implications of these disability data are
staggering..."5 "...These data underscore the need for health care professionals to renew their commitment to recognizing and effectively managing this important health problem."4 |
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"The top neurologists today admit that Migraine is grossly misunderstood, misdiagnosed, and underdiagnosed. For example, according to noted neurologist Dr. Joel Saper, "Migraine is a serious and underestimated health problem . . . patients with Migraine are shunted along an assembly line of misdiagnosis, undertreatment, or frank mismanagement. They are subjected to unnecessary procedures and preventable consequences." It has been estimated that 60% of women and 70% of men with Migraine have never been diagnosed with Migraine."1 Migraine affects more people than asthma, diabetes, or congestive heart failure.2
AMS II:
Recently, migraine treatment got a report card
in the form of the American Migraine Study II (AMS II). The AMS II was a
follow-up to the 1989 AMS. During the decade between studies, much has changed
in the area of available migraine treatments. The introduction of the first
triptan, Imitrex (Sumatriptan), in 1993 was the beginning of the development of
an entire class of migraine abortive drugs. Zomig (Zolmitriptan), Maxalt
(Rizatriptan), and Amerge (Naratriptan) were also introduced in that time. In
addition, research into the cause of migraine advanced, and different
medications met with success in the prevention of migraine.
AMS II Objective:
"A population-based survey was conducted in 1999 to describe the patterns of
migraine diagnosis and medication use in a representative sample of the US
population and to compare results with a methodologically identical study
conducted 10 years later."3
Data Collection and Response:
Data for the study was obtained via a self-administered headache questionnaire
sent to 20,000 American households, which were drawn from a panel recruited by
National Family Opinion, Inc. From those 20,000 households, 34,009 people
responded to the questionnaire. Of those, 3,738 severe headache sufferers met
the International Headache Society criteria
for migraine diagnosis, 2,818 females and 920 males.
Migraine Diagnosis and Demographics:
In 1999, 48% of the migraineurs had been diagnosed with migraine by a
physician. (41% of males, 51% of females. This was an improvement from 1989,
when 38% (29% of males, 41% of females) were physician diagnosed.4
Sociodemographic Characteristics:4
- Females were more likely to be diagnosed than undiagnosed.
- Older age groups of both men and women were more likely to be diagnosed.
- People with income of $50,000 or more were more likely to be diagnosed.
Use of Medications:4
In the AMS II, 41% of migraineurs used prescription medications for
migraine attacks. That figure was not much higher than the 1989 figure of 37%.
Those who used only over-the-counter medications comprised 59% in 1999,
compared to 57% in 1989. Only a very small number of participants used no
medications at all.
Symptoms:5
The symptoms most frequently reported by migraineurs were:
- pulsatile pain, 85%
- photophobia (sensitivity to light), 80%
- phonophobia (sensitivity to sound), 76%
- nausea, 73%
- unilateral pain, 59%
- blurred vision, 44%
- aura, 36%
- vomiting, 29%
Women were more likely to experience photophobia, phonophobia, and nausea
Intensity and Frequency of Pain:5
Male and female participants reported similar frequency of severe
attacks. One or more severe attack per month were experienced by 62% of
respondents. One to three severe attacks per month were reported by 36.8%,
and 10.8% reported a severe attack weekly.
Migraine-Related Disability:5 Next page >
Report Card: Pass or Fail? > Page 1,
2
Note: The research For the American Migraine
Study II was funded by grants from GlaxoSmithKline to the
National
Headache Foundation. The results were presented at the February 2000 13th
Annual Conference of the Diamond Headache Clinic Research and Education
Foundation (Palm Springs, California) and at the June 2000 42nd Annual
Scientific Meeting of the American Headache Society (Montreal, Canada).
1
Lipton, Richard B, M.D.; Diamond, Seymour, M.D.; Reed, Michael, Ph.D.; Diamond,
Merle L., M.D.; Stewart, Walter F., MPH, Ph.D.
Migraine Diagnosis and Treatment: Results From the American Migraine Study II
2
Functional impairment during migraine attacks was reported by 91% of
migraineurs. Severe attacks causing severe activity impairment or requiring
bed rest were reported by 53% with similar disability between males and
females. Females reported longer duration of impairment than males.
Approximately 31% missed at least one day of work of school during the three
month period immediately preceding the survey. Work or school productivity
reduced by at least 50% was reported by 51%. Family and social activities
were more likely to be disrupted than work or school activities. Not doing
any household work on at least 1 day of the last three months was reported
by 67%. Except for household work, which was more frequently disrupted for
women, the pattern was similar between females and males.
Headache: The Journal of Head and Face Pain 2001:41, 638-645
3
Lipton, Richard B, M.D.; Diamond, Seymour, M.D.; Reed, Michael, Ph.D.; Diamond,
Merle L., M.D.; Stewart, Walter F., MPH, Ph.D.
Migraine Diagnosis and Treatment: Results From the American Migraine Study II
Headache: The Journal of Head and Face Pain 2001:41, 638-645
4 Lipton, R.B et al, Migraine Diagnosis, Treatment, and Impact 1999
5 Lipton, R.B et al,
Prevalence and Burden of Migraine6 Silberstein SD. Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000;55:754-762.
7 Stewart WF, Lipton RB, Liberman J. Variation in migraine prevalence by race. Neurology 1996;47:52-59.
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