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Some Conclusions from the AMS II: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.
- One year prevalence of migraine was 18.2% among females and 6.5% among males. These results are very close to the 1989 AMS, which reported 17.6% prevalence in females and 5.7% in females. "The study results to not support the suggestion that migraine prevalence or incidence may be increasing over time."
- The sociodemographic factors have also held over the last decade. Migraine remains about three times more common in females over males. "The female preponderance, still present in elderly individuals cannot be explained by circulating hormones alone."
- The results of this study demonstrate that migraine episodes are associated with marked disability.
- "The economic and public health implications of these disability data are staggering in the context of the 13% prevalence of migraine in the United States and the fact that nearly one in four United States Households has a migraine sufferer."
- "During the decade since the first American Migraine Study was conducted in 1989, migraine pharmacotherapy has dramatically improved with the advent of the triptans and the approval of new preventive therapies.6 The data from the American Migraine Study II suggest that despite a decade of progress, the burden of migraine in the United States remains substantial. As migraine remains prevalent, disabling, under-diagnosed, and under-treated in the United States,7 public health initiatives to improve treatment are needed."5
So, what's the problem?
- Poor patient/physician communication is the most frequently noted problem in getting appropriate care.
- Appointment lengths in doctors' offices are often inadequate for the patient to communicate their symptoms and needs, the physician to reach a diagnosis, and a treatment plan to be set.
- If patients are seeing their family doctors for migraine, they may also have other conditions that sidetrack migraine treatment.
- Patients seldom visit their doctors during a migraine attack. That leaves the doctor to rely on the patient's description of symptoms of attacks that may have occurred quite some time before the appointment. This is further complicated by the confusion and emotional states sometimes caused by migraine attacks, which can skew the patient's perspective or make it less likely that all relevant details are remembered.
- Misdiagnosis. Many physician-diagnosed and undiagnosed migraineurs in the study had been diagnosed with other headache disorders — tension-type headache,44% of physician diagnosed and 32.3% of undiagnosed migraineurs; sinus headache, 43.1%of physician-diagnosed and 42% of undiagnosed migraineurs.1
- Financial problems. Especially for those without medical insurance, the expense of medical care is prohibitive. Even those who do have medical insurance sometimes have difficulty getting specialist referrals. In addition, increasingly, insurance companies have drug formularies that either don't include the needed medications or severely limit the amount or medication covered.
In summary . . .
"the results of the American Migraine Study II demonstrate that
diagnosis of migraine has increased over the past decade. Despite this
increase, approximately half of migraine sufferers in the United States
remain undiagnosed. Furthermore, the increases in consultation and diagnosis
of migraine have not been accompanied by increased use of prescription
medicines for migraine management. Migraine continues to cause significant
debilitation in sufferers whether or not they are diagnosed by a physician.
As in 1989, migraine in 1999 remains an under-diagnosed condition that
produces substantial disability. These data underscore the need for health
care professionals to renew their commitment to recognizing and effectively
managing this important health problem."4
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
Headache: The Journal of Head and Face Pain 2001:41, 638-645
2
The National Headache Foundation. Headache or Migraine?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, 638-6454 Lipton, R.B et al,
Migraine Diagnosis, Treatment, and Impact 19995 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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