From the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (Drs. Bigal and Lipton); Montefiore Headache Center, Bronx, NY (Drs. Bigal, Diamond, and Lipton); The New England Center for Headache, Stamford, CT (Dr. Bigal); Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA (Dr. Silberstein); Spaulding Rehabilitation Hospital, Boston, MA (Dr. Loder); Vedanta Research, Chapel Hill, NC (Dr. Reed); and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Dr. Lipton).
Patterns of Diagnosis and Acute and Preventive Treatment for Migraine in the United States: Results from the American Migraine Prevalence and Prevention Study
Article first published online: 17 NOV 2006
Headache: The Journal of Head and Face Pain
Volume 47, Issue 3, pages 355–363, March 2007
How to Cite
Diamond, S., Bigal, M. E., Silberstein, S., Loder, E., Reed, M. and Lipton, R. B. (2007), Patterns of Diagnosis and Acute and Preventive Treatment for Migraine in the United States: Results from the American Migraine Prevalence and Prevention Study. Headache: The Journal of Head and Face Pain, 47: 355–363. doi: 10.1111/j.1526-4610.2006.00631.x
- Issue published online: 17 NOV 2006
- Article first published online: 17 NOV 2006
- Accepted for publication August 23, 2006.
Vol. 47, Issue 9, 1365, Article first published online: 9 OCT 2007
Objective.—To describe the patterns of medical treatment for migraineurs in the United States.
Background.—Over the past decade, many new treatments for migraine have become available and awareness of migraine has improved. However, there is little information about the patterns of medical treatment in the US society.
Design/Methods.—A validated self-administered headache questionnaire was mailed to a random sample of 120,000 US households. Each household member with severe headaches was asked to complete the survey. The questionnaire assessed headache features, disability, and patterns of medical treatment. Subjects were classified according to their use of headache preventive medication, as current users, coincident users (using effective medications for other medical reasons), lapsed users (had used in the past but not at the time of the survey), or never users.
Results.—In 162,576 participants, the prevalence of migraine was 17.1% in women and 5.6% in men. Only 56.2% of those with migraine had ever received a medical diagnosis. Ninety-eight percent of the migraineurs used acute treatment for their migraine attacks. Forty-nine percent (49%) usually used over-the-counters, 20% usually used prescription medications, and 29% used both. Only 12.4% of migraineurs indicated that they were taking a migraine preventive medication, but 17.2% were using medications with potential antimigraine effects for other medical reasons. Current or past use of preventive medication was more likely in women than men (odds ratio [OR]= 1.37, 95% confidence interval [CI] 1.27-1.48), increased with age and individuals with high MIDAS grade (Grade IV vs I, OR 2.35, 95% CI 2.09-2.64). Preventive medication use increased with awareness of migraine and with illness severity.
Conclusions.—Migraine remains undertreated in the US population. Barriers to preventive treatment are greater in younger age groups, men, and people unaware that they have migraine.