The Migraine Cycle: Patient Burden of Migraine During and Between Migraine Attacks


  • Conflict of Interest: Dr. Brandes received editorial support for the preparation of this manuscript from Ortho-McNeil Janssen Scientific Affairs, LLC, Titusville, NJ. Dr. Brandes received no compensation for the preparation of this manuscript. Dr. Brandes has received grants, research support or served as a consultant to Merck, GlaxoSmithKline, UCB Pharma, Allergan, Johnson & Johnson, AstraZeneca, Pfizer, Bristol-Myers Squibb, Winston Laboratories, Sanofi-Aventis, Elan Pharmaceuticals, Novartis, Endo, POZEN, Vernalis, Ortho-McNeil, Advanced Bionics, MedPointe Pharmaceuticals, and Aradigm Corporation.

J. Brandes, Director, Nashville Neuroscience Group, Assistant Clinical Professor, Neurology, Vanderbilt University School of Medicine, 300 20th Avenue N., Suite 603, Nashville, TN 37203, USA.


Migraine is a neurologic disorder characterized by a cycle of attacks, including headache, separated by attack-free periods. Increasingly, episodic migraine is recognized as a disorder that may escalate to chronic migraine, with a frequency of 15 or more attacks per month. Migraine exacts a toll on the quality of life (QoL) of affected individuals, their families, and their workplace. Migraine adversely affects a patient's QoL during an attack, but also has an impact between attacks. This interictal burden on the patient manifests itself as worry in anticipation of the next painful attack and concern over its possible adverse impact on future plans or activities. The high prevalence of migraine, 12% in industrialized countries and approximately 28 million people in the United States, is considered a low estimate. Patients with disruptive migraines frequently overuse self-prescribed medications or may postpone a visit to a physician, which delays accurate diagnosis and appropriate treatment for migraine. Consequently, migraine remains underdiagnosed and undertreated. An extensive literature search of migraine reviewed its associated disability and reduced QoL during, and especially between, attacks. Assessment tools to evaluate the interictal burden on QoL, and to help in migraine diagnosis and patient–physician communication, are readily available. Nevertheless, patients with frequent and recurring migraines, who suffer a reduced QoL, continue to be underrecognized and undertreated. This segment of the migraine population could benefit from preventive therapy.