Migraine Facts from Published Research
Migraine Incidence and Demographics
- Migraine is a disease affecting approximately 30 million Americans, equivalent to roughly 13% of the adult U.S. population, or one migraine sufferer in every four U.S. households.
- Migraine is much more common among women than men. Migraine affects approximately 18% of women and 6% of men.
- The prevalence of migraine is widespread during the most productive adult years, between the ages of 25 and 55. The incidence of migraine increases from childhood through adolescence and early adult life. The highest frequency of migraine attacks is observed in 35-45 year-old patients, with the prevalence declining somewhat among older patients.
- The incidence of migraine has been on the rise in the United States. From 1980 to 1989, the prevalence of migraine increased nearly 60%. From 1989 to 1999, the number of migraine sufferers in the United States increased from 24 million to 28 million.
Migraine Diagnosis and Symptoms
- A population-based survey was conducted in 1999 to compare results with a methodologically identical study conducted 10 years earlier. Key findings of the American Migraine Study II include the following:
- Approximately half of migraineurs remain undiagnosed– only 48% of respondents who met the clinical definition of migraine reported ever having had their condition diagnosed by a physician.
- 80% said their migraine headaches were ‘severe’ or ‘extremely severe,’ with 24% seeking emergency room care as a result of an attack.
- While sufferers with a physician diagnosis tend to have more severe migraines and report more symptoms versus the undiagnosed, there is a high level of suffering reported by both groups:
- Throbbing pain (85% diagnosed vs. 85% undiagnosed)
- Sensitivity to light (89% diagnosed vs. 72% undiagnosed)
- Nausea (80% diagnosed vs. 66% undiagnosed)
Migraine Impact on Quality of Life
- Migraine has a negative effect on the quality of life, including physical, emotional and social aspects of daily life such as family, work and social relationships.
- In the American Migraine Study II, approximately one-third of migraine sufferers reported missing work or school, and between 58% and 76% discontinued their normal household activities or canceled family or social activities.
- 37% of the diagnosed migraineurs reported 1 to 2 days of activity restriction per episode
- More than half reported experiencing a 50% or more reduction in work and/or school productivity, and 66% said they experienced a 50% or more reduction in housework productivity.
- 39% of patients report migraine pain so severe they are driven to their beds, sometimes for days at a time.
- In another recent study, migraine sufferers and their families in the USA and UK reported very similar effects on their quality of life. Of those with migraine living with a household partner, most report negative effects on their relationships inside and outside of the home:
- 85% reported substantial reductions in their ability to do household work and chores
- 45% missed family social and leisure activities
- 32% avoided making plans for fear of cancellation due to headaches
- One half believed that, because of their migraine, they were more likely to argue with their partners (50%) and children (52%)
- Most reported other adverse consequences for their relationships with their partner and children, and at work (52-73%)
- 36% believed they would be better partners except for their headaches. Partners of those with migraine partly confirmed these findings: 29% felt that arguments were more common because of headaches and 20-60% reported other negative effects on relationships at home.
The Economic Impact of Migraine
- A recent study in JAMA estimated lost productive time from common pain conditions among U.S. workers costs an estimated $61.2 billion per year. The majority (76.6%) of the lost productive time was from reduced performance while still at work, and not work absence.
- Based on a random sample of 28,902 working adults in the United States, 13% of the total workforce experienced a loss in productive time during a 2-week period due to a common pain condition.
- Headache was noted as the most common pain condition resulting in lost productive time, affecting 5.4% of the workforce. Workers who had a headache lost an average of 3.5 hours per week.
- Migraine is an expensive illness to treat, yet two-thirds of the total financial burden is a result of indirect costs. Individuals with migraine, employers, and insurance companies all have an economic stake in reducing the migraine burden. In a recent study comparing migraine sufferers to those without migraine, migraineurs had higher direct medical costs, primarily due to a greater frequency of physician and emergency department visits. The cost of lost productivity for the migraine group was also higher.
- Since migraine headaches affect approximately 13% of the population in the United States and the condition is most prevalent during the prime working years (25 to 55 years of age), the cost impact on employers is substantial. Migraine causes absenteeism and lost productivity while on the job (“presenteeism”) that represent an enormous cost burden for employers.
- One recent study estimated that the annual cost of migraine for a single employer, BankOne (a financial services corporation with 80,000 employees), was at least $21.5 million from migraine-related absenteeism, and an additional $24.4 million from reduced on-the-job productivity due to migraine.
- On average, each migraine sufferer needs 4 to 6 days of bed rest each year.
- In total, it is estimated that 157 million workdays are lost annually in the United States because of the pain and associated symptoms of migraine.
- Migraine costs American employers at least $13 billion a year, with nearly $8 billion due to missed workdays and the remainder due to impaired work function. Patients of both sexes aged 30 to 49 years incur higher indirect costs compared with younger or older employed patients.
Migraine Diagnosis and Treatment
- Migraine remains one of the most underdiagnosed and undertreated neurological conditions. Many neurology researchers now consider migraine to be a neurovascular disorder, with a pathology involving the cerebral nerves, blood vessels, and inflammation. Currently popular theories propose that migraine-specific triggers promote a type of primary brain dysfunction that causes dilation of meningeal blood vessels, inflammation in the meninges (tissue covering the brain), and activation of the adjacent trigeminal nerves which causes the pain and associated symptoms of migraine.
- The American Migraine Study, based on the responses of more than 20,000 people, confirmed that despite high rates of headache-related disability, most people with migraine have never been diagnosed by a doctor or treated with prescription medications.
- In a study of individuals in the United Kingdom and the United States who reported six or more migraine headaches per year, patterns were similar in both countries, with most people treating with over-the-counter (OTC) medications and many choosing not to seek a doctor’s assistance to diagnose:
- patients with migraine who have never consulted a doctor for their headaches (UK 60%, US 68%);
- never received a correct medical diagnosis (UK 64%, US 77%);
- treat only with OTC medication (UK 72%, US 70%).
Migraine Medications – OTC and Rx
- Over 90% of the migraine sufferers in the United States use OTC medications as a part their migraine treatment arsenal, and nearly 60% use OTCs exclusively. Yet, there has been little innovation in the OTC migraine category for many years. In the past six years, a number of ‘new’ OTC medications to treat migraine have appeared, including Motrin Migraine, Advil Migraine and Excedrin Migraine (the first to be approved, January 1998).
- In fact, these drugs are not new at all; they are identical to the original analgesic formulation for regular Motrin, Advil and Extra-strength Excedrin. The FDA is allowing these companies to repackage these old formulations with a claim for the temporary relief of mild to moderate migraine. According to these companies’ studies, these medications worked better than placebo to treat migraine. However, most of these studies systematically excluded patients who are severely disabled by migraine, which could account for up to 40% of migraine-sufferers.
- The most common OTC recommendation request made of pharmacists is for a “headache product” – at the rate of approximately 53,000 times per day in the US. Pharmacists suggest an OTC remedy specifically for “migraine pain” nearly 16,000 times/day.
- Despite the availability of prescription medications designed specifically to treat migraine, there is a consistent preference among migraine sufferers to treat with OTC medications: 57% of migraine headache sufferers report using only OTC medications for treatment, virtually unchanged from 10 years earlier (59%).
- Though most migraine sufferers use OTC medications, given the frequency and associated disability of their migraine attacks, current therapy appears unsatisfactory.
- OTC analgesics are only marginally effective against migraine; in only about 25% of those with moderate to severe headache pain do they exhibit any effect.
- Unfortunately, the OTC medications that many chronic headache sufferers hope will bring them relief may actually trigger more headaches. These headaches, known as analgesic rebound headaches or medication-overuse headaches, are a result of overusing common pain relief medications.
- Of the prescription medications used to treat migraine, the triptan family of drugs are the most commonly prescribed. The biggest selling triptan is Imitrex®, which has consistently exceeded $1 billion in annual sales.
- Triptans are believed to work in part by constricting (narrowing) blood vessels. This effect is thought to relieve migraine pain, which is known to be associated with inflamed (enlarged) vessels in the brain. However, triptans also constrict other arteries, such as the coronary arteries.
- Narrowing of the coronary arteries can put patients at increased risk for heart attacks, and might account for the fact that unpleasant chest-related symptoms such as pressure and pain frequently occur with all triptans.
- Some researchers also suggest that pulmonary vasoconstriction is a possible underlying cause of the triptan-related chest symptoms.
- Unpleasant chest-related symptoms occur with all triptans; up to 41% of patients with migraine who receive sumatriptan experience chest-related symptoms, and these symptoms cause 10% of patients to discontinue triptan use altogether.
- Two-thirds of migraine sufferers delay or avoid taking their current prescription medication because of concerns about adverse effects. This can result in more intense and longer-lasting headaches, the need to rest and cancel social activities, and suboptimal performance.
- Almost 8 of 10 migraine sufferers (79%) showed an interest in trying a novel product with similar efficacy but fewer adverse effects than other prescription migraine medications. Among those migraine sufferers who use prescription products, pain relief and speed of onset were considered important by at least 75% of them.
- Headache specialists have also found that overuse of the prescription headache relief medications (analgesics, barbiturates, ergots, triptans) can also lead to rebound headaches.
- The prevalence of migraine is also increasing in children. Migraine occurs in approximately 5-10% of children, and up to 18% of adolescents.
- The quality of life (QOL) of children with headaches is significantly affected by their health condition. The impact of headaches on QOL is similar to that found for other chronic illness conditions, with impairments in school and emotional functioning being the most prominent The impact on QOL of children with migraine was similar to that of children with arthritis and cancer.
- No prescription migraine medication has been approved for use in children or adolescents.
Sinus Headaches and Migraine
- Many “sinus headaches” are likely migraine. In one recent study, researchers interviewed a group of patients with ‘sinus headaches’ regarding their headache symptoms and treatment experiences. 96% of the people interviewed actually described symptoms consistent with a diagnosis of migraine.
- Other recent research also suggests that migraine and perhaps other headache types are sometimes mistaken for sinus headache. Sinus headache is commonly diagnosed, and patients with headache often cite sinus pain and pressure as a cause of their headaches. Nasal symptoms frequently accompany migraine, and there is a possibility that sinus inflammation can sometimes act as a migraine trigger. Considered in aggregate, the data show that the occurrence of nasal symptoms associated with a headache should neither trigger a diagnosis of sinus disease nor exclude a diagnosis of migraine. It should, in fact, prompt diagnostic consideration of both conditions.
Tension-Headaches and Migraine
- Migraine may be closely related to other types of headaches as well. Researchers recently noted that the similarities between migraine and ‘tension-type’ headaches suggest a ‘convergence model’ for various primary headache types. Symptoms escalate, beginning with a ‘premonitory period,’ progressing into ‘tension-type’ headache and, if uninterrupted, finally into a full-blown migraine. Other headache types, such as ‘sinus headache’ or ‘temporomandibular headache’, may also be explained by this model.
- In another study, 32% patients initially clinically classified as having disabling episodic ‘tension-type’ headache were determined after further review to actually have migraine or migrainous headache. Among study participants, 90% of subjects with disabling headache had a migraine-related disorder.
Migraine – International
- Migraine is a global problem. Differences in diagnosis and clinical practice exist, but the prevalence of migraine in most countries approximates that of the U.S., or about 13% of the adult population.
- Just as in the U.S., migraine is an important public health problem in other countries and is associated with very substantial costs. The international statistics closely mirror the findings of U.S. researchers.
- For example, a recent study in the UK found 7.6% of males and 18.3% of females reporting migraines within the previous year.
- The prevalence of migraine varied with age, rising through early adult life and declining by the early 50s. Attack frequency was typically 1-3 migraines per month, and most migraineurs experienced interference with daily activities in 50% of their attacks.
- On average, an estimated 5.7 working days were lost per year for every migraineur. These results are consistent with those from surveys in other countries.
- If these findings are projected to the entire UK population, approximately 5.85 million people aged 16-65 years experience 190,000 migraine attacks every day in the UK and lose 25 million days from work or school each year because of them.