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Migraine Prevalence and Disease Burden

A massive epidemiologic study confirms previous seminal findings, but questions remain about who needs preventive therapy.

The American Migraine Prevalence and Prevention study was a massive population-based epidemiologic study of migraine prevalence, disease burden, and need for preventive daily medication. A random sample of 77,879 U.S. households responded to a mailed survey asking about migraine symptoms in any household members. An expert consensus panel determined when, on the basis of days with migraine symptoms, preventive medication should be offered to patients (6 headache days/month, 4 headache days with impairment, or 3 headache days with severe impairment), should be considered (4–5 migraine days/month with normal functioning, 3 migraine days with impairment, or 2 migraine days with severe impairment), or is not indicated (<4 headache days/month and no impairment, or 1 headache day/month).

Since the previous major survey in 2001, U.S. migraine prevalence was unchanged: 1-year female prevalence was 17.1% and male prevalence, 5.6%. Prevalence was higher in whites than blacks. There was a striking inverse relation between family income and migraine prevalence. Most respondents with migraine had 1 to 4 attacks per month, and >50% had severe impairment during headaches. Using the consensus criteria, 38.8% of respondents were "candidates for or should be considered for preventative treatment."

Comment: These findings confirm that migraine prevalence has been stable in the U.S. The results should be used in planning public policy and embraced, as the authors of an editorial suggest. The prevention criteria were intended for "research and not [for] clinical management . . . [and are] admittedly somewhat arbitrary . . . Patients in the ‘offer prevention’ group . . . might be well-managed by modifying acute treatment." Therefore, take these recommendations with a grain of salt. Katsarava and colleagues followed patients with episodic migraine for 1 year and found an odds ratio of 6.2 for developing chronic daily headache for patients starting off the year with 6 to 9 headache days per month compared to those with 0 to 4 headache days per month (Neurology 2004; 62:788). Patients with 10 to 14 headache days per month were in a critical state (OR, 20.1 compared to the low-frequency group); these patients would unequivocally be in an "offer prevention" group.

— Stewart J. Tepper, MD

Dr. Tepper is Director, The New England Center for Headache, Stamford, CT, and Associate Clinical Professor of Neurology, Yale University School of Medicine, New Haven, CT.

Published in Journal Watch Neurology April 10, 2007

Citation(s):

Lipton RB et al on behalf of the AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007 Jan 30; 68:343-9.

• Original article (Subscription may be required)
• Medline abstract (Free)

Henry KA and Vargas BB. Migraine: Not just your mother’s headache anymore. Neurology 2007 Jan 30; 68:319.

• Original article (Subscription may be required)