Scooped: American Migraine Study II
abstract & commentary
Source: National Headache Foundation Expedited Press Release, March 2000.
A new american study (ams ii) by the national headache Foundation (underwritten by a grant from Glaxo Wellcome Inc.) was undertaken to measure the prevalence of migraine and the effect this chronic illness has on the daily lives of patients. The study was designed to replicate the seminal 1989 American Migraine Study I (Stewart WF, et al. JAMA 1992;267:64-69) and compare fundamental changes in patient management over the past 10 years in light of significant scientific breakthroughs and the emergence of the triptan class of medications.
A 20-item symptom screening and impact questionnaire following International Headache Society (IHS) guidelines was mailed to 20,000 U.S. households in 1999. Approximately 13,869 completed questionnaires were returned (69.3% response rate) and included data from 29,258 individuals aged 12 and older. The study identified 12.6% (compared to 12.1% in 1989) of the population, or an estimated 28 million Americans (compared to an estimated 24 million in 1989), suffering from migraine.
Other key findings include:
• 48% of respondents who met IHS criteria for migraine still report never having their condition diagnosed by a physician (compared to 65% undiagnosed in 1989).
• 57% of migraine sufferers reported using only over-the-counter medications for treatment, virtually the same as 59% 10 years ago.
• 80% of respondents reported their headaches as severe, including 24% who sought care at an emergency room.
• 51% of sufferers report a 50% or more reduction in work and/or school productivity; 66% report a 50% or more reduction in household work.
Commentary
The AMS II confirms the high prevalence and significant morbidity associated with migraine. It is striking to note the similarities in findings with the original Stewart et al study (AMS I). Over the past 10 years, diagnosis and treatment of migraine has not progressed despite the revolution in migraine treatment as initially promised by the new triptan class of drugs. Migraine as a legitimate medical condition has not even gained in appreciation despite major scientific breakthroughs in migraine research using positron emission tomography (PET) and fMRI to identify dynamic blood flow changes in the cortex of migraine sufferers, as well as genetic studies localizing the subgroup of autosomal dominant familial hemiplegic migraine patients to chromosomes 1 and 19.
As the current survey reconfirms, migraine patients suffer major disability ranking among the lowest by any number of quality-of-life parameters. The chief problem has been a lack of education and understanding on the part of both patients and physicians. Neurologists must take the lead to ensure progress in overall migraine care and provide relief to this often neglected group of patients. —jr
Nearly half the respondents to the survey in the AMS II study report never having their migraines diagnosed by a physician.
a. True
b. False
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