Migraine by the Numbers
An estimated 28 million Americans, or 12 percent of the U.S. population, suffer from migraines. Adult women are roughly three times more likely to suffer from migraine than men; one in five women experience migraine headaches versus one in 20 men. The condition occurs most commonly between the ages of 15 to 55, and migraine occurrence seems to diminish with age; adults age 18 to 44 were nearly three times as likely to report suffering a migraine or severe headache over the past three months than adults age 65 or older.
Migraine is also an expensive disease. A 2006 survey found that migraines cost American health care and business a staggering $24 billion each year. This includes direct medical expenditures for migraine care (i.e., prescription drugs, emergency room care, and inpatient and outpatient treatment) of over $12 billion.
In addition, American employers lose another $12 billion each year from employee absences, short-term disability insurance, and workers' compensation claims — and that doesn't include costs for lost productivity of employees who go to work during a migraine episode.
That cost may be exacerbated by the fact that many people living with migraine do not have adequate prescription drug insurance coverage. In a study of patients who used prescription triptan medication for migraine relief, 42 percent of those surveyed said that their insurance did not cover enough monthly medication to treat their migraine, and 37 percent had not filled a triptan prescription because of the out-of-pocket cost.
During a migraine attack, men and women spend 4.5 hours and 6 hours confined to bed, respectively. Over the course of a year, that translates to about 3.8 bedridden days for men and 5.6 bedridden days for women, and over 112 million bedridden days for the total American migraine population.
The American Migraine Prevalence and Prevention Study (AMPP), a large-scale, population-based epidemiological study of migraine and migraine prevention commissioned by the National Headache Foundation, found that only an estimated 48 percent of people with migraine symptoms receive the correct diagnosis. Among women, the percentage may be even lower.
The stereotypes and stigmas associated with migraine may prevent women from seeking help. Historically, headache pain has often been discounted as a legitimate medical condition. Patients may dismiss migraine symptoms as “just a headache” and fail to seek help. The fact that migraine often coexists with mood disorders like depression and anxiety may also contribute to this problem.
Migraineurs may hesitate to seek help because of the fear that they'll be considered psychologically unstable or not taken seriously. Research shows, however, that migraine is clearly not a psychiatric or psychological condition — it is a biological brain disorder.
Some of the fault for the high underdiagnosis rate of migraine lies with the health care provider. Primary care physicians may not be knowledgeable in the diagnosis and treatment of the condition or familiar with the criteria. According to one study, less than half of internal medicine residents and 62 percent of family practice residents consider themselves prepared to treat patients with headache.
Many undiagnosed migraineurs are actually misdiagnosed with other types of headache. One study found that sinus headache was the clinical diagnosis given in 42 percent of migraine cases, and tension headache was the diagnosis in 32 percent of migraine cases. A patient's assertion that they believe they have sinus or tension headaches seemed to be a strong factor in misdiagnosis by doctors.
A 2006 study of adult migraineurs published in the journal Headache found that African American patients studied were less likely to receive a migraine diagnosis and/or treatment than their Caucasian counterparts. They were also less likely to seek out professional care for head pain and reported lower levels of trust in doctors.
Migraine also seems to be undertreated, with more than half of migraine sufferers relying on over-the-counter pain relievers or simply toughing it out with no drugs at all to treat their migraine headache.
Over 40 percent have never used preventative therapies such as propranolol (Inderal), topiramate (Topamax), and divalproex sodium (Depakote) to treat a migraine attack, although these drugs have been proven to significantly decrease migraine occurrence, severity, and duration. And an estimated 60 percent use over-the-counter treatments only to ease the pain of migraine. Overuse of some OTC treatments can result in rebound headaches, resulting in a constant cycle of headache pain (for more on rebound headaches, see page 98).
With such effective treatments available to ease this debilitating condition, why do so many people continue to suffer the pain and poor quality of life associated with migraine? Sometimes, migraineurs who have had a bad previous experience with a doctor or course of drugs will attempt to self-treat the condition. The patient may discontinue a medication due to side effects, unaware that dosage adjustments or other medications are an option. Or, the patient and doctor may not be up-to-date on the available therapies. Understanding the nature of your condition and the choices available to you are key to getting the best possible care.