The Social Stigma of Migraine Is as Great as That of Epilepsy or Panic Disorder and Greater Than That of Asthma
In addition to the clinical features of the syndrome, individuals with migraine also must cope with the stigma of having the disorder, often at the hands of friends, family, and coworkers, according to a new study.
Researchers at the University of Vermont and the University of British Columbia surveyed 765 Americans using the crowdsourcing website Mechanical Turk to assess attitudes toward several episodic medical conditions, including migraine, epilepsy, panic disorder, and asthma.
Subjects were randomly assigned to assess a fictional vignette of one of four conditions; each condition described an individual with attacks of migraine, epilepsy, panic disorder, or asthma occurring nearly every week. Respondents were then presented with the Attitudes towards Mental Illness Questionnaire (AMIQ), a well-validated tool to assess stigma. The maximum potential score on the AMIQ is 500; higher scores indicate greater stigmatizing attitudes. In addition to demographic data, subjects were also asked if they had ever had an episode of the relevant disorder, if they had ever been diagnosed with the relevant disorder, and if they had a family member or close friend diagnosed with the relevant disorder.
The lowest AMIQ score in this survey was obtained when the individual in the vignette was described as having asthma (250.1). The AMIQ scores for the other vignettes were significantly higher than that for asthma, but not significantly different from each other: migraine (266.5), panic (267.7), and epilepsy (262.3).
“As if the pain of migraine weren’t disabling enough, it also comes with a stigma that often renders it invisible at home and in the workplace,” said lead author Robert E. Shapiro, MD, PhD, Professor of Neurological Sciences at the University of Vermont College of Medicine. “Many people believe that the mild and tolerable headaches they experience are the same as migraine, and tend to discount the disabling impact that migraine has on the quality of life of those who have these attacks.”
Suboptimal Treatment of Episodic Migraine Increases Risk of Progression to Chronic Migraine
Individuals with episodic migraine may progress to chronic migraine at higher rates without optimal treatment, according to recent epidemiologic research.
Using data from the American Migraine Prevalence and Prevention (AMPP) Study, Richard B. Lipton, MD, and colleagues at Montefiore Medical Center and Albert Einstein College of Medicine in New York City and Vedanta Research in Chapel Hill, North Carolina, found that patients receiving maximally optimized treatment were more than three times less likely to progress to chronic migraine than were those with poorly optimized treatment.
Study participants with episodic migraine in 2006 who completed the Migraine Treatment Optimization Questionnaire (mTOQ-4) and provided outcome data in 2007 were eligible for the analyses. The mTOQ-4 assesses the frequency of four acute response outcomes: pain free at two hours, sustained pain free at 24 hours, perceived ability to plan daily activities, and perceived control of migraine. Response options include never (0), rarely (0), less than half the time (1), and half the time or more (2). Sum scores ranged from 0 to 8 and were divided into four categories: very poor optimization (0), poor optimization (1 to 5), moderate optimization (6 or 7), and maximal optimization (8). Episodic migraine was defined according to ICHD-2 criteria as 15 or fewer headache days per month on average; chronic migraine was defined as more than 15 headache days per month.
“Of 4,625 eligible subjects with episodic migraine, 48% had very poor or poor treatment optimization,” said Dr. Lipton, lead author of the study. “We found that people in those groups had three times the risk of progression to chronic migraine.”
“We have seen in the AMPP Study that those with episodic migraine have certain risk factors, such as headache frequency, medication use, and depression, that are associated with increased risk of chronic migraine,” Dr. Lipton said. “This observational study chart shows that as treatment is increasingly optimized, the risk of progression from one year to the next declines.”
Study coauthor Dawn C. Buse, PhD, noted, “These findings are exciting, as they provide clinical targets for intervention. When we discover factors that increase the risk of progression, health care providers can focus their efforts in those areas to improve care and outcomes. In this case, we have found several factors in acute migraine treatment that may likely improve outcomes, including using medications that work quickly and maintain pain-free results, which allows and empowers people who live with migraine the freedom and confidence to make plans and fully engage in their lives.”