PHILADELPHIA – Millions of U.S. patients who could benefit from migraine prophylaxis are not being offered this treatment by their doctors, Stephen Silberstein, M.D., said at the annual meeting of the American Headache Society.
Based on the results of the American Migraine Prevalence and Prevention (AMPP) study, Dr. Silberstein estimated that 7.7 million U.S. patients (3% of the population) should be offered preventive treatment for migraines and another 3.8 million (1.5% of population) should consider preventive treatment.
The study found, however, that of those candidates, only about 1 in 10 was actually receiving migraine prophylaxis.
The AMPP study was based on a survey mailed to 120,000 households selected to be representative of the U.S. population with respect to gender, age, and census region.
Surveys were returned from 77,879 households (a 65% response rate), yielding data for 162,576 household members aged 12 years or older. The study was funded by an educational grant from Ortho-McNeil Neurologics.
Using the ICHD-2 (International Classification of Headache Disorders updated in 2003) criteria, the researchers determined the overall prevalence of migraine in the United States to be around 12%, with a prevalence of 5%–6% in men and 17%–18% in women.
These numbers confirmed the findings of early surveys conducted in 1989 and 1999, said Dr. Silberstein, who is director of the headache center at Thomas Jefferson University Hospital in Philadelphia.
None of the earlier surveys, however, looked at candidates for prophylaxis.
To do this, Dr. Silberstein and his colleagues used data from the AMPP study to determine the severity and frequency of survey responders' migraine attacks.
Based on expert consensus, they then identified two groups for whom they said prophylaxis should be considered:
▸ Those who reported 6+ migraine days per month; or 4+ migraine days with at least some impairment; or 3+ migraine days with severe impairment or requiring bed rest.
▸ Those who reported 4–5 migraine days per month with normal functioning; 3 migraine days with some impairment; or 2 migraine days with some or greater impairment.
They found that of all the migraine sufferers identified through the survey, 26% fell into the first group and 13% fell into the second. They then extrapolated the data to the general population.
“These results clearly show that not only is migraine underdiagnosed, but when it's diagnosed, it's undertreated,” Dr. Silberstein told this newspaper.
“Doctors need to be aware that migraine is more than an individual attack,” he said. “When it becomes more frequent and disabling, it needs to be prevented,” he said.
He also stressed the need for more dialogue between doctors and patients regarding preventive treatment, and the importance of exploring the wide range of preventive strategies available.
Depending on the possible causes of the migraines, they might be prevented using medications, biofeedback, discontinuation of medications, or other strategies. “Preventive treatment includes everything we do,” he said.