Migraine Sufferers Need More Intervention

Millions of Americans suffer needless migraine pain, headache experts say.

The calculation comes from an all-star team of headache specialists led by Stephen D. Silberstein, director of the headache center at Philadelphia's Thomas Jefferson University. Silberstein presented the findings at this week's meeting of the American Headache Society.

Silberstein's team conducted a large mail survey, asking a national sample of 120,000 U.S. households about their families' headache pain. Nearly 78,000 households responded to this American Migraine Prevalence and Prevention survey.

The main result: 12 percent of Americans report headache symptoms that qualify as migraine headaches. More than half of them, Silberstein says, have frequent enough migraines to qualify for migraine-preventing medicines. Yet relatively few use these drugs.

"There is an immense degree of unnecessary suffering in the U.S.," Silberstein said in a telephone news conference. "One of the best ways to prevent a migraine headache is to stop it before it starts -- to give medicines that stop the attack. But only one in 10 take these medicines. We think eight times that many can benefit."

Read Web MD's "Get the Facts about Migraines."

Lots of Headaches

The survey indicates that 11.5 million Americans aged 12 and older get migraines at least once a week. That's often enough to benefit from preventive treatment, Silberstein says.

Based on the survey results, some 7.7 million Americans have such frequent and severe headaches that they often miss work or school. Doctors definitely should offer preventive treatment to these patients, Silberstein says.

Headaches regularly disrupt the lives of another 3.8 million Americans, the survey shows. Silberstein recommends that these people, too, should consider preventive treatment.

"In the U.S., migraines are still underdiagnosed and undertreated," Silberstein says. "Most patients with migraine need preventive medicine."

Read Web MD's "Prevention: The Future of Migraine Therapy."

Migraine Front Line: Primary Care Doctors

Most people with migraines first see their primary care doctor. Some of them see general practitioner David Propp, MD, assistant professor of medicine at Emory University in Atlanta, and medical director of primary care Emory Clinic.

Propp says primary care doctors rely on guidance from headache experts such as Silberstein. But he wonders how many of the patients in Silberstein's survey were offered migraine prevention, but chose not to take it.

"It is hard to know whether these patients who meet the criteria for migraine prevention already had that discussion with their doctors," Propp tells WebMD. "Maybe some of them decided not to try those things -- or maybe they tried them and didn't like them. Some of those medicines have side effects. It is a risk/benefit trade-off."

In his experience, Propp says, some patients love being able to ward off migraine attacks by taking a daily medication. Other, he says, do not want to do this.

"You have to individualize the care of migraine patients," Propp says. "We often try some of the common preventive agents. If they work, fine. If they don't work, or if we are having problems or something seems wrong, we do refer the patient to a specialist for help."

Read Web MD's "Surgery for Migraines Looks Promising."

Read Web MD's "Herbal Extract May Help Prevent Migraines."

By Daniel DeNoon, reviewed by Brunilda Nazario, MD

SOURCES: Silberstein, S. Presentation abstract, American Headache Society 47th Annual Scientific Meeting , Philadelphia, June 23-26, 2005. American Headache Society news conference with Stephen D. Silberstein, director, headache center, Thomas Jefferson University. David Propp, MD, assistant professor of medicine, Emory University, Atlanta.