FREQUENCY OF SEVERE ATTACKS IN MIGRAINE SUFFERERS OF THE GAZEL COHORT

The concept of severe migraine was raised to define migraineurs most i n need of care and for use in clinical practice. We aimed to measure t he frequency of severe attacks in a working sample of 276 migraine suf ferers using a diary over a 3-month period. Migraine sufferers recorde d each attack's clinical features, the degree of their disability, the ir use of drugs and the effectiveness of the drugs. Since the definiti on of severe attack is not standardized, we studied the impact of diff erent definitions on the frequency. The frequency of severe attacks wa s 0.9% and appeared to be very sensitive to the definitions, ranging b etween 0.4 and 13%. In France, the extrapolated number of severe attac ks is nearly one million out of a total of 115 million. In the migrain eurs who had had at least one severe attack, the individual variabilit y of intensity, duration or disability was very high, so the proportio n of severe attacks in a given sufferer was low-between 15% and 50%. W e conclude that the global concept of severe migraine is not relevant and should be split into two components-severe attack and severe migra ine sufferer. The goals are different, too. Regarding treatment, for e xample, the severe attack concept is more valid for acute treatment st rategies, whereas the severe migraine sufferer concept should be prefe rred to determine the need for prophylactic treatment. Since much work is being done nowadays to define acute treatment strategies, definiti on of the criteria of severe attack and validation of a measurement to ol should be a priority.