Frequency and profile of migraine patients seen by general practioners.

The prevalence of migraine in France is estimated at 12% of the general adu lt population. Earlier studies have shown, however, that many migraine pati ents do not receive regular follow-up for their condition and resort to sel f-medication. A study was conducted to evaluate the proportion of patients seen by general practitioners who have unidentified migraine and to compare clinical profiles in patients with identified migraine (IM), unidentified migraine (UM), and nonmigraine headaches (NMH). A random sample of general practitioners (GPs) participated in the study. For each GP, an investigator collected data corresponding to an entire, day,of patient visits at the GP 's office. GPs asked all adults (18-65 years) seen during the study day to complete an individual questionnaire. Also, GPs completed a visit diagnosis and comorbidity form for each of these adults. Migraine was identified usi ng the diagnostic algorithm developed by Michel et al, (1993) based on IHS (International Headache Society) criteria. A total of 175 GPs distributed t hroughout France recruited 2 353 patients. The prevalence of migraine was 1 4.9% (8% in males and 19% in females); 6.3% of patients had IM and 8.6% UM. The prevalence of NMH was 62.8%; 14.1% of patients were given a diagnosis of migraine although they failed to meet IHS criteria. Pain severity was gr eater in IM than in UM patients (P<0.001). Nausea and/or vomiting were repo rted by 73% of IM patients versus 43% of UM patients (P<0.001). The impact on everyday activities and the frequency of attacks were also greater in IM than in UM patients. The reason for the GP visit was more likely to be mig raine in the IM patients (70%) than in the UM patients (29%) (P<0.001). For ty-six per cent of all migraine patients (IM + UM) had already seen a physi cian for their headaches, versus only 25% of NMH patients (P<0.001). Among IM patients, 48 % reported use of several medications for their headaches, versus only 25 % of UM patients (P = 0.002) and 19 % of NMH patients (p<0.0 01 versus all migraine patients). Self-medication was more common in UM tha n in IM patients (P<0.001). Headache severity was greater in IM than in UM patients (P<0.001) and was also greater in all migraine patients (IM + UM) than in NMH patients (P<0.001). These data show that migraine is common amo ng GP patients and remains underdiagnosed. Pain severity in UM patients is less than in IM patients but considerably greater than in NMH patients. Mig raine should be screened for and treated more effectively.