Migraine diagnosis and treatment: Results from the American Migraine StudyII

Objective.-A population-based survey was conducted in 1999 to describe the patterns of migraine diagnosis and medication use in a representative sampl e of the US population and to compare results with a methodologically ident ical study conducted 10 years earlier. Methods.-A survey mailed to a panel of 20 000 US households identified 3577 individuals with severe headache meeting a case definition for migraine ba sed on the International Headache Society (IHS) criteria. Those with severe headache answered questions regarding physician diagnosis and use of medic ations for headache as well as headache-related disability. Results.-A physician diagnosis of migraine was reported by 48% of survey pa rticipants who met IHS criteria for migraine in 1999, compared with 38% in 1989. A total of 41% of IHS-defined migraineurs used prescription drugs for headaches in 1999, compared with 37% in 1989. The proportion of IHS-define d migraineurs using only over-the-counter medications to treat their headac hes was 57% in 1999, compared with 59% in 1989. In 1999, 37% of diagnosed a nd 21% of undiagnosed migraineurs reported 1 to 2 days of activity restrict ion per episode (P<.001); 38% of diagnosed and 24% of undiagnosed migraineu rs missed at least 1 day of work or school in the previous 3 months (P<.001 ); 57% of diagnosed and 45% of undiagnosed migraineurs experienced at least a 50% reduction in work/school productivity (P<.001). Conclusions.- Diagnosis of migraine has increased over the past decade. Non etheless, approximately half of migraineurs remain undiagnosed, and the inc reased rates of diagnosis of migraine have been accompanied by only a modes t increase in the proportion using prescription medicines. Migraine continu es to cause significant disability whether or not there has been a physicia n diagnosis. Given the availability of effective treatments, public health initiatives to improve patterns of care are warranted.