What's New in Medicine

The most recent data released from the American Migraine Prevalence and Prevention Study has continued to focus on the effects of social economic status, depression, disability, BMI (weight) and emergency department use. The reports confirm that the overall prevalence of migraine in the United States population remains roughly 12%. This is consistent with two earlier large U.S. population based epidemiologic studies.

The most recent study as reported by Drs. Lipton and Bigal continue to shed light on the strong influence of the genetics of migraine as demonstrated by the biological predisposition, proving to be a stronger risk factor than the social economic status of an individual. It still must be commented on that the social economic status does have an influence and presently the findings support that the stresses related to a lower social economic status serves as a risk factor for migraine.

Many studies have documented the relationship between migraine and depression, but there also seems to be a relationship with BMI(weight), thus this complex of variables interplays as risk factors for the development and progression of migraine. It has been shown that patients either morbid obesity or under weight report a greater percentage of disability.

In the general population, roughly 6-8% develop depression. The prevalence although for headache patient is higher, roughly 18% for people with a history of migraine, over 30% with patients with a history of transform or chronic migraine, and about 13% for patients with history of tension type headache. Dr. Lipton’s study continues to support the evidence that the existence of depression increases the probability of migraine and vice versa.

Dr. Lipton’s study evaluating the general population as it relates to headache and visiting the emergency room reported some interesting findings. Surprisingly the vast amount of patients, over 94% who suffer from severe migraines did not use the emergency room over the previous 12 months evaluated, and 97% of those with severe tension type headache also had not used the emergency room in the past year, and 87% of those with chronic headache had not visited the emergency room. Various reasons have been postulated for the individuals who did use the emergency room; anywhere from increased severity to lack of the ability to obtain medical care other than through the emergency room. Clearly further study needs to take place with regard to the relationship of the use of the emergency room and the patient’s suffering from severe headaches. The study goes on to comment on the fact that the emergency room and even sometimes urgent care centers may not be the best place for a patient with severe headache; although clearly when there are concerns for secondary headache disorder such as meningitis it is imperative that patients seek appropriate care.

This study is important because it addresses the population at large and gives us insight into the underpinnings of headache and its influence on the population. Headache is the fifth most common complaint seen in the emergency rooms in the United States mirroring the fact that this is such a common disorder experienced by our population. This is an ongoing study that will improve our understanding of how migraine, and headaches in general, influences the population.

References:

Lipton RB, Bigal ME, et al. The American Migraine Prevalence and Prevention Study. Neurology Reviews. 2007; 15 (8):13-14.

Lipton RB, Bigal ME, Diamond M, et al Migraine Prevalence, Disease Burden, and Need for Preventive Therapy. Neurology. 2007; 68 [5]: 343-349.

Lipton RB, Diamond S, Reed M, et al. Migraine Diagnosis and Treatment: Results from the American Migraine Study 2 Headache. 2001; 41 [7]: 638-645.

Silverstein S, Lipton E, Diamond S, et al. Probable Migraine in the United States: Results of the American Migraine and Prevalence [AMPP] Study. Cephalalgia. 2007; 27 [3]: 220-234.

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