Headache-related disability in the management of migraine

Existing barriers to successful migraine care. Migraine is a common neurologic disorder that affects 11% or more of the adult population.1 The past decade has seen huge advances in our understanding of the epidemiology and underlying mechanisms of migraine.2 Several effective new acute and preventive therapies have been introduced. Unfortunately, clinical treatment has not kept pace with scientific advances: Migraine remains relatively under-recognized, under-diagnosed and under-treated.3 Migraine is a heterogeneous condition that results in a spectrum of disability within and among different individuals.4 Disability from migraine can be measured as time lost from paid work, household work, school, and family, and from social and leisure activities. Unlike the long-term disability of stroke or multiple sclerosis, migraine-associated disability can be relieved by successful treatment of the headache. However, during an attack migraine-related disability can be severe and imposes a considerable aggregate burden on the sufferer and on society. Although severely affected sufferers tend to receive more medical care than those less affected,5 over half of all migraine sufferers deny having received a migraine diagnosis from a physician,5-7⇓⇓ and of those patients who receive an accurate diagnosis, many do not receive suitable therapy.8 Most migraine sufferers rely on over-the-counter medications to the exclusion of prescription …