Assessing and Managing All Aspects of Migraine: Migraine Attacks, Migraine-Related Functional Impairment, Common Comorbidities, and Quality of Life

Abstract

Migraine can be characterized as a chronic disorder with episodic attacks and the potential for progression to chronic migraine. We conducted a PubMed literature search (January 1, 1970 through May 31, 2008) for studies on the impact of migraine, including disability, health-related quality of life (HRQoL), comorbidities, and instruments used by health care professionals to treat patients with migraine. Numerous studies have shown that migraine substantially impairs a person's functions during attacks and diminishes HRQoL during and between attacks. Despite its impact, migraine remains underestimated, underdiagnosed, and undertreated. Several tools are available to help physicians assess the impact of migraine on the daily activities and HRQoL of their patients, such as the 36-Item Short-Form Health Survey and the Headache Impact Test. Improving communication during the office visit through active listening, use of open-ended questions, and use of the "ask-tell-ask" strategy can also help in assessing migraine-related impairment. Together, these tools and communication techniques can lead to a more complete assessment of how migraine affects patients' lives and can aid in the development of the optimal treatment plan for each patient. Both pharmacotherapy (acute and preventive treatment strategies) and nonpharmacological therapies play important roles in the management of migraine.

Errors in Recognition and Management are Still Frequent in Patients with Cluster Headache

“…Teaching on primary headaches should be improved, though not only quantitatively increasing the passive time devoted to these entities in the lecture rooms, but also qualitatively educating doctors in active strategies, which have been shown to improve medical communication [28]. In primary headaches, where diagnosis is based on reported symptoms and where treatment success largely depends on patient compliance, these strategies have demonstrated to improve diagnosis and patient satisfaction without adding time to the medical visit [29].…”

Migraine management: How do the adult and paediatric migraines differ?

“…The usual age of onset is 12 to 17 years of age for females and 5 to 11 years for males with incidence of migraine with aura cresting earlier in this range for both. In the American Migraine Study II, 92% of women and 89% of men with migraine reported some headache-related disability, and 53% were severely disabled or needed bed rest during an attack (Buse et al, 2009). Number of neurologic and psychiatric disorders, including epilepsy, stroke, major depression and anxiety disorder, show increased co-morbidity with migraine.…”

Chronic migraine: comorbidities, risk factors, and rehabilitation

“…Therefore, special attention should be paid to both control and reduction of risk factors which might favor the chronicization process and/or the outbreak of MOH [40,41]. Among the risk factors for chronicization are non-changeable agents such as demography, age, and socio-economic status, as well as changeable factors, such as obesity and a specific psychological pattern (Table 1).…”