Migraine is a particularly agonizing condition, much more than a simple headache, affecting 5% to 12% of the population. However, the condition is not diagnosed in many patients, forcing them to undergo severe pain for years on end. One of the causes for this widespread under-diagnosis is the lack of knowledge of the features that distinguish a migraine from a non-migraine headache.
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A new study found that both people with and those without migraine history showed an incomplete knowledge of the condition, though the former had significantly more. Migraine treatment with prescription pain relievers was self-assessed as very effective in most cases. Among those who did not use medication, about 20% said they had no idea that it was available.
Both patients and physicians are implicated in this failure. Patients do not know how to detail their symptoms precisely to let the physician identify the differentiating features. On the other hand, physicians are not alert or informed enough to enquire about these symptoms. Since a migraine typically requires specific treatment, failure to distinguish it from other headaches leads to failure of treatment. The study aimed at exploring how much people knew about migraines outside the health profession. This would help increase the rate of migraine diagnosis and therefore of treatment.
How the study was done
The study, published in the journal SN Comprehensive Clinical Medicine, was carried out on a sample of 226 university students, who were assumed to be highly educated, among the upper crust in terms of literacy. This means that knowledge gaps present here will be only more pronounced in less literate population groups. The group was administered a three-part survey: first to characterize the demographic profile; the second part to examine their knowledge of migraine; and the third exploring the responder’s personal knowledge of migraine and its treatment from experience, if any.
Among these students, about 26% had a definite history of migraine, with another 40% being unsure whether their headache was a migraine. Across all groups, including those with migraines, 20% or more responded wrongly indicating that they did not know migraine had distinct symptoms from other headaches. In those who were not sure, the percentage went up to 32%. Only about 60% of non-migraine participants knew that migraine is typically confined to one side of the head in contrast to other headaches. Other symptoms had a higher degree of accuracy. The greatest knowledge gap related to the aura preceding a migraine, which was known to over 90% of migraineurs but only 65% of the not-sure group.
Increasing severity with routine activity and the duration of the headache appeared to be relatively unknown characteristics among non-migraineurs.
With respect to the personal experience of migraines and their treatment, about 37% of migraineurs had received a diagnosis from a healthcare professional, but no non-migraineurs did. Greater pain and disability occurred among migraineurs compared to the not-sure group, but with marked differences in the responses between individual migraineurs. However, all three groups knew that effective short-term treatment was available for migraines (about 80% in migraineurs and 95% in the not-sure group), and for migraine prevention (80% of migraineurs and 85% of non-migraineurs). Not quite so many knew about the dangers of overusing migraine medication.
Dr Stephanie Goodhew: “I have had migraines my whole life, but I only received a diagnosis in my twenties.”
About 90% in both groups knew that OTC medication was available for migraine, but only half of migraineurs used such drugs, and one-third of the not-sure group. About 60% and 70% found them moderately effective. However, the most stated reason to not use them was the feeling that the headache was not intense enough to need the medication in both groups (over 70% of the not-sure group cited this reason vs 36% of migraineurs), followed by the lack of relief with the drug.
Prescription drugs to treat migraine were used by only a fifth of migraineurs but almost half of them rated these as extremely effective. In the not-sure group, only one in ten used them and about three-fourth rated them moderately effective. A fifth of migraineurs who did not use them said they did not know they were available.
Only 12% of migraineurs used preventive prescription drugs. Among the rest, 17% did not know effective preventive medication was available. 43% of users rated them moderately effective. Most commonly, they were not used because the headache was not felt to be intense enough.
The lessons learned from this study are many. For one, even the migraineurs, who knew the most about their condition and its treatment, fell short in their knowledge of migraine in many areas. One in five of them did not know that migraine symptoms significantly differ from those of a headache. Many did not know migraine is one-sided and worsens with routine physical activity. One in five also did not know that overuse of migraine medication is potentially dangerous.
Also, prescription medications achieved high efficacy in migraineurs, yet one in five were not aware of such a possibility. Only 12% used these medications. Most migraineurs preferred not to use these drugs, despite knowing about them. This study points to the need for more effective education of the general population about migraine and related issue, to avoid unnecessary suffering and loss of productivity. Researcher Stephanie Goodhew says, “This research shows people suffering from migraines often have incomplete or insufficient information about their own condition. If we can allow people to have greater knowledge about migraine they can advocate for the right level of care.”
Migraine literacy and treatment in a university sample. Stephanie C. Goodhew. Clinical Medicine (2019). 13 August 2019. DOI https://doi.org/10.1007/s42399-019-00124-y. https://link.springer.com/article/10.1007/s42399-019-00124-y