'Aggressive treatment' key to new strategy for fighting migraines

April 24, 2000
Web posted at: 5:19 p.m. EST (2119 GMT)

From staff reports

ATLANTA (CNN) -- The American Academy of Neurology announced Monday a new strategy for diagnosing, treating and preventing migraine headaches. It emphasizes closer communication between doctor and patient, a systematic search for medications and devising an individual plan for each migraine sufferer.

These and other components constitute "aggressive treatment," as recommended in the latest issue of Neurology, the academy’s peer-reviewed scientific journal.

In the United States, "an estimated 18 percent of women and 6 percent of men have migraines," reported Dr. Stephen D. Silberstein of Philadelphia and Dr. Jay Rosenberg of La Jolla, California.

But, they added, about 50 percent of migraine sufferers never see a doctor for treatment.

"Patients experience headache more than any other type of pain. Headache accounts for over 10 million physician visits annually," the researchers wrote. But "relatively few headache sufferers receive appropriate diagnosis and adequate care."

Presenting recommendations from the U.S. Headache Consortium, Silberstein and Rosenberg underscored the importance of the primary-care physician or neurologist taking a thorough history of the patient’s experiences with headache, noting durations and apparent causes.

After a physical exam, the patient should work with the doctor to find medications -- both over-the-counter and prescription -- that seem best to prevent migraines or reduce disability. By using the report’s grid chart, displaying expected benefits and common negative reactions for each drug, doctor and patient can experiment. Guided by the outcome of treatments used by other physicians and patients, they can find the best treatment, wrote Silberstein and Rosenberg.

"Migraine sufferers are often the most dissatisfied patients," the veteran headache researchers reported. "Half of those who consult stop seeking medical care for the headaches. Only 28 percent of sufferers are very satisfied with their usual treatment."

Satisfaction would increase if doctors produced an individual plan of treatment for each patient, especially if the patient participated in the plan’s development, suggested Silberstein and Rosenberg.

They also noted that migraines have "major implications for the patient’s job and for his or her family and social life. Migraine sufferers experience significant disability, lost work days and diminished quality of life, accounting for more than $13 billion a year in missed work days."

The recommendations were drafted by participants in the U.S. Headache Consortium, an association of the American Academy of Neurology, the American College of Emergency Physicians, the Academy of Family Physicians, the American Headache Society, the American Osteopathic Association and other organizations.

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American Academy of Neurology
Migraine Resource Center
Journal of the American Medical Association Migraine Information Center

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