Assessment and Treatment of the Burden of Migraine

Abstract

Migraine can take a significant toll on many aspects of sufferers' lives, including occupational, academic, social, and personal functioning. Individuals with migraine experience substantial pain and disability during migraine headaches (the ictal period), and many experience functional impairment and emotional consequences between attacks (the interictal period). The majority of migraine sufferers spend most of their lives in this interictal period; therefore, it is of great importance. Treatment planning must take into account both the ictal and interictal burden. Several tools have been developed to measure the burden of migraine and to assist health care professionals in making management decisions. The Migraine Disability Assessment Scale focuses exclusively on ictal burden. The Migraine Interictal Burden Scale complements the Migraine Disability Assessment Scale by measuring interictal burden. The Migraine Prevention Questionnaire was developed based on clinical guidelines to identify patients who are appropriate candidates for preventive pharmacotherapy for migraine. This article presents 4 cases selected to exemplify the ictal and interictal burden of migraine and the benefits of effective treatment. For each patient, individualized treatment strategies were developed using acute and preventive pharmacotherapy, as well as biobehavioral treatments. Migraine preventive medication and/or biobehavioral intervention may substantially improve patient health-related quality of life by reducing the frequency of migraines and the emotional and lifestyle burden produced by interictal anxiety.