American Migraine Prevalence And Prevention Research Articles

Economic Burden of Transformed Migraine: Results From the American Migraine Prevalence and Prevention (AMPP) Study

To evaluate the impact of incident transformed migraine on health care resource utilization, medication use, and productivity loss. In addition, the study estimates the total direct and indirect costs associated with transformed migraine. Emerging evidence indicates that migraine may be a chronic progressive disorder characterized by escalating frequency of headache attacks, often termed transformed migraine. Little is known about the economic impact of transformed migraine. AMPP is a 5-year, national, longitudinal survey study of headache in the US. The study utilized data from the 2006 follow-up survey based on an initial sample of 14,544 adults identified as having migraine in either the 2004 screening or 2005 baseline survey. A diagnosis of migraine was assigned based on criteria proposed by the International Classification of Headache Disorders, 2nd Edition. Participants completed self-administered, validated questionnaires on headache features, frequency, impairment, resource use, medication use, and productivity loss. Direct and indirect headache-related costs were estimated using unit cost assumptions from the PharMetrics Patient-Centric database, wholesale acquisition costs (Red Book), and wage data from the US Bureau of Labor Statistics. Those who developed transformed migraine were compared with those who did not develop transformed migraine in the 1-2 year interval between screening/baseline and follow-up. A total of 7796 (54%) identified migraine cases completed the 2006 follow-up survey. Of those cases, 359 (4.6%) developed transformed migraine. Participants who developed transformed migraine reported significantly more primary care visits, neurologist or headache specialist visits, pain clinic visits, and emergency room visits compared with participants whose migraine remained episodic. Hospital nights and urgent care visits did not reach statistical significance. Transformed migraine participants reported significantly more time missed at work or school because of headaches and more time where work or school productivity was reduced by >50% in the previous 3 months because of headaches. Average per-person annual total costs, including direct and indirect costs, were 4.4-fold greater for those who developed transformed migraine ($7750) compared with those who remained episodic ($1757). Transformed migraine exacts a significantly higher economic toll on patients and health care systems compared with other forms of migraine. Our findings support the need to prevent migraine progression and to provide appropriate management and treatment of transformed migraine.

Tracing transformation

Migraine attacks sometimes increase in frequency over time. Headache experts conceptualize this process with a model that envisions transition into and out of four distinct states: no migraine, low-frequency episodic migraine (<10 headaches per month), high-frequency episodic migraine (10-14 headaches per month), and chronic migraine (CM, >or=15 headaches per month). Transitions may be in the direction of increasing or decreasing headache frequency and are influenced by specific risk factors. Overall, population studies estimate that patients who have low-frequency episodic migraine or high-frequency episodic migraine will transition to CM at the rate of about 2.5% per year. Two longitudinal population studies, the Frequent Headache Epidemiology study and the ongoing American Migraine Prevalence and Prevention (AMPP) study provide longitudinal population data that has defined the rates of and risk factors for transition. Launched in 2004, the AMPP study has followed a sample of >10,000 migraine sufferers annually for 4 years. Cross-sectional data from the Frequent Headache Epidemiology study and the AMPP study show that patients with chronic daily headaches have lower levels of education and household income. In addition, epidemiologic profiles show that CM sufferers tend to be older and have higher body mass indexes. These studies have also assessed a number of potential risk factors associated with the transition to CM. These include baseline high attack frequency, obesity, stressful life events, snoring, and overuse of certain classes of medication. In particular, opiate and barbiturate combination products contribute to migraine progression, and nonsteroidal anti-inflammatory agents are protective in patients with <10 headache days per month. The influence of medication is modified by both headache attack frequency and frequency of medication use. Although depression and anxiety are associated with an increased risk of new-onset CM, the influence of depression is accounted for by migraine disability assessment scale score, whereas the effect of anxiety may be independent of migraine disability assessment scale score. Emerging data on the longitudinal risk of CM suggest that, in a population at risk, CM may be a preventable disorder.

Adolescents with migraine

For adults, primary headaches have been associated with both socioeconomic and health factors. Oftentimes it is difficult to determine whether the socioeconomic component is a contributor to the impact of the headache or whether the headaches influence the socioeconomic status. For migraine this is complicated by the underlying genetic etiology and the separation of this genetic family history from the socioeconomic family history. Population-based epidemiology studies have attempted to sort out the degree of contribution of these multiple factors. In this issue of Neurology , Bigal et al. examine these roles in adolescents as part of the American Migraine Prevalence and Prevention (AMPP) study.1 Migraine is a common pain condition that significantly burdens an individual, his or her family, and society.2–4 Migraine frequently starts in childhood and adolescence; the prevalence increases and peaks in the most socioeconomic productive years for adults. This combination not only creates increased cost and utilization of medical services, but …

Probable Migraine in the United States: Results Of The American Migraine Prevalence and Prevention (AMPP) Study

Probable migraine (PM) is a prevalent migraine subtype fulfilling all but one criterion for migraine with or without aura. The aims of this study were: (i) to describe the epidemiology, medical recognition and patterns of treatment for PM in the USA; (ii) to compare the patterns of preventive PM treatment in the population with expert panel guidelines for preventive treatment. A validated self-administered headache questionnaire was mailed to a random sample of 120,000 US households. Subjects were classified as PM according to the second edition of the International Classification of Headache Disorders (ICHD-2). The questionnaire also assessed patterns of migraine treatment. Guidelines for preventive medication use were developed by a panel of headache experts, who used headache frequency and impairment to assess the need for preventive therapy and the gap between current and ideal use. Our sample consisted of 162 576 individuals aged > or = 12 years. The 1-year period prevalence of PM was 4.5% (3.9% in men and 5.1% in women). In women and men, prevalence was higher in middle life, between the ages of 30 and 59 years. The prevalence of PM was significantly higher in African-Americans than in Whites (female 7.4% vs. 4.8%; male 4.8% vs. 3.7%) and inversely related to household income. During their headaches, most (48.2%) had at least some impairment, while 22.1% were severely disabled. The vast majority (97%) of PM sufferers used acute treatments, although 71% usually treated with over-the-counter medication. Most PM sufferers (52.8%) never used a migraine-preventive treatment and only 7.9% were currently using preventive medication. According to the expert panel guidelines, prevention should be offered (16.9%) or considered (11.5%) for 28.4% of the PM sufferers in the survey. We conclude that PM is a frequent, undertreated, sometimes disabling disorder. It has an epidemiological profile similar to migraine. In contrast to migraine, which is less prevalent in African-Americans than in Whites, PM is more prevalent in African-Americans than in Whites. In the USA, many with PM do not receive adequate treatment.