Migraine: Burden of disease, treatment, and prevention

Migraines are perhaps the most studied of the headache syndromes secondary to the high incidence and have significant effect on the quality of life of those suffering from this condition. Despite the high prevalence of migraines, an estimated two-thirds of sufferers either have never consulted a doctor or have stopped doing so. Therefore, it is an underdiagnosed and undertreated condition. The prevalence of migraine attacks is estimated to be 17% in women and 6% in men each year. Evidence-based guidelines for both the immediate treatment as well as preventive therapy have been established. These guidelines outline several management strategies for migraine headaches, including immediately aborting the migraine at the onset of headache, controlling the pain once it has fully evolved, and prophylactic therapy. Abortive treatment should be initiated as soon as an aura or other warning sign is noted. Patient education plays an integral role in any management plan. Headache journals may help patients identify and avoid migraine triggers and document the response to therapeutic intervention. Physicians must be aware of warning signs that may reflect more severe underlying pathology and when neuroimaging, neurology consultation, and hospitalization are warranted.