Are migraines more common than thought?
Tuesday, Jul 31 2012
Neurologists, who may know headaches better than anyone, report a much higher-than-average rate of migraines, a new survey from Norway finds.
The national survey found that of 245 neurologists, 35 percent said they’d ever had migraine headaches. And 26 percent had had one in the past year - double what’s reported among Norwegians as a whole.
Worldwide, an estimated 11 percent of people have suffered a migraine in the past year.
It’s not clear why neurologists are so taxed by migraines. But one possibility is that the general public actually has higher migraine rates, but doesn’t realize it or report the headaches, according to the researchers, led by Dr. Karl B. Alstadhaug of Nordland Hospital in Bodo, Norway.
Still, another explanation could be that neurologists, or doctors in general, have a higher-than-average risk of migraine, said Dr. Randolph Evans, a clinical professor of neurology at Baylor College of Medicine in Houston.
“It is a curious finding,” Evans said in an interview.
In his own study of 220 neurologists, Evans found that about half to three-quarters said they had ever had migraines.
A statistical stumbling block called “selection bias” could be at work, however: The neurologists in Evans’s study were attending a course on headache, so he may have sampled a group of doctors especially interested in headache - which could include those who suffer migraines themselves.
The same might be true of the new study, which was published in the journal Headache. Alstadhaug’s team sent surveys to all of the neurologists registered in Norway. But more than one-third did not respond, and it’s possible that the doctors who did respond were more likely to be migraine sufferers.
“I certainly believe that a questionnaire study like this is biased,” Alstadhaug told Reuters Health in an email, “but I don’t think that it can explain the results.”
Even if all the non-responders were migraine-free, Alstadhaug said, that would still leave the rate of migraines among all Norwegian neurologists at 17 percent.
He and his colleagues also asked the doctors whether their own migraines had, in part, led them to become neurologists (since that could help explain the high migraine rates). But only one doctor said that was the case.
Alstadhaug’s team suspects that the migraine rate among neurologists may be a more accurate estimate of what’s going on in the public at large.
Neurologists specialize in disorders of the brain and nervous system, and some focus on headaches in particular. So if anyone should know the signs and symptoms of migraine, it would be a neurologist.
Migraines typically involve an intense throbbing sensation in one area of the head, plus sensitivity to light and sound, and nausea or vomiting in some cases.
About 30 percent of people with recurrent migraines have sensory disturbances shortly before their headache hits.
Those disturbances, known as aura, are usually visual - like seeing flashes of light or blind spots - but they can also include problems like tingling sensations or numbness, or difficulty speaking or understanding language.
In this study, about one-third of neurologists said they’d ever had an aura alone, with no headache. Most said it had happened at least twice.
“In my opinion, the results illustrate that aura and migraines may occur a few times during a lifetime in normal brains,” Alstadhaug said.
He said he does not think the findings imply that more people should be going to the doctor for their head pain.
Of the neurologists in this study who’d had a recent migraine, less than half said they had taken prescription migraine drugs known as triptans.
According to Alstadhaug, that suggests their migraines were fairly mild.
Evans agreed that many of the doctors may have found their migraines manageable with an over-the-counter pain reliever. “If an over-the-counter works, why use a prescription?” he said. “Why use an elephant gun to kill a mosquito?”
But Evans said he suspects neurologists might have a higher-than-average migraine risk because of their work.
“It’s possible people in stressful occupations may be more likely to develop migraines,” Evans speculated.
Of course, he added, a lot of us might consider our jobs stressful. It would be interesting, Evans said, for studies to look at whether migraine prevalence varies among different occupations.
SOURCE: Headache, online July 23, 2012.
Migraine Among Norwegian Neurologists
Results Among the 384 neurologists, 245 (64%) participated. Of these, 95 (39%) reported having experienced migraine aura, and 86 having experienced migraine headache (35%). By employing the International Headache Society criteria for migraine with regard to the number of attacks, the gender-adjusted lifetime and 1-year prevalence was 38.7% (95% CI 30.3-47.7) and 33.8% (95% CI 25.9-47.2), respectively. Age-adjusted 1-year prevalence of migraine headache (not including subjects experiencing visual aura only) for men was 15.9% and for women 36.7%, which gives an overall age and gender-adjusted prevalence of 26.3% (95% CI 18.5-34.2). Solitary auras were experienced by 83 (34%), of which 73 (30%) had experienced this twice or more frequently. The majority of the neurologists thought that migraine was underdiagnosed and undertreated, 70% and 68%, respectively.
Conclusion The study confirms the results of previous studies, indicating that migraine, including visual aura, is more common among neurologists than what would be expected from population-based studies. Because this group, through professional experience with the condition, can make accurate diagnoses in themselves, and will have fewer problems with recalling headache episodes, the prevalence figures obtained may give the most precise estimate of the true population prevalence.
Karl B. Alstadhaug MD, PhD,
Antonio Hernandez MD,
Halvor Næss MD, PhD,
Lars Jacob Stovner MD, PhD
Article first published online: 23 JUL 2012
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