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Living Well with Migraine Disease and Headaches

HarperCollins Publishers, Inc.

Chapter One

What Are Headaches and Migraine Disease?

Before we delve more deeply into the details of Migraine disease and headaches, it will help to have some background information about how many people are affected by Migraine disease and headaches, and some basics on the different kinds of head pain disorders will give us a base to build upon.

Not only is headache painful, but headache disorders are also disabling. Worldwide, according to the World Health Organization, Migraine alone is 19th among all causes of years lived with disability. Headache disorders impose recognizable burden on sufferers, including sometimes substantial personal suffering, impaired quality of life and financial cost. Repeated headache attacks, and often the constant fear of the next one, damage family life, social life, and employment. For example, social activity and work capacity are reduced in almost all Migraine sufferers and in 60% of TTH (tension-type headache) sufferers. -- From the World Health Organization

Migraineurs required 3.8 bed rest days for men and 5.6 days for women each year, resulting in a total of 112 million bedridden days. Migraine costs American employers about $13 billion a year because of missed workdays and impaired work function; close to $8 billion was directly due to missed workdays. Patients of both sexes aged 30 to 49 years incurred higher indirect costs compared with younger or older employed patients. Annual direct medical costs for migraine care were about $1 billion, and about $100 was spent per diagnosed patient. Physician office visits accounted for about 60% of all costs; in contrast, emergency department visits contributed less than 1% of the direct costs.

-- Hu XH et al.

The Human and Economic Impact of Migraine Disease and Headaches

The preceding statistics are startling for more than one reason. Not only do they show how much time Migraineurs lose to Migraine, but when carefully examined, the $100 spent per diagnosed patient makes it clear that most Migraineurs aren't getting the care we need and deserve. Think about it. That $100 will barely cover one office visit. That substantiates something we already know -- Migraine is a very underdiagnosed and undertreated disease.

Here is more information about how many people are affected by Migraine disease and headaches and the economic impact:

Tension-type headaches and Migraine disease are the two most common head pain disorders.

Of the people who consult their primary care physician for head pain, 94 percent have Migraine disease or Migraine-type headache.

More than 90 percent of patients who go to their doctor for what they think are sinus headaches actually have Migraine disease.

Migraine disease affects 18 percent of women and 6-8 percent of men. Those percentages convert to the following statistics:

• Nearly 33 million Migraineurs in the United States. This is more than the 32 million sufferers of asthma, diabetes, and coronary heart disease combined.
• More than 7.5 million Migraineurs in the United Kingdom.
• More than 4 million Migraineurs in Canada.
• In developed countries, tension-type headache affects two-thirds of adult males and over 80 percent of females. Once again, let's see some numbers from those percentages:
• Nearly 200 million people in the United States.
• More than 43 million people in the United Kingdom.
• More than 23 million people in Canada.

Migraine attacks result in 112 million bedridden days per year for U.S. Migraineurs alone.

The best estimate is that the cost to U.S. industry of absenteeism and reduced productivity due to Migraine is $13 billion per year.

It is also estimated that Migraineurs in the United States lose more than 157 million workdays each year.

Many people with Migraine disease also have clinical depression, which is also a disease. We don't fully understand the link between the two diseases, but this very strong statistic shows there clearly is a link: 47 percent of Migraineurs also have clinical depression. In the general population, that figure is only 17 percent.

The Most Common Types of Headaches and Migraine Disease

The most common type of head pain is tension-type headache (TTH). The pain of a TTH is usually on both sides of the head. The pain has a pressing or tightening quality, often feeling like a band around the head. The pain is seldom made worse by physical activity, but it may be accompanied by tenderness of the head and/or muscles in the jaw, neck, scalp, and shoulders. It may also be accompanied by sensitivity to light or noise, but not both. In developed countries, TTH affects two-thirds of adult males and over 80 percent of females. In the United States alone, that's over 187 million people.

Migraine is a genetic neurological disease that produces flare-ups referred to as "Migraine attacks" or "Migraine episodes." Within the disease, there are different types of Migraine, subtypes of the disease:

• Migraine without aura is the most common type of Migraine. It usually consists of a moderate to severe headache that's made worse by physical activity. It's also accompanied by at least one of the following: nausea, vomiting, sensitivity to light, or sensitivity to sound.
• Migraine with aura differs from Migraine without aura in that it has an extra phase before the headache, the aura. The most commonly thought of Migraine aura is visual disturbances, but aura can also include hearing or smelling things that aren't actually present as well as other symptoms.
• Abdominal Migraine occurs mainly in children. It consists of abdominal pain, nausea, and vomiting.
• Hemiplegic Migraine can include a prolonged aura that can last for days or weeks, paralysis on one side of the body, impaired consciousness, plus the symptoms of Migraine with aura. Hemiplegic Migraine should not be treated with triptans. It can be frightening and difficult to diagnose because it has symptoms that can be thought to be stroke, epilepsy, or other conditions.
• Basilar-type Migraine (BTM) is Migraine with aura with a twist. The aura symptoms can be far different from those typical of Migraine with aura -- and very frightening. The aura of BTM can include temporary blindness, impaired hearing, double vision, and numbness or prickly feelings. BTM should not be treated with triptans.
• Retinal Migraine is characterized by repeated attacks of visual disturbances in one eye only. Those disturbances can include "sparkling lights," small blank spots in the vision, or blindness. These symptoms are usually, but not always, followed by a headache and other symptoms of Migraine without aura. Before diagnosing retinal Migraine, it's essential that doctors rule out any other possible causes of visual problems.

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Excerpted from Living Well with Migraine Disease and Headaches by Teri Robert Copyright © 2005 by Teri Robert. Excerpted by permission.
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