Migraine Disorders: Steiner TJ

Anonymous00401, Olesen J, Bousser MG, Diener HC, Dodick D, First M, Goadsby PJ, Göbel H, Lainez MJ, Lance JW, Lipton RB, Nappi G, Sakai F, Schoenen J, Silberstein SD, Steiner TJ. · Department of Neurology, University of Copenhagen, Glostrup Hospital, Demark. · Cephalalgia. · Pubmed #16686915 No free full text.

Abstract: After the introduction of chronic migraine and medication overuse headache as diagnostic entities in The International Classification of Headache Disorders, Second Edition, ICHD-2, it has been shown that very few patients fit into the diagnostic criteria for chronic migraine (CM). The system of being able to use CM and the medication overuse headache (MOH) diagnosis only after discontinuation of overuse has proven highly unpractical and new data have suggested a much more liberal use of these diagnoses. The International Headache Classification Committee has, therefore, worked out the more inclusive criteria for CM and MOH presented in this paper. These criteria are included in the appendix of ICHD-2 and are meant primarily for further scientific evaluation but may be used already now for inclusion into drug trials, etc. It is now recommended that the MOH diagnosis should no longer request improvement after discontinuation of medication overuse but should be given to patients if they have a primary headache plus ongoing medication overuse. The latter is defined as previously, i.e. 10 days or more of intake of triptans, ergot alkaloids mixed analgesics or opioids and 15 days or more of analgesics/NSAIDs or the combined use of more than one substance. If these new criteria for CM and MOH prove useful in future testing, the plan is to include them in a future revised version of ICHD-2.

Steiner TJ, Voelker M. · Division of Neuroscience and Mental Health, Imperial College London, London, UK. · J Clin Pharm Ther. · Pubmed #19250138 No free full text.

Abstract: RATIONALE: For the management of common disorders producing short-lasting pain, there is very good evidence of the efficacy of aspirin. Yet paracetamol is often preferred, despite that evidence of its efficacy is much less sound. The reason for this appears to be a concern over gastrointestinal (GI) toxicity. If this concern is misplaced, so may be the preference for paracetamol, with the consequence of widespread sub-optimal treatment. Our purpose in this analysis of pooled individual patient data from clinical studies of aspirin is to adduce the evidence that will show whether or not this is so, for the benefit of consumers and health-care professionals who advise them. METHODS: The frequencies of all and GI adverse events (AEs) and adverse drug reactions (ADRs) were calculated from the pooled individual patient data of nine similar randomized, double-blind, placebo controlled clinical trials of single-doses of aspirin 1000 mg in the treatment of acute migraine attacks, episodic tension-type headache and dental pain. Absolute differences between active and placebo AE and ADR rates, and numbers-needed-to-harm (NNH), were calculated. RESULTS: Of 2852 patients included in the analysis, 1581 were treated with aspirin and 1271 with placebo. Reported AE rates were 14.9% and 11.1% amongst patients allocated to aspirin and placebo respectively (NNH: 26), with the GI system most frequently affected (aspirin: 5.9%; placebo: 3.5%; NNH: 42). Reported ADR rates were much lower (aspirin: 6.3%; placebo: 3.9%; NNH: 42), especially for the GI system (aspirin: 3.1%; placebo: 2.0%; NNH: 91). Most of the AEs and ADRs were mild or moderate, and none was serious. CONCLUSIONS: The GI ADR differences between aspirin and placebo are not great enough to support decision choices for short-lasting acute pain based on tolerability: these are better based on efficacy.

Martelletti P, Farinelli I, Steiner TJ, Anonymous00075. · Department of Medical Sciences, Internal Medicine, Regional Referral Headache Centre, 2nd School of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy. · Intern Emerg Med. · Pubmed #18785015 No free full text.

Abstract: The World Health Organization (WHO) placed migraine 19th among all causes of disability (12th in women) measured in years of healthy life lost to disability (YLD). The importance of headache disorders, particularly of the primary forms, is established by their distribution worldwide, their duration (the majority being life-long conditions) and their imposition of both disability and life-style restrictions among large numbers of people. For these reasons, headache disorders should represent a public-health priority. In the Emergency Department (ED), as elsewhere, migraine is often under-diagnosed-and under-treated when it is diagnosed. The result is likely to be failure of treatment. Particular attention to diagnosis is needed in ED patients with acute headache, since there is a higher probability of secondary headache due to underlying pathologies. According to European principles of management, acute migraine treatment generally is stepwise. Of the two main steps, the first relies on symptomatic medication, preferably NSAIDs with or without antiemetics. The second step uses specific therapies, usually triptans. Modifications to routine practice are appropriate in the ED. Parenteral administration of symptomatic therapies is a preferred first choice, whilst immediate resort to triptans may be appropriate, and achieve better outcomes, in patients with severe headache and diagnostic confirmation of migraine.

Tfelt-Hansen P, Steiner TJ. · Department of Neurology, Danish Headache Centre, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark. · CNS Drugs. · Pubmed #17927293 No free full text.

Abstract: In 2006, the triptans sumatriptan 50mg and naratriptan 2.5mg were approved as over-the-counter (OTC) drugs in pharmacies in the UK and Germany, respectively. Both drugs have been used in a large number of patients with migraine and are considered to have good safety profiles.The implications of OTC triptan availability for clinical practice are that more migraine patients will use a triptan and will tend to medicate early when their headache is still mild, which should be beneficial. The problem with OTC access to triptans is medication overuse; therefore, patients should be warned of this and advised to use a triptan on fewer than 10 days per month.Pharmacists should be educated regarding migraine types and symptoms and on contraindications to triptans, so they are then able to discern the patients who should receive triptans and, as importantly, those who should not.The annual cost of migraine is euro27 billion in Europe, $US1.4 billion in the UK and $US16.6 billion in the US. By far the greatest opportunity for cost-savings comes from the potential to reduce costs associated with lost productivity from migraine. OTC availability of triptans will inevitably result in easier access to these medications, which, in turn, may result in improved treatment and lower migraine-related disability. There is currently a lack of empirical evidence that treating migraine effectively does in fact recover lost productivity; well designed studies are required to show this.The availability of triptans OTC is a logical development for the better management of a common, benign, self-limiting but nonetheless burdensome disorder that is currently grossly undertreated. We welcome this development, but recognise that advice at the point of sale is crucial for effective and safe use of these drugs.

Leonardi M, Steiner TJ, Scher AT, Lipton RB. · Scientific Direction, Italian National Neurological Institute Carlo Besta, Via Celoria 11, I-20133, Milan, Italy. · J Headache Pain. · Pubmed #16388337 No free full text.

Abstract: This overview of the published epidemiological evidence of migraine helps to identify the size of the public-health problem that migraine represents. It also highlights the need for further epidemiological studies in many parts of the world to gain full understanding of the scale of clinical, economic and humanistic burdens attributable to it. This paper presents some of the work on migraine undertaken by the World Health Organization (WHO) in the Global Burden of Disease study conducted in 2000 and reported in the World Health Report 2001. Migraine was not included in the first Global Burden of Disease 1990. The paper also discussed the measurement of disability attributable to headache disorders using WHO ICF Classification. Using disability-adjusted life years (DALYs) as a summary measure of population health (which adds disability to mortality), WHO have shown that mental and neurological disorders collectively account for 30.8% of all years of healthy life lost to disability (YLDs) whilst migraine, one amongst these, alone accounts for 1.4% and is in the top 20 causes of disability worldwide. This information is combined with the increasingly widely accepted belief that disability and functioning are relevant parameters for monitoring the health of nations and that there is an increasing need to measure them. WHO's Classification of Functioning, Disability and Health (ICF) provides a model of human functioning and disability, as well as a classification system, that allows us to highlight and measure all dimensions of disability. ICF applied to headache disorders allows comparability with other health conditions as well as evaluation of the role of the environment as a cause of disability amongst people with headache. Migraine causes a large proportion of the non-fatal disease-related burden worldwide. Our knowledge of headache related burden is incomplete and it is necessary to add to it epidemiological studies in many parts of the world and to combine this with measurements of disability using both DALYs and WHO's ICF Classification. The work described here has been the base for the Global Campaign against Headache disorders: "Lifting the Burden", launched in 2004 jointly by WHO, IHS (International Headache Society), WHA (World Headache Alliance) and EHF (European Headache Federation).

Martelletti P, Haimanot RT, Láinez MJ, Rapoport AM, Ravishankar K, Sakai F, Silberstein SD, Vincent M, Steiner TJ. · ITSE 2nd School of Medicine, Rome University La Sapienza, Via Vitorchiano 81, I-00189, Rome, Italy. · J Headache Pain. · Pubmed #16362681 No free full text.

Abstract: The social perception of headache, everywhere at low levels in industrialised countries, becomes totally absent in developing ones. Headache disorders came into the World Health Organization's strategic priorities after publication of the 2001 World Health Report. Among the leading causes of disability, migraine was ranked 19th for adults of both sexes together and 12th for females. The Global Campaign (GC) to Reduce the Burden of Headache Worldwide was planned by the major international headache organizations together with WHO in order to identify and remove those cultural, social and educational barriers recognised as responsible factors for the inadequate treatment of headache disorders worldwide. Within the GC activities, the education of the medical body will represents a central pillar. An International Team for Specialist Education (ITSE) has been created to train physicians from all over the world through the acquisition of a university level Master Degree in Headache Medicine. Once trained as headache specialists, physicians will become trainers, offering education in this field to other health care providers in their own countries. In this way they will give life to a cultural chain raising awareness locally of headache, its burden and its medical control.

Lipton RB, Bigal ME, Steiner TJ, Silberstein SD, Olesen J. · Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461-1926, USA. · Neurology. · Pubmed #15304572 No free full text.

Abstract: Given the range of disorders that produce headache, a systematic approach to classification and diagnosis is an essential prelude to clinical management. For the last 15 years, the diagnostic criteria of the International Headache Society (IHS) have been the accepted standard. The second edition of The International Classification of Headache Disorders (January 2004) reflects our improved understanding of some disorders and the identification of new disorders. Neurologists who treat headache should become familiar with the revised criteria. Like its predecessor, the second edition of the IHS classification separates headache into primary and secondary disorders. The four categories of primary headaches include migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalalgias, and other primary headaches. There are eight categories of secondary headache. Important changes in the second edition include a restructuring of these criteria for migraine, a new subclassification of tension-type headache, introduction of the concept of trigeminal autonomic cephalalgias, and addition of previously unclassified primary headaches. Several disorders were eliminated or reclassified. In this article, the authors present an overview of the revised IHS classification, highlighting the primary headache disorders and their diagnostic criteria. They conclude by presenting an approach to headache diagnosis based upon these criteria.

Steiner TJ. · Division of Neuroscience, Imperial College School of Medicine, Charing Cross Campus, St. Dunstan's Road, London W6 8RP, UK. · Funct Neurol. · Pubmed #11200795 No free full text.

Abstract: All elements of headache burden, and those who bear them, need to be identified if headache is to secure its rightful place in the priority queue for scarce healthcare resources. This paper sets out to do this. Illness manifesting as headache imposes substantial burdens on individual people and on society. Whilst different diagnostic categories of headache vary quantitatively in their impact, the elements of burden are similar for all common headaches. Migraine, being the most studied, is a good model. The AASH/IHS Consensus Symposium on Improving Migraine Management, held in Washington DC on October 2nd 1998, argued that, world-wide, migraine is both under-diagnosed and under-treated. Whilst improved allocation of healthcare resources to migraine and other headache illnesses will mitigate these burdens, this will not happen unless the size and full nature of the problem are recognised. Using rhetoric, I answer two questions: what are the burdens of headache, and who bears them? Migraine has a peculiar tendency to extend its burdens beyond attacks and to others than the immediate sufferer. In many cases it should be characterised as a chronic rather than episodic illness. Other categories of headache impose qualitatively similar and heavy and widely-placed burdens. Healthcare resources expended on better treatment are likely to be repaid several-fold by savings elsewhere.

Steiner TJ, Diener HC, MacGregor EA, Schoenen J, Muirheads N, Sikes CR. · Division of Neuroscience, Imperial College London, London, UK. · Cephalalgia. · Pubmed #14984226 No free full text.

Abstract: Eletriptan 40 mg and 80 mg have shown greater efficacy in acute migraine than oral sumatriptan 100 mg and naratriptan 2.5 mg. This study continues the systematic series of active comparator trials in the eletriptan clinical development programme. In a multicentre double-blind, double-dummy, parallel-groups trial, 1587 outpatients with migraine by IHS criteria were randomised in a 3: 3 : 3: 1 ratio to eletriptan 80 mg, eletriptan 40 mg, zolmitriptan 2.5 mg or placebo. Of these, 1312 treated a single migraine attack and recorded baseline and outcome data to be included in the intention-to-treat population. The primary analysis was between eletriptan 80 mg and zolmitriptan. For the primary efficacy end-point of 2-h headache response, rates were 74% on eletriptan 80 mg, 64% on eletriptan 40 mg, 60% on zolmitriptan (P < 0.0001 vs. eletriptan 80 mg) and 22% on placebo (P < 0.0001 vs. all active treatments). Eletriptan 80 mg was superior to zolmitriptan on all secondary end-points at 1, 2 and 24 h, in most cases with statistical significance. Eletriptan 40 mg had similar efficacy to zolmitriptan 2.5 mg in earlier end-points, and significantly (P < 0.05) lower recurrence rate and need for rescue medication over 24 h. All treatments were well tolerated; 30-42% of patients on active treatments and 40% on placebo reported all-causality adverse events that were mostly mild and transient. On patients' global ratings of treatment, both eletriptan doses scored significantly better than zolmitriptan.

Lipton RB, Scher AI, Kolodner K, Liberman J, Steiner TJ, Stewart WF. · Department of Neurology, Albert Einstein College of Medicine, and Headache Unit, Montefiore Medical College, Bronx, NY, USA. · Neurology. · Pubmed #11914403 No free full text.

Abstract: OBJECTIVE: To determine the prevalence and distribution of migraine in the United States as well as current patterns of health care use. METHODS: A random-digit-dial, computer-assisted telephone interview (CATI) survey was conducted in Philadelphia County, PA, in 1998. The CATI identifies individuals with migraine (categories 1.1 and 1.2) as defined by the diagnostic criteria of the International Headache Society with high sensitivity (85%) and specificity (96%). Interviews were completed in 4,376 subjects to identify 568 with migraine. Those with 6 or more attacks per year (n = 410) were invited to participate in a follow-up interview about health care utilization and family impact of migraine; 246 (60.0%) participated. RESULTS: The 1-year prevalence of migraine was 17.2% in females and 6.0% in males. Prevalence was highest between the ages of 30 and 49. Whereas 48% of migraine sufferers had seen a doctor for headache within the last year (current consulters), 31% had never done so in their lifetimes and 21% had not seen a doctor for headache for at least 1 year (lapsed consulters). Of current or lapsed consulters, 73% reported a physician-made diagnosis of migraine; treatments varied. Of all migraine sufferers, 49% were treated with over-the-counter medications only, 23% with prescription medication only, 23% with both, and 5% with no medications at all. CONCLUSION: Relative to prior cross-sectional surveys, epidemiologic profiles for migraine have remained stable in the United States over the last decade. Self-reported rates of current medical consultation have more than doubled. Moderate increases were seen in the percentage of migraine sufferers who use prescription medications and in the likelihood of receiving a physician diagnosis of migraine.

Diener HC, Jansen JP, Reches A, Pascual J, Pitei D, Steiner TJ, Anonymous00230. · Department of Neurology, University of Essen, Essen, Germany. · Eur Neurol. · Pubmed #11844898 No free full text.

Abstract: The 5-HT(1B/1D/1F) agonist eletriptan, at an oral dose of 80 mg, has been shown to be more efficacious than sumatriptan 100 mg and placebo in the treatment of migraine attacks with or without aura. Another commonly prescribed oral treatment for migraine attacks is Cafergot (1 mg ergotamine tartrate with 100 mg caffeine per tablet). The efficacy, tolerability and safety of 40- and 80-mg doses of eletriptan and 2 tablets of Cafergot were compared in a double-blind, randomised, placebo-controlled, parallel-group trial involving 733 migraine patients. Patients recorded symptoms at baseline (before treatment) and 1, 2, 4 and 24 h after dosing. Headache intensity was assessed on a 4-point scale (3 = severe pain, 2 = moderate pain, 1 = mild pain, 0 = no pain). Significantly more eletriptan-treated patients (80 mg, 68%; 40 mg, 54%) than Cafergot-treated patients (33%; p < 0.001) reported headache response (improvement from moderate-to-severe to mild or no pain) at 2 h. Substantially more eletriptan recipients reported no pain (80 mg, 38%; 40 mg, 28%; Cafergot, 10%; placebo, 5%; p < 0.001). Eletriptan headache response rates at 1 h were significantly higher (80 mg, 39%; 40 mg, 29%; Cafergot, 13%; placebo, 13%; p < 0.002 for each comparison). Both doses of eletriptan were significantly more effective than Cafergot in reducing nausea (p < 0.0001), photophobia (80 mg, p < 0.0001; 40 mg, p < 0.002), phonophobia (80 mg, p < 0.0001; 40 mg, p < 0.003) and functional impairment (p < or = 0.001) at 2 h. Adverse events were generally mild or moderate and transient. This randomised trial shows that oral eletriptan is more efficacious in the acute treatment of migraine than oral Cafergot and is well tolerated.

Wells NE, Steiner TJ. · Pfizer Central Research, Sandwich, England. · Pharmacoeconomics. · Pubmed #11227394 No free full text.

Abstract: BACKGROUND: The growing literature on the economics of migraine and its treatment generally indicates that the direct healthcare costs of managing the disorder are relatively low compared with the personal and societal burdens resulting from the disruption to normal functioning caused by migraine attacks. OBJECTIVE: To investigate the effectiveness of eletriptan, a new selective serotonin (5-hydroxytryptamine; 5-HT)5-HTIB/ID agonist, in reducing both the patient-focused burden of migraine and the amount of work time foregone during a single attack. DESIGN: In a phase III, multinational, randomised clinical trial, 692 patients treated a migraine attack with eletriptan 40 mg or 80 mg, or placebo. Patients responded to a questionnaire seeking information concerning the amount of time lost from usual activities during the attack. Time loss assessments were made 24 hours after the last dose taken and recorded in a diary. MAIN OUTCOME MEASURES AND RESULTS: Patients receiving either dose of the active compound were unable to perform their usual activities for a median period of 4 hours compared with 9 hours experienced by those taking placebo. This difference was highly statistically significant (p < 0.001). The time saving associated with eletriptan usage reflected the differences in efficacy findings in the clinical component of the study. CONCLUSION: In this placebo-controlled trial, eletriptan produced a significant reduction in the loss of usual functioning time associated with a migraine attack. This gain clearly represents a substantial benefit to patients with migraine irrespective of how it might most appropriately be valued in monetary terms. Further methodological progress in this area is warranted.

Lipton RB, Hamelsky SW, Kolodner KB, Steiner TJ, Stewart WF. · Departments of Neurology, Epidemiology, and Social Medicine (Dr. Lipton), Albert Einstein College of Medicine, Bronx, NY, USA. · Neurology. · Pubmed #10980724 No free full text.

Abstract: OBJECTIVE: This study reports on the influence of migraine and comorbid depression on health-related quality of life (HRQoL) in a population-based sample of subjects with migraine and nonmigraine controls. METHODS: Two population-based studies of similar design were conducted in the United States and United Kingdom. A clinically validated, computer-assisted telephone interview was used to identify individuals with migraine, as defined by the International Headache Society, and a nonmigraine control group. During follow-up interviews, 389 migraine cases (246 US, 143 UK) and 379 nonmigraine controls (242 US, 137 UK) completed the Short Form (SF)-12, a generic HRQoL measure, and the Primary Care Evaluation of Mental Disorders, a mental health screening tool. The SF-12 measures HRQoL in two domains: a mental health component score (MCS-12) and a physical health component score (PCS-12). RESULTS: In the United States and United Kingdom, subjects with migraine had lower scores (p < 0.001) on both the MCS-12 and PCS-12 than their nonmigraine counterparts. Significant differences were maintained after controlling for gender, age, and education. Migraine and depression were highly comorbid (adjusted prevalence ratio 2.7, 95% CI 2.1 to 3. 5). After adjusting for gender, age, and education, both depression and migraine remained significantly and independently associated with decreased MCS-12 and PCS-12 scores. HRQoL was significantly associated with attack frequency (for MCS-12 and PCS-12) and disability (MCS-12). CONCLUSIONS: Subjects with migraine selected from the general population have lower HRQoL as measured by the SF-12 compared with nonmigraine controls. Further, migraine and depression are highly comorbid and each exerts a significant and independent influence on HRQoL.

Kukava M, Dzagnidze A, Janelidze M, Mirvelashvili E, Djibuti M, Fritsche G, Jensen R, Stovner LJ, Steiner TJ, Katsarava Z. · Department of Neurology, University Hospital Essen, University of Essen, Hufelandstr. 55, DE-45122 Essen, Germany. · J Headache Pain. · Pubmed #18074104 No free full text.

Abstract: In a pilot phase of a survey of the prevalence of primary headache disorders in the Republic of Georgia, we validated a Georgian language questionnaire for migraine (MIG), tension-type headache (TTH), MIG+TTH and trigeminal autonomic cephalalgias (TAC). A population-based sample of 186 people with headache completed the questionnaire and were blindly examined by one of two headache experts. The questionnaire diagnoses were: MIG 49, TTH 76, MIG+TTH 45 and TAC 16. The physicians' diagnoses were: MIG 59, TTH 77, MIG+TTH 34, TAC 2 and "symptomatic headache" in 14 subjects. Sensitivity and specificity for MIG were 0.75 and 0.96, for TTH 0.79 and 0.86, and for MIG+TTH 0.61 and 0.84 respectively. Of 16 TAC diagnoses, the physicians confirmed cluster headache in two patients only. The questionnaire can be utilised to investigate the prevalence of MIG and of TTH. It offers preliminary screening only for TAC, which should be confirmed during a face to face examination.

Sheftell F, Steiner TJ, Thomas H. · The New England Center for Headache, Stamford, CT, USA. · Headache. · Pubmed #17578544 No free full text.

Abstract: Headache disorders are common in children and adolescents. Even young male Wizards are disabled by them. In this article we review Harry Potter's headaches as described in the biographical series by JK Rowling. Moreover, we attempt to classify them. Regrettably we are not privy to the Wizard system of classifying headache disorders and are therefore limited to the Muggle method, the International Classification of Headache Disorders, 2nd edition (ICHD-II). Harry's headaches are recurrent. Although conforming to a basic stereotype, and constant in location, throughout the 6 years of his adolescence so far described they have shown a tendency to progression. Later descriptions include a range of accompanying symptoms. Despite some quite unusual features, they meet all but one of the ICHD-II criteria for migraine, so allowing the diagnosis of 1.6 Probable migraine.

Katsarava Z, Kukava M, Mirvelashvili E, Tavadze A, Dzagnidze A, Djibuti M, Steiner TJ. · Department of Neurology, University of Essen, Hufelandstrasse 55, DE-45122, Essen, Germany. · J Headache Pain. · Pubmed #17497261 No free full text.

Abstract: We report the methodology of an epidemiological survey of the prevalences of migraine, tension-type headache and chronic daily headache in Georgia. Medical residents visited adjacent households in Tbilisi to interview a pre-defined target of 100 biologically unrelated subjects. All respondents reporting headache in the previous year, as well as random 20 non-headache controls, were examined by a neurologist. The response rate was 70%. Of 156 respondents, 93 were biologically unrelated and 45 (48%) reported headache in the previous year. Eight subjects fulfilled all IHS criteria for migraine (1-year prevalence 8.6% [95% CI: 2.9-14.3%]), and 13 had probable migraine, meeting all but the criterion for duration. Nineteen had tension-type headache (20.4% [95% CI: 12.2-28.6%]) and five had chronic daily headache (5.4% [95% CI: 1-10.0%]). In comparisons of diagnoses by questionnaire and neurologist (considered the gold standard), sensitivities for the questionnaire of 89% for migraine and 67% for tension-type headache were calculated (overall kappa=0.74).

Diener HC, Steiner TJ, Tepper SJ. · Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany. · J Headache Pain. · Pubmed #17149560 No free full text.

Abstract: Despite the availability of effective treatments, many migraine sufferers in Europe still do not receive optimal treatment. A panel of specialists, primary-care physicians and patient-group representatives met in Rome on 10-11 June 2005, under the auspices of the European Headache Federation (EHF), the World Headache Alliance (WHA) and the University of Duisburg-Essen, to review the scientific background, management issues, and physician, patient and government perspectives on migraine. The goal of the meeting was to produce the EHF/WHA Rome Declaration on Migraine, a statement of the actions required to improve migraine care and the quality of life of people with migraine. The key recommendation of the EHF/WHA Rome Declaration on Migraine is education of migraine sufferers, health professionals and health-policy makers.

McCrory DC, Gray RN, Tfelt-Hansen P, Steiner TJ, Taylor FR. · Duke University Medical Center, Center for Clinical Health Policy Research Durham, NC, USA. · Headache. · Pubmed #15953262 No free full text.

Abstract: Recent efforts to make headache diagnostic classification and clinical trial methodology more consistent provide valuable advice to trialists generating new evidence on effectiveness of treatments for headache; however, interpreting older trials that do not conform to new standards remains problematic. Systematic reviewers seeking to utilize historical data can adapt currently recommended diagnostic classification and clinical trial methodological approaches to interpret all available data relative to current standards. In evaluating study populations, systematic reviewers can: (i) use available data to attempt to map study populations to diagnoses in the new International Classification of Headache Disorders; and (ii) stratify analyses based on the extent to which study populations are precisely specified. In evaluating outcome measures, systematic reviewers can: (i) summarize prevention studies using headache frequency, incorporating headache index in a stratified analysis if headache frequency is not available; (ii) summarize acute treatment studies using pain-free response as reported in directly measured headache improvement or headache severity outcomes; and (iii) avoid analysis of recurrence or relapse data not conforming to the sustained pain-free response definition.

Steiner TJ, Scher AI, Stewart WF, Kolodner K, Liberman J, Lipton RB. · Division of Neuroscience, Imperial College London, London, UK, Neuroepidemiology Branch, NINDS/NIH, Bethesda, MD, USA. · Cephalalgia. · Pubmed #12950377 No free full text.

Abstract: This study estimates the 1-year prevalence of migraine in adults in England in relation to the major demographic variables of age, gender and ethnicity, and describes some of its features, including aspects of consequential disability. A telephone survey was conducted of a random sample (n = 4007) of the population aged 16-65 years of mainland England using a previously validated diagnostic interview. The response rate was 76.5%. Overall, 7.6% of males and 18.3% of females reported migraine with or without aura within the last year meeting diagnostic criteria closely approximate to those of the International Headache Society. Prevalence of migraine varied with age, rising through early adult life and declining in the late 40s and early 50s. Prevalence was higher in Caucasians than in other races. Attack rates were > or = 1/month in most migraineurs, and most experienced interference with daily activities in > or = 50% of their attacks. On average, an estimated 5.7 working days were lost per year for every working or student migraineur, although the most disabled 10% accounted for 85% of the total. Results were in keeping with those from surveys in other countries. If these findings in mainland England are projected to the entire UK population, we estimate that 5.85 million people aged 16-65 years experience 190 000 migraine attacks every day and lose 25 million days from work or school each year because of them. Migraine is an important public health problem in the UK, associated with very substantial costs.

Lipton RB, Bigal ME, Kolodner K, Stewart WF, Liberman JN, Steiner TJ. · Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA. · Cephalalgia. · Pubmed #12807522 No free full text.

Abstract: Despite an extensive body of research on the individual burden of migraine, few studies have examined its impact on the family. We aimed to assess the impact of migraine on family life both from the perspective of those with migraine and from the perspective of their partners. A validated computer-assisted telephone interview (CATI) identified 574 people with migraine from a population sample of 4007 in mainland England, and 568 from 4376 in Philadelphia County, in the USA. Migraine cases with six or more migraine attacks per year and living as married with partners were asked, along with their partners, to participate in this study. In a follow-up interview, questions were asked of the proband (i.e. subject identified with migraine in the survey) about the impact of migraine. Similar questions were also asked of the probands' partners regarding the impact of the proband's migraine on their participation in social, family and leisure activities and on family relationships. The samples from the two countries showed similar characteristics, and were combined. Of 389 people with migraine living with a household partner, 85% reported substantial reductions in their ability to do household work and chores, 45% missed family social and leisure activities, and 32% avoided making plans for fear of cancellation due to headaches. One half believed that, because of their migraine, they were more likely to argue with their partners (50%) and children (52%), while majorities (52-73%) reported other adverse consequences for their relationships with their partner and children, and at work. A third (36%) believed they would be better partners but for their headaches. Participating partners (n = 100) partly confirmed these findings: 29% felt that arguments were more common because of headaches and 20-60% reported other negative effects on relationships at home. Compared with subjects who did not have migraine regarding their work performance, a statistically significantly higher proportion of migraine partners were unsatisfied with work demands placed on them (P = 0.02), with their level or responsibilities and duties (P = 0.02), and with their ability to perform (P = 0.001). Results from this study show that the impact of migraine extends to household partners and other family members.

Lipton RB, Scher AI, Steiner TJ, Bigal ME, Kolodner K, Liberman JN, Stewart WF. · Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA. · Neurology. · Pubmed #12578925 No free full text.

Abstract: OBJECTIVE: To assess patterns of medical consultation, diagnosis, and medication use in representative samples of adults with migraine in England and the United States. METHODS: Validated computer-assisted telephone interviews were conducted in the United Kingdom (n = 4,007) and the United States (n = 4,376). Individuals who reported six or more headaches per year meeting the criteria for migraine were interviewed. RESULTS: Patients with migraine in the United Kingdom were more likely to have consulted a doctor for headache at least once in their lifetime (86% vs 69%, p < 0.0001), but also were more likely to have lapsed from medical care (37% vs 21%, p < 0.001). In the United States, patients with migraine who had consulted made more office visits for headache and were more likely to see a specialist. In the United States, but not in the United Kingdom, women with migraine were more likely than men to consult doctors for headache. Patients with migraine in the United Kingdom were more likely to receive a medical diagnosis of migraine (UK 67%, US 56%; p < 0.05). Patterns of medication use were similar in both countries, with most people treating with over-the-counter (OTC) medications. Substantial disability occurred in a high proportion of those who never consulted (UK 60%, US 68%), never received a correct medical diagnosis (UK 64%, US 77%), and treated only with OTC medication (UK 72%, US 70%). CONCLUSION: Medically unrecognized migraine remains an important health problem both in the United States and the United Kingdom. Furthermore, there may be barriers to consultation for men in the United States that do not operate in the United Kingdom.

Tfelt-Hansen P, Steiner TJ. · No affiliation provided · Int J Clin Pract. · Pubmed #11321860 No free full text.

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