Assessing and managing all aspects of migraine: migraine attacks, migraine-related functional impairment, common comorbidities, and quality of life

Abstract

Migraine can be characterized as a chronic disorder with episodic attacks and the potential for progression to chronic migraine. We conducted a PubMed literature search (January 1, 1970 through May 31, 2008) for studies on the impact of migraine, including disability, health-related quality of life (HRQoL), comorbidities, and instruments used by health care professionals to treat patients with migraine. Numerous studies have shown that migraine substantially impairs a person's functions during attacks and diminishes HRQoL during and between attacks. Despite its impact, migraine remains underestimated, underdiagnosed, and undertreated. Several tools are available to help physicians assess the impact of migraine on the daily activities and HRQoL of their patients, such as the 36-Item Short-Form Health Survey and the Headache Impact Test. Improving communication during the office visit through active listening, use of open-ended questions, and use of the "ask-tell-ask" strategy can also help in assessing migraine-related impairment. Together, these tools and communication techniques can lead to a more complete assessment of how migraine affects patients' lives and can aid in the development of the optimal treatment plan for each patient. Both pharmacotherapy (acute and preventive treatment strategies) and nonpharmacological therapies play important roles in the management of migraine.

Figures

FIGURE 1.

Impact of migraine on important aspects of life. From Cephalalgia, with permission from Blackwell Publishing.

FIGURE 2.

Four-item clinic version of the Migraine Interictal Burden Scale (MIBS-4).

FIGURE 3.

Depression, anxiety, and panic disorder in persons with migraine by level of interictal burden as measured by the 4-item Migraine Interictal Burden Scale (MIBS-4).

FIGURE 4.

Mean quality of life ratings (Migraine-Specific Quality of Life Questionnaire [MSQ] subscales) in persons with migraine by level of interictal burden as measured by the 4-item Migraine Interictal Burden Scale (MIBS-4). MSQ role function-restrictive is a measure of the degree to which performance of daily activities is limited by migraines; MSQ role function-preventive is a measure of the degree to which performance of daily activities is interrupted by migraines; MSQ emotional function examines feelings of frustration and helplessness due to migraine.

FIGURE 5.

Absenteeism, presenteeism, and lost productive time in persons with migraine by level of interictal burden as measured by the 4-item Migraine Interictal Burden Scale (MIBS-4).

FIGURE 6.

Migraine Prevention Questionnaire 5 (MPQ-5).