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MIGRAINEUR POPULATION IN U.S. ESTIMATED AT 11.2 MIL.

Executive Summary

MIGRAINEUR POPULATION IN U.S. ESTIMATED AT 11.2 MIL. by a national survey presented at the Fifth International Headache Congress in Washington, D.C. on July 2. The survey estimates that 8.6 mil. females and 2.6 mil. males in the U.S. suffer from "moderate to severe disabling . . . migraine headache." An estimated 3.4 mil. females and 1.1 mil. males experience one or more severe, disabling headaches per month. The study, presented by Walter Stewart, MD, Johns Hopkins University, and Richard Lipton, MD, Montefiore Medical Center, randomly surveyed 15,000 households from a panel maintained by National Family Opinion, Inc., a marketing research organization. Stewart said that 9,510 households (63.4%) responded to the mailed questionnaire, providing information on 20,468 individuals. Stewart described the survey as "broad-based," covering the entire country, with respondents ranging in age from 12 to 80 years old. Individuals were asked about migraine and tension- related symptoms, including the intensity, frequency and duration of their headaches, and the frequency and severity of disability from their headaches. Respondents were then evaluated according to "a modified version" of International Headache Society criteria and were designated migraineurs as appropriate. Glaxo, a participant in the migraine survey, previously has estimated that 12% of the population suffer from occasional migraine ("The Pink Sheet" Dec. 10, 1990, p. 11); the company's calculation would indicate there are about 30 mil. migraineurs in the U.S. overall. Stewart and Lipton's 11.2 mil. figure represents about 4.4% of the population. The smaller figures resulting from the Stewart study are very similar to those reported by the National Center for Health Statistics in the Centers for Disease Controls' May 24 Morbidity and Mortality Weekly Report. That report notes the overall prevalence of reported cases of migraine has risen from 2.9% of the population in 1980 to 4.1% in 1989. These data come from personal interviews conducted over 10 years with a "representative sample of the civilian, noninstitutionalized U.S. population," and a sample size ranging between 60,000 and 125,000 people. Like the IHS study, data were based on self-report. The International Headache Society's 1988 headache guidelines describe a migraine without aura (common migraine) as five headache attacks lasting four to 72 hours, accompanied by two of the following characteristics: localized on one side of the head; pulsating; severe enough to inhibit daily activity; aggravated by physical activity. The headache must be accompanied by either nausea and/or vomiting or hypersensitivity to sound or light. The Stewart survey modified these criteria by requiring migraineurs to be at least partially disabled by their headaches and employed more "conservative" criteria in order to estimate more clearly the potential users of prescription migraine drugs. One "very surprising" finding of the survey, Stewart said, was an inverse relationship between migraine prevalence and income. The survey researchers found that the highest incidence of migraine is found in households with an income of less than $ 10,000 per year, and the lowest rate of migraine is found in households with $ 30,000 or more in yearly income. Hypothesizing why lower income correlated with a higher prevalence of migraine, Stewart suggested that "it is, of course, more stressful to live in modern society with less; stress is commonly recognized as a possible precipitating factor for migraine, although it's often poorly defined." He added that dietary precipitants may differ by income status. Stewart noted alternatively that "individuals who suffer from chronic disabling migraine headache may suffer a loss of income -- they may be less likely to advance in their occupation, to hold an occupation, and to pursue education." Lipton also commented on the income-migraine relationship, noting that "the clinical impression that migraine is a disorder of high socioeconomic status is a consequence of the fact that migraine in a doctor's office is a disorder of high socioeconomic status."

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