Medical Consultation for Migraine: Results From the American Migraine Study Richard B. Lipton, MD; Walter F. Stewart, MPH, PhD; David Simon, MS ~ground.-Migraine headaches are often disabling But usually responsive to treatment. Nonetheless, many people with migraine never consult a ductor for heada&as. In a sample of the US population, we sought to determine the proportion of active migaineurs who ever cunsulted a doc- tor for headache and to identify the headache characteristiu and sociodemographii factors associated with consulting. Method.-A mailed questionnaire survey was sent to 15060 US households, selected from a panel to be repre- sentative of the US population. Of 20 468 eligible respon- dents ranging in age from 12 to 86 years, 2479 met a case definition for migraine. We mailed a secund questionnaire to all migraineurs identified on the first survey and achieved a 69.4% response rate. The sacond survey m headache characterbtics, patterns of medial care use, madbtion use, and method of payment for health care. Resutta-Sixty-eight percant of female and 57% of male migrainaurs reported having ever consulted a doctor for headache. Consultatiar~ was more likely with increasing age and in women who ever married. In fernalas, sevaral head- ache characteristics including pain intansity, number of mi- graine symptoms, attack duration, and disability were asso- ciated with consultation. of those who n- consult, 61% report severe or very severe pain and 67% report savere dii- ability or the need for bed rest with their headaches. Conclusion.-The results of this urvey indicate that a significant proportion of migraine suffarers never consult daators far their head&res. Given that a large proportion of parsons who newa consult report high levels of pain and disability, these data suggest that thare are opportunitias to appropriately increase heahh care utilization for migraine. Given that 46% of migraineurr who have ever consulted do not report a physician diagnosis of migraine, there is a need to improve headache diagnusis and/or doctor-patient com- munication abut migraine. Key wards: migraine, consult, questionnaire Abbreviations: HDHCCl Headache Disability and Health Care Questionnaire (Headache zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA 1998;38:87-96) From the Departments of Neurology, Epidemiology, and Social Medicine, Albart Einstein CoKaga of Medicine, Haad- ache Unit MonWiore Medical Canter, Bronx, NY 6Yrs. Lipton and Stewart); Epidemiology, Johns Hapkii School of Public Health (Mr. Simon); and Innovative Medical Research (Drs. Lipton and Stewart). Address all correspondence to Dr. Richard B. Lipton, De- partment of Neurology, Muntefiure Medical Centter, 111 East 210th street# Bronw. NY 10467. -tad for publication June 27,1997. HEADACHE Though migraine is a highly prevalent, often painful, and frequently disabling disorder, rea- sons for seeking and not seeking medical care are not well understood.” Although headaches are a major reason for outpatient medical visits,’ in the United States 71% of men and 59% of women with migraine report that they have never been medically diagnosed with migraine.‘* Of people with undiagnosed migraine, 25% re- port severe disability or the need for bed rest with their headaches and over 90% report at least some headache-related disability.‘* These find- ings suggest that undiagnosed migraine is a sig- nificant public health problem.‘**” Because there are effective treatments for migraine, many peo- ple with undiagnosed disabling migraine might benefit from medical care?” There are several possible barriers to the effec- tive diagnosis and treatment of migraine.28’o’” Some individuals who would benefit from treat- ment for migraine may not consult doctors about their headaches. Others may consult without re- ceiving a specific diagnosis; still others may re- ceive an accurate diagnosis without getting effec- tive treatment.” Recent efforts have focused on defining the individuals with migraine most in need of medical care.11’13 To understand the con- tribution of various barriers to care, we evaluated the patterns of consultation and diagnosis in a population-based sample of migraine zyxwvutsrqponmlkj sufferers. Population-based studies are required to address these issues so that people with migraine are identified whether or not they seek medical care.” The present study is based on a large sample of migraine sufferers identified in an epidemio- logic sun/ey (the American Migraine Study).“” In this article, we examine the patterns of medical consultation, and the predictors of who consults doctors for headache among migraineurs. By comparing the sociodemographic profiles of mi- graineurs who do and do not consult doctors, we can examine the influence of age, gender, race, income, and insurance status on utilization of medical care for headaches. By assessing pain intensity, attack frequency and duration, as well as associated features (nausea, photophobia, etc) PAGE 87