REVIEWS

Despite extraordinary scientific advances during the past decade in knowledge of the epidemiology and pathophysiology of migraine and the introduction of seven effective migraine‐specific therapies, migraine continues to be under‐recognized, underdiagnosed, and undertreated. Migraine affects 18% of women and 6.5% of men in the United States. Recent research contradicts the historical conception of migraine as a trivial illness and has established it as a disabling condition warranting aggressive management. Concurrently, understanding of the pathophysiology of migraine has evolved, and migraine‐specific treatments that can restore patients' functional ability have been introduced. Still, several barriers to optimizing migraine care remain. Perhaps the most significant is the failure to recognize which primary headaches are migraines. Those with migraine are usually diagnosed as having tension‐type or sinus headache. In a 1999 U.S. population‐based survey, less than half (48%) of those meeting International Headache Society (IHS) diagnostic criteria for migraine reported having received a physician's diagnosis of migraine. Moreover, the frequency of migraine diagnosis in 1999 did not increase appreciably from diagnosis rates in 1989, while consultations for headache tripled during this 10‐year period. Effective migraine‐specific therapies have been available for nearly a decade in the United States, but relatively few patients with migraine have benefited from them. In 1999, only 4 of 10 U.S. migraineurs used prescription medication for symptomatic relief. Comment: This article from Taylor et al should strike a note with most primary care and headache physicians in the United States and in Europe. Why, despite the efforts of the pharmaceutical industry, academic and professional groups such as the AHS (American Headache Society), IHS, and others, are so few patients with migraine identified and treated with appropriate specific prescription treatments?
—David S. Millson