Neurologists characterize more of their headaches as migraines

Clinical Psychiatry News, Sept, 2004 by Timothy F. Kirn

VANCOUVER, B. C. -- Neurologists report having more migraines than other physicians, which may mean the stated prevalence rate of migraine needs to be revised upward.

Of 135 neurologists, 50% reported having had a migraine during the past year, and 67% reported having had a migraine during their lifetime, Dr. Jonathan Gladstone said at the annual meeting of the American Headache Society.

That compared with 13% of 92 medical students who reported a migraine in the past year, and 32% of 74 family physicians.

Most likely, this prevalence among neurologists indicates that they are more likely to call their own headaches migraines, which suggests that previous estimates of migraine in the population--a lifetime prevalence of one in eight--is an underestimate, Dr. Gladstone of the Mayo Clinic in Scottsdale, Ariz., said in a poster presentation.

There are two reasons for this conclusion. First, the neurologists did not report more headache.

Overall, 83% of the neurologists reported any headache in the past year, compared with 91% of the medical students and 82% of the family physicians. Second, a different, recent survey found that their own headaches were not a significant reason that neurologists chose their specialty.

The neurologists "have no reason to be biased," Dr. Gladstone said in an interview. "I think migraine is much more common than we realize."

The difference in the reporting was probably because headaches that the neurologists were calling migraines, the other physicians were calling sinus headaches, an entity that is not recognized by the International Headache Society classification system, Dr. Gladstone said. In the survey, 35% of the medical students and 9% of the family physicians reported a sinus headache in the past year, but only 3% of the neurologists did.

Tension-type headache was the most frequently reported kind of headache in the survey, among 82% of the medical students, 69% of the family physicians, and 66% of the neurologists.

The migraine finding was particularly surprising because migraine is generally thought to be more common in females, and 80% of the neurologists who responded to the survey were male, Dr. Gladstone said. In the survey, migraine was more prevalent in female neurologists, with 74% of the females reporting a migraine in the past year, compared with 44% of males.

The survey also found that the neurologists tended to use a nonsteroidal anti-inflammatory drug or acetaminophen to treat their migraines. Of the neurologists who reported migraine, 96% said they had used an over-the-counter analgesic to treat themselves, while only 43% said they had also used a prescription medication.

BY TIMOTHY F. KIRN

Sacramento Bureau