June 10, 2004

How many of you have wished that your neurologist were a Migraineur or would have a severe headache so he or she would know how you feel? A new study shows that may be the case more often than we know.

In the past year, more than four of five Canadian and Mayo Clinic neurologists have had a headache, and 50 percent have had a Migraine, according to a study being presented at the 46th Annual Scientific Meeting of the American Headache Society (AHS).*

AT A GLANCE • While only 1 in 8 American adults get Migraines, 1 in 7 medical students, 1 in 3 family doctors and 1 in 2 neurologists report having Migraines, a new study suggests.       • Greater familiarity with the spectrum of Migraine likely helps neurologists to recognize their own headaches as Migraine disease.       • Compared with neurologists, family doctors were three times more likely and medical students 12 times more likely to report having "sinus headaches."      • 96 percent of neurologists treat their Migraines with over-the counter medications and 43 percent use prescription medications. In contrast, alternative therapies are used by only 1 percent.       • Anti-inflammatories and triptans are the treatment of first choice for neurologists with Migraine.

When it comes to headaches overall, neurologists are on par with the general population. But they're way ahead of the curve for Migraine attacks: studies have shown about 1 in 8 adults in the United States and Canada get them. Does that mean treating headache and Migraine patients gives neurologists Migraines? Or that they opt to specialize in neurology because they suffer from Migraines?

Neither, believes the researcher. "A recent study demonstrated that for the vast majority of neurologists, having Migraines did not influence their decision to become a neurologist," said lead investigator Jonathan Gladstone, M.D., a headache fellow at the Mayo Clinic in Scottsdale, Arizona, and neurology resident at the University of Toronto. "Rather, neurologists are armed with more knowledge about headache types, and are better able to understand and appreciate the spectrum of Migraine. As a result, neurologists are better able to recognize that their own headaches are Migraines."

And yes, Dr. Gladstone is counted among the neurologists with Migraines - he gets them every once in a while.

"For years, I believed I had ordinary 'tension-type' headaches, but once I began specializing in neurology, I was able to recognize that they were indeed Migraines," he said. In the study, 2 out of every 3 neurologists reported that they have had at least one Migraine in their lifetime.

"We believe this indicates that Migraines are much more common than previous general population studies have suggested," he said.

The study involved a questionnaire answered by 135 neurologists: 75 in the Toronto, Canada area and 60 from the Mayo Clinics in Jacksonville, Rochester and Scottsdale. As is the case in the general population, Dr. Gladstone found:

• Female neurologists were more likely to get Migraines than were male neurologists.
• Overall, 50 percent of neurologists who participated in the study said they had at least one Migraine in the past year:
  • 74 percent of the 27 female neurologists surveyed
  • and 44 percent of the 108 male neurologists.

Dr. Gladstone also looked at headache and Migraine in medical students and family doctors. While overall 92 percent of medical students and 82 percent of family physicians reported having a headache in the past year, they were less likely to report Migraines. In fact, neurologists were almost twice as likely as family physicians, three times as likely as final-year medical students and five times as likely as first-year medical students to report having Migraine.

So, if family doctors and medical students were less likely to call their own headaches Migraine, what were they diagnosing themselves with? Family doctors were three times more likely than neurologists to report having sinus headaches and medical students were 12 times more likely to report sinus headaches. Dr. Gladstone noted that while Migraine is under-recognized, under-diagnosed and under-treated in the general population, sinus headache is over-recognized, over-diagnosed and over-treated by non-neurologists. "Clearly, physicians share some of the responsibility for this," he said.

Dr. Gladstone said he believes having Migraines might make neurologists more empathetic to individuals with Migraine. "Often in the general population those with Migraine are stigmatized. People may assume that Migraineurs are 'complainers,' don't have good coping skills or that they are just using Migraines as an excuse to get out of obligations," he said. "In contrast, through either personal or work-related experience, neurologists recognize Migraines as a real neurobiological problem, and know how disabling they can be."

How do these neurologists treat their own Migraines? Overwhelmingly with medication. Of neurologists who get Migraines:

• 96 percent treat themselves with over-the-counter medication including acetaminophen and non-steroidal anti-inflammatories (NSAIDS) such as ibuprofen and naproxen;
• 43 percent use prescription medication, including 31 percent who have used a triptan in the past year. Triptans are Migraine-specific medications which must be prescribed by a doctor.

"While one-third of neurologists with Migraine have taken a triptan in the past year, less than one-fifth of Migraine sufferers in the general population have been prescribed a triptan," noted Dr. Gladstone. "Considering that neurologists utilize triptans to treat their own Migraines, clearly they believe these medications are generally safe and effective. This should give patients confidence that neurologists are practicing what they preach."

Neurologists are much less likely than the general population to use alternative therapies to treat their Migraines. In the past year, no neurologists surveyed in this study used acupuncture or naturopathic treatments for their Migraine. As well, in the past year, only 1 percent of the neurologists had personally utilized chiropractic manipulation, massage or herbal therapies for their Migraines.

"While some of these alternative therapies may be helpful in certain selected patients, neurologists didn't seem to value them as important treatment options for their own headaches," he said. "Neurologists overwhelmingly indicated that when they get a Migraine they look for a fasting-acting, consistently effective and safe treatment, and they see non-steroidal anti-inflammatories (NSAIDs) and triptans as the most important first-line treatment options."

Co-authors of a paper Dr. Gladstone is presenting at the AHS meeting are Drs. R. Gladstone, E. Eross, and D.W. Dodick.

The American Headache Society (AHS), founded in 1959 as the American Association for the Study of Headache, is based in Mt. Royal, N.J. AHS is a professional organization for those interested in the study and management of headache and face pain. AHS has approximately 2,500 members. For more information, visit the AHS Web site at http://www.achenet.org/. To fill the need for patient education, AHS established the American Council for Headache Education (ACHE), a non-profit patient-physician organization for the advancement of the treatment and management of headache and the encouragement of more constructive social attitudes toward the disease. Individuals who would like more information about headache, who would like a referral to a specialist who treats headache or who would like information on support groups can call (800) 255-ACHE at 19 Mantua Road, Mt. Royal, N.J. 08061, or visit the ACHE Web site at http://www.achenet.org/.