Migraine is a common neurological disorder with symptoms ranging from headache to changes in vision and to language and speech disorders. The 2019 Global Burden of Disease study reported migraine to be the second cause of global disability. Among young women ages 15-49, migraine is the first. For a disease that has such a significant impact on the quality of life, it is surprising that less than half of people with migraine have been diagnosed. Closing the diagnosis gap should be a priority in migraine epidemiology research and public health application, but the COVID-19 pandemic may further hinder accurate migraine diagnosis.
GlobalData provides epidemiology analysis for the total and diagnosed prevalent cases of migraine in the seven major markets (7MM: US, France, Germany, Italy, Spain, UK and Japan) in 2021. The upcoming report, Migraine: Epidemiology Forecast to 2030, found that around 12% of the population in the 7MM have migraine, but only 45% of those with migraine have been diagnosed. This corresponds to more than 72.75 million people with migraine and more than 40 million people without adequate diagnosis or treatment. This condition disproportionally impacts women, with prevalence reported more than twice as high in women than men. Figure 1 provides a detailed look at the difference in diagnosed prevalent cases and total prevalent cases, as well as the disparity in prevalent cases in men and women in the 7MM in 2021.
Chronic migraine is the more severe form of the disease, where a person has more than 15 headache days a month. Chronic migraine sufferers are encouraged to seek treatment because a study by Ann and colleagues published in Neurology in 2015 reported that 49.9% of patients with chronic migraine improved to episodic frequency within a three-month period with routine care. However, this subtype of migraine is often misdiagnosed because people frequently underestimate headache days. For example, after the first episode of migraine, migraine sufferers may continue to experience low-level headaches for several days afterwards but consider them as a single headache day. Physicians recommend keeping a headache journal to aid in the diagnosis process.
Migraine diagnosis may be further complicated by the coronavirus-19 (COVID-19) pandemic. Headache is one of the most common symptoms in patients with COVID-19, a quarter of whom have migraine-like symptoms. Tolebeyan and colleagues reported in Headache: The Journal of Head and Face Pain in 2020 that the body’s inflammation response may be the cause for these headaches. Al-Hashel and Ismail reported in the same journal in September 2020, that based on their survey of migraine sufferers during the pandemic, 60% of respondents experienced increase in migraine frequency, 16% reported decrease in frequency and 10% changed to chronic migraine. It is also important to note that Al-Hashel and Ismail found that almost two-thirds of the respondents did not communicate with their neurologists during this period and regular treatments were disrupted.
Migraine’s low diagnosis rate can be attributed to misdiagnosis and the ever-changing nature of the disease. Considering the size of the patient population and its significant disability burden, more public health efforts should be aimed toward improving diagnosis and access to treatment.