Migraine Headache Misconceptions: Barriers to Effective Care

Richard Wenzel, Pharm.D.; Marcus Dortch, Pharm.D.; Roger Cady, M.D.; Jennifer H. Lofland, Pharm.D., M.P.H.; Seymour Diamond, M.D.


Pharmacotherapy. 2004;24(5) 

In This Article

Abstract and Introduction

Migraine headaches affect 12% of the adult population in the United States and cause a significant economic loss due to decreased workplace productivity. Although interactions between pharmacists and individuals with headache are common, few pharmacists receive adequate training regarding migraine therapy. We refute several misconceptions that hinder effective care, such as that migraine is a vascular disease, triptans cause rampant cardiac-related morbidity and even mortality, a best oral triptan exists, sinus and tension headaches are prevalent, and migraine is a minor economic problem. Our pathophysiologic understanding demonstrates that migraine is a neurologic process of the trigeminovascular system, of which vascular effects are secondary. This process can result in a myriad of clinical signs and symptoms, often leading to a misdiagnosis of sinus or tension headache. The last decade's experience with triptans in more than half a billion people worldwide reveals a benign adverse-effect profile, particularly when taken early in an attack. Published reports and real-world experiences illustrate that these drugs do not merit fears of triptan-induced cardiac consequences in appropriately selected individuals. Society's productivity loss due to migraine is measured in billions of dollars. Restoring a patient's ability to function normally is now recognized as the primary treatment goal, not merely relieving pain. Thus, the overreliance on "pain killer" drugs such as butal-bital-containing products and the continued underutilization of migraine-specific drugs need to be addressed. Opportunities exist for pharmacists and other health care providers to dispel continually propagated migraine misconceptions and familiarize themselves with advances in therapy. Such actions will benefit patients, the health care system, and society as a whole.

At some point in life, virtually every human being will experience a headache. Yet headache, as a medical condition, has received comparatively little health policy discussion or scientific inquiry. The World Health Organization laments this problem, "...both the public and the majority of healthcare professionals tend to perceive headache as a minor or trivial complaint. As a result, the physical, emotional, social and economic burdens of headache are poorly acknowledged in comparison with those of other, less prevalent, neurological disorders."[1]

Headache is a heterogeneous syndrome divided empirically into primary (nonorganic) and secondary (organic) pathogenesis.[2] Migraine is the most common recurrent severe primary headache and affects at least 12% of the adult population in the United States or more than 28 million people.[3,4,5,6] Individual attacks are characterized by bouts of neurologic, gastro-intestinal, and autonomic manifestations, which vary in intensity, severity, and disability within and between patients.[2,3,4,5,6] Migraine is a leading cause of employee absenteeism, and owing to the disruptive and unpredictable nature of attacks, patients and their families experience a decreased quality of life.[7,8]

Only 48% of cases in which people report headaches that fulfill International Headache Society (IHS) criteria for migraine are diagnosed.[3] Furthermore, the therapy afforded those with a diagnosis of migraine remains less than optimal, despite the last decade's advent of screening tools, new drugs, and other therapies.[3,4,5,6] Reliance on ineffective butalbital-containing products and over-the-counter (OTC) agents remains widespread, whereas only a minority of patients receives a migraine-specific drug such as a triptan or dihydroergotamine.[6,9,10,11] Every day, thousands of migraineurs endure treatable, often preventable, attacks.

Few practicing pharmacists are familiar with current migraine treatment approaches, and pharmacy students receive little migraine education, creating situations for false beliefs to proliferate.[12,13] We refute some of the most pervasive misconceptions, such as that migraine is a vascular disease, triptans cause rampant cardiac-related morbidity or even mortality, a best oral triptan is available, debilitating sinus and tension headaches are prevalent, and headaches are economically insignificant.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.