Neuro-3. Functional disability and reduction in quality of life associated with migraine in the primary care setting.

The extent of migraine-associated disability is rarely evaluated in the primary care (PC) setting. This study compared functional disability and quality of life of previously diagnosed and undiagnosed migraineurs and patients with nonmigraine headaches in PC. Patients (N = 451; mean age, 39 years; 76% women) seeking PC at one of 27 practice sites and who also had headaches within the past 3 months completed the ID Migraine screener and also visited a headache expert for a gold standard diagnosis of their headache (migraine, migrainous disorder or other headache types). They completed functional assessment and health-related quality of life (HRQoL) questionnaires, including the Migraine-Specific Quality of Life Questionnaire (MSQ), Migraine Disability Assessment (MIDAS) and Henry Ford Hospital Headache Disability Inventory (HDI). Disability outcomes and HRQoL were compared in migraineurs (diagnosed or undiagnosed) and nonmigraineurs. Sixty-one percent of patients with a migraine diagnosis confirmed by the headache specialist had never been diagnosed before. Previously diagnosed and undiagnosed migraineurs who were positive on the ID Migraine screener (ie, satisfying two of three items) had greater impairment than nonmigraineurs on the HDI-total score, the MIDAS-total score and all three of the MSQ functional/emotional subscale scores (P < 0.0001). There was a linear relationship between the number of positive items on ID Migraine and functional disability and HRQoL--with a significant difference between patient with 0-1 vs 2-3 symptoms (P < 0.001). The proportion of patients with high levels of disability according to MIDAS was greater in migraineurs with (74%) or without (64%) a previous diagnosis than in patients with nonmigraine headache (25%). Undiagnosed migraineurs frequently have high levels of impairment and would benefit from diagnosis and treatment. Migraineurs with or without a previous diagnosis suffer significantly more headache-related disability than those with nonmigraine headache.

R. Lipton, D. Dodick, and J. Hettiarachchi. Albert Einstein College of Medicine, Bronx, NY. Mayo Clinic College of Medicine, Scottsdale, AZ. Pfizer Inc, New York, NY.