Beyond its debilitating pain, migraine is a staggering global health crisis, affecting 39 million Americans and ranking as the world’s second leading cause of years lived with disability.
Key Takeaways
- Globally, migraine is the second leading cause of years lived with disability (YLDs) worldwide, accounting for 45.1 million YLDs in 2019.
- In the United States, approximately 39 million people suffer from migraine, representing about 12% of the population.
- Lifetime prevalence of migraine is 14% in the general population, 18% in women, and 6% in men.
- Migraine attacks last 4-72 hours untreated in 90% of cases.
- Unilateral head pain occurs in 60% of migraine episodes, bilateral in 40%.
- Throbbing or pulsating pain quality is reported in 85% of migraineurs.
- Female sex hormones fluctuate, triggering 60% of migraines in women.
- Family history increases risk 3-4 fold; 50-60% heritability.
- Stress triggers 50-70% of attacks.
- Triptans abort 70% of moderate-severe attacks within 2 hours.
- Prophylactic topiramate reduces attacks by 50% in 50% of patients.
- Beta-blockers (propranolol) effective in 50-60% for prevention.
- Migraine causes $78 billion annual economic burden in US.
- Chronic migraine leads to 44 workdays lost per year per patient.
- 50% of migraineurs miss work/school due to attacks annually.
Migraine affects millions globally, causing severe disability, especially among women during peak working years.
Epidemiology
- Globally, migraine is the second leading cause of years lived with disability (YLDs) worldwide, accounting for 45.1 million YLDs in 2019.
- In the United States, approximately 39 million people suffer from migraine, representing about 12% of the population.
- Lifetime prevalence of migraine is 14% in the general population, 18% in women, and 6% in men.
- Migraine prevalence peaks between ages 25-55 years, with 20-30% of women and 10-15% of men affected in this range.
- In Europe, the 1-year prevalence of migraine is 14.7%, affecting 15% of women and 8% of men.
- Children aged 7-11 years have a migraine prevalence of 7-11%, rising to 8-23% in adolescents.
- Migraine with aura occurs in 25-30% of migraine sufferers, while migraine without aura affects 70-75%.
- In low- and middle-income countries, migraine underdiagnosis rate is over 80%.
- US annual migraine incidence is 2,440 per 100,000 person-years for women and 790 for men.
- Globally, females are 3 times more likely to have migraine than males, with a ratio of 3:1.
- Migraine prevalence in Latin America is 14.7%, similar to North America and Europe.
- In Asia, migraine prevalence is lower at 9-10%, but underreporting is high.
- Postmenopausal women see a 30-50% reduction in migraine frequency.
- Migraine accounts for 1.3% of all primary care visits in the US.
- In Australia, 16% of the population experiences migraine annually.
- Migraine remission rate is 40% by age 70.
- In the UK, 190,000 migraine-related GP consultations occur yearly.
- Pediatric migraine prevalence is 7.7% globally.
- Migraine is more prevalent in urban (16%) than rural (12%) areas in developing countries.
- In Canada, 14% of adults report migraine diagnosis.
- Globally, migraine YLDs increased 20% from 1990-2019.
- In India, migraine prevalence is 14.1% in urban adults.
- Migraine onset before age 10 in 10-20% of cases.
- Remission rate in children 20-40% by adulthood.
- In Africa, prevalence estimated at 10-15% with high underdiagnosis.
- US emergency visits for migraine: 1.2 million annually.
- Migraine without aura 1-year prevalence 11.7% globally.
- Aura prevalence 28% among diagnosed migraineurs.
- Chronic migraine (>15 days/month) in 1-2% population.
- Episodic migraine (0-14 days/month) in 12-15%.
- Pediatric chronic migraine 1.8% prevalence.
Epidemiology Interpretation
When you stack the staggering global disability, the stark gender gap, and the vast ocean of silent suffering against its frequent dismissal as 'just a headache,' it becomes clear that migraine is a neurological tyrant whose widespread, debilitating reign we have catastrophically underestimated.
Impact
- Migraine causes $78 billion annual economic burden in US.
- Chronic migraine leads to 44 workdays lost per year per patient.
- 50% of migraineurs miss work/school due to attacks annually.
- Quality of life (SF-36) scores 20-30% lower in migraineurs.
- Depression prevalence 45% higher in migraine patients.
- Suicide attempt risk 2.5 times higher in migraine with aura.
- Stroke risk 2-fold in migraine with aura women under 45.
- Annual direct healthcare costs $11 billion in US for migraine.
- Indirect costs (lost productivity) $13 billion yearly in US.
- 25% of migraineurs have severe disability (MIDAS score >20).
- Migraineurs 2x more likely to have anxiety disorders.
- Global DALYs for migraine 16 million in 2019.
Impact Interpretation
Migraine is a neurological wrecking ball that not only shatters individual lives with pain and disability but also delivers a staggering $78 billion annual gut punch to the US economy, proving it's far more than just a bad headache.
Risk Factors
- Female sex hormones fluctuate, triggering 60% of migraines in women.
- Family history increases risk 3-4 fold; 50-60% heritability.
- Stress triggers 50-70% of attacks.
- Sleep disturbances (insufficient or excess) trigger 35-50% of migraines.
- Skipping meals provokes 40-57% of attacks.
- Alcohol (red wine) triggers 30-35%, caffeine withdrawal 15-20%.
- Sensory stimuli (bright lights 80%, strong smells 50%) common triggers.
- Obesity increases chronic migraine risk 5-fold.
- Depression comorbidity raises risk 2-5 times.
- Smoking doubles migraine risk in women.
- Oral contraceptives increase risk 2-3 fold in susceptible women.
- Weather changes (barometric pressure) trigger 30-50%.
- High caffeine intake (>200mg/day) triggers 14%.
- Low socioeconomic status correlates with 1.5-2x higher prevalence.
- Head trauma history increases risk 2-fold.
- Chronic medication overuse escalates episodic to chronic in 50%.
- Menstrual migraine in 60% of women, pure in 14%.
- Low magnesium levels trigger 50% in deficient.
- Dehydration triggers 33% of attacks.
- Chocolate triggers 20-30%.
- Hormonal replacement therapy increases risk 1.5-fold.
- Anxiety disorders precede migraine onset in 30%.
- Neck pain chronicity triggers 25%.
- Bright screens/fluorescent lights 52% trigger.
- Processed meats (nitrates) trigger 15%.
- Shift work disrupts sleep, triggering 40%.
- Olfactory triggers cause attacks with smell sensitivity 45%.
- Monosodium glutamate (MSG) triggers 10-20%.
- Raynaud's phenomenon comorbidity 25%.
- Epilepsy history increases risk 3-fold.
Risk Factors Interpretation
Your brain's migraine system is a temperamental diva who demands perfect hormonal balance, impeccable sleep, zero stress, and a timely meal, while also holding a grudge against your family history, your wine, your weather, and your paycheck.
Symptoms
- Migraine attacks last 4-72 hours untreated in 90% of cases.
- Unilateral head pain occurs in 60% of migraine episodes, bilateral in 40%.
- Throbbing or pulsating pain quality is reported in 85% of migraineurs.
- Photophobia accompanies 80-90% of migraine attacks.
- Phonophobia is present in 77% of attacks, osmophobia in 25-40%.
- Nausea occurs in 60-95% of migraine episodes, vomiting in 30-50%.
- Aura symptoms last 5-60 minutes in 99% of cases with aura.
- Visual aura (scintillations, zigzags) affects 90% of aura migraineurs.
- Sensory aura (paresthesias) occurs in 30-40% of aura cases.
- Prodrome symptoms (fatigue, mood changes) precede 60% of attacks by 24 hours.
- Postdrome (migraine hangover) lasts 24-48 hours in 80% of sufferers.
- Moderate to severe pain intensity (7-10/10) in 90% of untreated attacks.
- Aggravation by routine physical activity in 90% of cases.
- Neck pain accompanies 75% of migraine attacks.
- Allodynia (cutaneous sensitivity) during attacks in 70% of chronic migraineurs.
- Vertigo in 30-50% of migraineurs, known as vestibular migraine.
- Aura can include speech disturbances (aphasia) in 10-20%.
- Basilar-type aura (dizziness, ataxia) rare at <1% of auras.
- Facial sweating and nasal congestion in 20% during attacks.
- Pain worsens with movement in 89% of attacks.
- Blurred vision or blind spots in 25% aura cases.
- Diarrhea or constipation in prodrome 20%.
- Yawning excessively precedes 45% of attacks.
- Food cravings (sweet/salty) in 30-50% prodrome.
- Stiffness in neck/shoulders during 67% attacks.
- Dizziness/vertigo in 40% of attacks without aura.
- Hemiplegic migraine rare, <0.01% prevalence.
- Olfactory hallucinations (auras) in 10%.
- Cognitive fog during postdrome in 70%.
- 90% of untreated attacks last 24+ hours.
- Aura motor weakness in hemiplegic 100% by definition.
- Hyperacusis in 70-80% during attacks.
- Fluid retention precedes 40% menstrual migraines.
- Scalp tenderness in 60% post-attack.
Symptoms Interpretation
Migraine is less a headache and more a meticulously cruel, hours-long theatrical production featuring throbbing spotlights, nausea as a supporting actor, a 24-hour sensory hangover, and the persistent stage direction that any attempt at normal movement will worsen your review.
Treatments
- Triptans abort 70% of moderate-severe attacks within 2 hours.
- Prophylactic topiramate reduces attacks by 50% in 50% of patients.
- Beta-blockers (propranolol) effective in 50-60% for prevention.
- Botox injections reduce chronic migraine days by 8.4 per month.
- CGRP monoclonal antibodies (erenumab) cut attacks by 50% in 50%.
- NSAIDs (ibuprofen 400mg) relieve 50% of mild-moderate attacks.
- Rimegepant (oral gepant) pain freedom at 2h in 21% vs 11% placebo.
- Occipital nerve blocks provide relief in 70-80% for short-term.
- Cognitive behavioral therapy reduces attack frequency by 30-50%.
- Acupuncture decreases attacks by 50% in 53% of patients.
- Magnesium supplementation (600mg/day) prevents in 41% deficient patients.
- Feverfew herb reduces frequency by 24% over placebo.
- Neuromodulation devices (Cefaly) reduce days by 50% in 30%.
- Lasmiditan (5HT1F agonist) pain-free at 2h in 32% vs 15%.
- Verapamil effective for cluster but 40% for migraine prevention.
- Sumatriptan nasal spray 65% pain relief at 2h.
- Amitriptyline prophylaxis reduces attacks 50% in 60%.
- Candesartan as effective as beta-blockers, 50% response.
- Ubrogepant pain freedom 22% at 2h vs 14% placebo.
- OnabotulinumtoxinA (Botox) 50% responder rate 47%.
- Ibuprofen + caffeine combo 55% effective vs 40% alone.
- Yoga reduces frequency by 40% over 3 months.
- Coenzyme Q10 (100mg tid) 50% reduction in 48%.
- Petasites (butterbur) 68% response vs 45% placebo.
- GammaCore vagus nerve stimulator 40% pain reduction.
- Fremanezumab reduces monthly days by 7.6.
- Galcanezumab 50% responder 62% vs 39% placebo.
- Aspirin 900mg relieves 45% mild attacks.
- Venlafaxine 150mg prevents 50% in 55%.
- Nerivio device (remote electrical) 66% pain relief.
- Eptinezumab IV reduces days by 8.5 monthly.
- Atogepant oral CGRP reduces mMIDAS by 4.1.
- Biofeedback success in 70% for prevention.
Treatments Interpretation
Migraine treatment is a numbers game where we throw a lot of promising darts, but the board seems to have only three spaces: "works great for about half," "helps some of the people some of the time," or "hey, at least it's better than a sugar pill."
Sources & References
- Reference 1THELANCETthelancet.comVisit source
- Reference 2AMERICANMIGRAINEFOUNDATIONamericanmigrainefoundation.orgVisit source
- Reference 3PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 4CDCcdc.govVisit source
- Reference 5NCBIncbi.nlm.nih.govVisit source
- Reference 6WHOwho.intVisit source
- Reference 7ICHD-3ichd-3.orgVisit source
- Reference 8NICEnice.org.ukVisit source
- Reference 9CANADAcanada.caVisit source
- Reference 10NEJMnejm.orgVisit source