The impact of migraine is that it is the most common neurological condition in the world. It is also the most frequently seen disabling headache in primary care. In Ireland, 12-15% of the population have migraine. Only about half of these 500,000 people are actually diagnosed and even fewer are receiving treatment for their condition.
Because of this, migraine continues to have a huge impact not only on people’s professional, social and family lives but also on the Irish economy in general. Indeed, it is this impact that distinguishes migraine from other benign headache disorders.
It is common for patients with severe migraine to say that the condition has taken control of their lives. Many claim that at its height, migraine is the worst pain they have ever experienced.
Despite the severity of the pain involved and the huge personal impact it has, some people still do not seek treatment at all in the mistaken belief that headache disorders are untreatable or not recognised as ‘real’ medical conditions.
The truth of the matter is that migraine is an increasingly well-understood condition that can be effectively managed through primary care in the majority of cases.
Assessing the impact of Migraine
Before initiating a treatment plan for a patient with migraine, it is important to assess the level of disability the condition causes that individual and base the treatment plan accordingly. It can be very difficult to gauge this effect however, as the symptoms and impact of migraine can vary from person to person. In addition, patients sometimes have difficulty describing the nature of the pain or the symptoms involved.
There are two simple questionnaire-based tests that may assist when assessing the impact of migraine on a patient. These tests can be filled out in about two minutes by either the patient or the medical professional. On-line as well as paper versions are available for both.
The Headache Impact Test (HIT)
The patient answers six questions relating to the severity and impact of their headache. For each question there are five alternatives, with a scoring scale from 6 to 13 points. The higher the overall score, the greater the impact on the patients life. There are four levels of impact that an individual can fall under ranging from ‘No/ Little impact’ to ‘Very Severe’.
The web-based version formulates a personalised report based on the patients individual answers and a pool of collected data. An interpretation of the score and suggested action steps are also recommended.
The Migraine Association of Ireland
is a Non-Profit Patient Charity
(Migraine Disability Assessment Score)
Consists of seven questions, five of which are attributed scores and two that are included to provide qualitative information. The five ‘scoring questions’ calculate the number of days lost by the patient in:
- Household work
- Non-work activities (leisure/social time)
The MIDAS score is calculated by adding up the total days lost in the last three months in each of the areas. There are four grades of severity defined in terms of the disability suffered. Treatment recommendations are given corresponding to each grade.
These tests have a number of key benefits for medical professionals and patients alike:
- They are useful in summarising the effect of headache/ migraine on the individual
- Standardised approaches to measuring headache related disability
- They have both been validated and proved accurate
- They offer an opportunity to allow better communication between doctor and patient
- They are both easy to follow and access
- Patients can use the tests to see if their condition is improving or worsening