Migraine in America: Early Symptoms and Diagnosis

While head pain is widely understood as the primary symptom in patients with migraine, there are many other symptoms that patients experience that can have a great impact on their overall quality of life. We took a closer look at the initial symptoms experienced by migraineurs, and how these symptoms related to the diagnostic process.  We examined data from the Migraine In America 2015 online survey, which gathered insights from over 4,500 patients currently diagnosed with migraines.  The survey ranged in its spectrum of questions, from symptoms and diagnosis to treatment experience to migraine’s life impact.  Survey respondents were from across the U.S., primarily female and over the age of 40, as well as being married with children. Over half of respondents experienced 8 or more migraine attacks each month, and almost half experienced migraine symptoms on 15 or more days a month.

Across those patients surveyed, the average number of initial symptoms reported was 10.3, however a majority experienced ten or fewer (62%) and only 3% experienced 30 symptoms or more.  As expected, head pain is accounted as the primary complaint among patients (87%).  Other initial symptoms prominently reported included:

• 72% - Sensitivity to light
• 61% - Sensitivity to sound
• 49% - Moderate to severe nausea
• 48% - Sensitivity to smell

Additional initial symptoms experienced by over a third of patients (37%) included neck pain, eye pain and vomiting. While unusual and infrequently reported, initial symptoms also consisted of hiccups, euphoria, swollen lymph nodes, sneezing and itchy nose (reported by less than 3% of those surveyed).  In further investigation, this myriad of initial symptoms was found to affect patients throughout their migraine journey.

An interesting finding was that a ¼ of patients were able to identify a specific event or incident that coincided with the start of their migraines, and almost 30% were unsure if there was such an event. Almost half of these “incidents” were associated with hormonal changes, typically menstruation, as well as puberty, childbirth, pregnancy or menopause; primarily reported by female patients.  Highly stressful events were also mentioned, such as abuse, death of a loved one, divorce or loss of a job.  One in 5 of those able to identify an event individuals cited head injury or trauma.

71% of patients surveyed had immediate family members who also suffered from migraines

A total of 59% of patients reported experiencing migraine related symptoms before reaching adulthood. For most of these individuals, migraine onset occurred throughout their adolescence. Of those experiencing migraines before adulthood, 42% were at least moderately impacted by them.  Those with such impact found their school attendance to be most affected (67%), as well as their social life/relationships with peers (48%).  About a 1/3 had their participation in sports/athletics impacted.

In examining the survey data, trends indicate that younger patients experienced a shorter duration between initial symptoms and their diagnosis of migraines. Almost half (49%) of survey respondents went at least 5 years between initial symptoms and migraine diagnosis; 15% of went more than 15 years.  A total of 27% of patients were able to obtain their migraine diagnosis within less than a year.

Among diagnostic physicians, it was typically the patient’s PCP/family physician (45%), with only 26% being diagnosed by a neurologist and even fewer by a headache specialist (3%).  Eighty-seven percent of patients have been diagnosed with a particular type or classification of migraines.  Further, 30% of those surveyed have been classified as migraine with aura and 10% as migraine without aura.

It is not surprising that among those surveyed, most were classified as chronic, since 48% of respondents were impacted by migraines 15 or more days a month at the time of taking the survey.  Sixty five percent indicated they have been diagnosed as chronic by their HCP, however only 62% of such individuals fit the classification based on their migraine frequency.  However 83% of those who have migraines 15 or more days a month have been classified as chronic by a healthcare professional.

The impact of migraines on a patient’s quality of life is significant given the numerous symptoms associated with this condition. Unfortunately, most patients suffering from migraines are not diagnosed within a short period of experiencing their first symptoms, which may be due to the wide variety in symptoms, family history, and possible occurrence of a life event leading to diagnosis. It is critical that practitioners understand that the presentation of migraine is not the same across all patients, and personalized care is the best way to optimize treatment of this condition.