Prevalence, recognition rate and self-awareness of migraine in Germany 2004

Introduction: Migraine is a common headache disorder which has a considerable individual and societal impact. However, the recent prevalence of migraine in the general population in Germany and the agreement between diagnoses by IHS criteria, diagnoses by treating physicians and self-awareness of migraine are unknown.

Methods: Nation-wide telephone survey of a representative sample of the general adult population in Germany (modified random digit dialing sampling design, n=7341). A diagnosis of migraine was assigned based on the 2003 IHS criteria if respondents reported 1) severe headaches in the past year, 2) unilateral or pulsatile pain or aggravation of pain by routine physical activity, 3) nausea/vomiting or photo- and phonophobia and 4) a duration of attacks of 4 to 72 hours. A simplified question for visual auras was used (flickering lights or lines for at least 5 minutes).

Results: The 12-months prevalences were: headaches 67% in women and 53% in men, migraine 15.6% in women and 5.3% in men (overall population prevalence 10.6%), migraine with visual aura 5.5% in women and 1.5% in men. The majority of migraineurs (56%) had more than 20 headache days in the previous 12 months, 25% had 10–20 headache days and 19% less than 10 days. However, only 42% had a medical follow-up for their headaches in the last year and in only 11% of these the main treating physician was a neurologist. Migraine was recognised by the treating physician in the previous 12 months in only 63% of migraineurs (moderate agreement, kappa=0.40). Migraine self-awareness was slightly higher (70% of all migraineurs, kappa=0.46). Multivariate analysis of the association of the individual migrainous features with self-awareness and physician recognition of migraine revealed that both awareness and recognition were best in the presence of vomiting, photophobia with phonophobia and unilateral pain.

Discussion: Migraine is highly prevalent in the general population in Germany. Our results confirm previous findings which show similar and stable prevalence estimates in industrialised countries despite differences in study methodology. The rate of physician-diagnosed migraine among migraineurs by IHS criteria is unsatisfactory, although it compares favourably with rates reported from other countries. Physician recognition of migraine and patient awareness need to be improved since they are essential for the proper use of current effective treatments of migraine.