46 Treatment of Headache

In an epidemiological study of migraine [2] using a self-administered questionnaire filled out by 23,611 individuals from 9,507 American households, 17.6% of women and 5.7% of men between ages 12 and 80 years had headaches that met a definition of migraine that was based on a modification of the International Headache Society’s criteria [1]. Projections from this study to the country as a whole indicate that 18 million women and 5.6 million men over age 12 suffer from severe migraine headaches. Diagnostic criteria for migraine with and without an aura are given in >Table 146‐2. Among these individuals, a projected 8.7 million women and 2.6 million men have moderate to severe disability from headache [2]. Fifty-five percent of men and seventy-two percent of women never consult a doctor for a headache problem [3]. Among those who seek medical attention, 44.5% of men and 46.3% of women consult family practitioners. With increasing awareness of headache as a biological problem, it is expected that a larger number of migraine patients will seek help for this condition. Migraine can occur with or without an aura (warning symptoms). The most common aura is visual in nature, although neurological auras such as hemisensory disturbances, hemiparesis, dysphasia, and changes in memory and state of consciousness occur occasionally. Migraine