Are Two Head(ache)s Better Than One

Migraine is a common and debilitating condition that virtually all neurology clinicians see regardless of specialty. In a recent systematic review of the US adult population, 20.7% of women and 9.7% of men experience a migraine attack over a 3-month period. Migraine also disproportionately affects those with limited access to health care including the unemployed and those with lower family incomes.¹ The World Health Organization studies global burden of disease (GBD) to inform health decision making. In 2016, the GBD for all diseases worldwide found that tension-type headache was the third most prevalent and migraine the sixth. In terms of years of life lived with disability, migraine ranked second globally.² Given these statistics, it is not surprising that migraine is costly. A 2018 study found that patients with migraine had total annual direct costs (health care) plus indirect costs (missed work and short- and long-term disability) that were $8924 higher than those of demographically similar individuals without evidence of migraine.³ What these data do not capture is the impact on career trajectory, family involvement, interpersonal relationships, and identity, which is likely to be much greater.