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Migraine prevalence was stable in the U.S. from 2006 to 2016 but the proportion of migraine patients with moderate or severe disability nearly doubled, a systematic review showed.

Across U.S. population-based studies, the proportion of people with migraine with moderate to severe disability rose from 22% in 2004 to 43% in 2016, reported Fred Cohen, MD, of Thomas Jefferson University in Philadelphia.

Disability levels remained high, affecting 42% of people with migraine in 2018, Cohen said during a presentation at the American Headache Society annual meeting.

Migraine disability has been assessed in several large-scale epidemiologic studies over the past 30 years. Looking at serial snapshots may offer insight into changing disease patterns, Cohen observed.

"We set out to do a systematic review to analyze these studies for trends in migraine prevalence and burden over time," he said.

"Migraine and burden has been defined in different ways across various studies," he pointed out. "Some studies have used criteria from the International Classification of Headache Disorders [], while others have used self-reported diagnosis of migraine or included severe headache."

Cohen and co-authors limited the studies they used in their review to ones published before February 2022 with a representative U.S. sample. The studies all used a migraine screener based on the ICHD. U.S. government surveys that included self-reported medical diagnoses of migraine were excluded.

Disease burden was assessed with the Migraine Disability Assessment Scale (), a measure of the effect of headache attacks on daily school, work, home, or social activities over 3 months. MIDAS defines moderate (grade III) or severe (grade IV) disability based on scores of 11 or more points.

A total of 11 population-based studies that assessed either episodic or chronic migraine from 26 publications met the final eligibility criteria.

For the past 30 years, the prevalence in the U.S. population remained relatively consistent: 11.7% to 14.7% overall, affecting 17.1% to 19.2% of adult women and 5.6% to 8.2% of adult men. Migraine prevalence consistently was two to three times higher in women versus men.

Prevalence data for chronic migraine were sparse, with the American Migraine Prevalence and Prevention () study reporting a rate of 0.91% (1.29% among females and 0.48% of males), and the Chronic Daily Headache in Adolescents study () reporting a rate of 0.79% among adolescents.

The percentage of patients reporting 15 or more monthly headache days rose from 6.8% in the 2005 AMPP cohort to 11.7% in the 2018 cohort.

The proportion of people with migraine with moderate to severe disability (MIDAS III/IV) also rose from 22% in 2004 to 39% in 2012, and then to 43.2% in 2016. It was 42.4% in 2018. Women consistently reported a higher prevalence of MIDAS III/IV scores than men.

This increase in MIDAS disability was unexpected and needs to be explored, Cohen said. Changes in methodology might account for part of the increase: early studies like the AMPP were mailed questionnaire surveys, while newer studies like OVERCOME used online panels. Notably, response rates have declined over time, which may have led to bias, he added.

It's also possible cultural changes are a factor, Cohen observed. "Nowadays, we have commercials with Serena Williams talking about migraine but in the '90s, we didn't have that," he said. "It wasn't as talked about."

Shifts in national trends like opioid use and unemployment also may contribute to migraine disability, as may environmental stresses and triggers, Cohen noted. The next steps involve analyzing the most recent OVERCOME data from 2020 and examining the role migraine treatment patterns might play, he added.

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