Quality of life in migraine

Migraine headaches vary in severity from moderate pain with no activity limitations to severe pain and prolonged incapacitation undermining severely the quality of life. The physical, emotional, social, and economic burdens of headache are poorly acknowledged in general practice. Both moderate and severe disabling migraines have a profound impact on HRQoL. In addition to disease-specific measures, enhancing daily functioning and well-being are increasingly advocated goals. The evolution of the measurement of QoL in migraine has followed a progression from being discriminative, to evaluative, to predictive. HRQoL measures have not only added another dimension to migraine clinical trials endpoints but have also led to research predicting response to therapy. To measure the effect of headache and the effectiveness of therapy, instruments (generic and disease specific) have been developed that assess headache patients' perceptions of personal functioning and well-being during or between attacks. Disease specific instruments are more sensitive in evaluating variations in patient perceptions of HRQoL during the course of disease. Most HRQoL research in migraine has been conducted in subspecialty clinics or patients participating in clinical trials which are more likely to be refractory to treatment than subjects with migraine in the community, thus not representative of patients with migraine in the community. Population-based studies have the strength of identifying and inclusion of cases that otherwise do not come to the attention of the health care system. Migraine and depression exert a significant and independent influence on HRQoL. The qualitative studies further help to gain insight into the management of migraine from the patients' perspective, as the patients' perceptions of migraine and expectations from treatment are sometimes conflicting and thus influencing the patients' behavior. The incorporation of HRQoL measures in the treatment of patients with migraine is an increasing and valued practice by its specialists. The research on newer pharmaceuticals should focus on impact of headache on QoL, and outcomes. Such data is needed to compare prophylactic with abortive therapies or to compare outcomes among different therapeutic agents.