Ten lessons on the epidemiology of migraine.

The epidemiologic studies of the last 15 years have taught many lessons that will help define the clinical and research agenda in migraine for the next 15 years. Because the condition is common, disabling, and costly (Lesson 1) and because it has major comorbidities (Lesson 2), migraine is an important target for treatment. Because consultation, diagnosis, and effective treatment rates are low (Lessons 3 and 4) it is important to develop strategies for closing the gap between treatment available and treatment delivered in the primary care setting where the majority of patients seek care (Lesson 5 and 6). Strategies include public and provider education as well as the use of screening tools such as ID-migraine to improve the recognition of migraine in primary care (Lesson 7). In addition, strategies that measure disability, with tools such as MIgraine Disability ASssessment, when coupled with treatment guidelines which consider illness severity in the selection of treatment provide great hope for improving patient outcomes (Lesson 8). Finally, the emerging evidence that migraine is progressive in a subgroup (Lesson 9) mandates the development of strategies to reduce the risk of progression by addressing modifiable risk factors and by assessing the effects of treatment on headache progression (Lesson 10).