Neurologists More Apt to Suffer Migraines

Megan Brooks

August 09, 2012

August 9, 2012 — A new study provides additional evidence that migraine is more common among neurologists than the general population.

The study of Norwegian neurologists joins studies from several other countries — including the United States, Canada, Germany, Italy, Spain, Taiwan, and the United Kingdom — that have shown an increased prevalence of migraine headache among neurologists.

This study was published online July 23 in Headache.

So why are neurologists more prone to migraine? "We can only speculate," lead author Karl B. Alstadhaug, MD, PhD, of the Department of Neurology at Nordland Hospital, in Bode, Norway, told Medscape Medical News.

"Neurologists may be predisposed due to stressful jobs; perhaps they are overly vigilant for symptoms, or perhaps they became neurologists due to interest in their own affliction," he said.

Randolph Evans, MD, clinical professor of neurology at Baylor College of Medicine, in Houston, Texas, said it is possible that "migraines are more common in neurologists than in the general population because of occupational stress." Dr. Evans was not involved in Dr. Alstadhaug's study.

He also noted that "5 surveys have found an increased prevalence of migraine among general practitioners. Additional surveys of other physician specialties and other occupations would help to confirm this hypothesis," he said.

Migraine Twice as Common in Neurologists

Of the 384 neurologists registered with the Norwegian Medical Association on March 19, 2010, 245 (63.8%) responded to a survey on migraine, including 151 men (mean age, 58.4 years) and 92 women (mean age, 48.6 years). Two respondents did not indicate age.

Ninety-five (39%) participating neurologists reported having experienced migraine aura, and 86 (35%) said they had experienced migraine headache.

The overall age- and gender-adjusted 1-year prevalence of migraine headache was 26.3% — more than twice that typically found in the Norwegian population (13.2%), the researchers say.

In other Scandinavian populations, the prevalence of migraine is between 11% and 15%, roughly. It's about 15% in Europeans, and worldwide prevalence is around 11%, the authors note.

"This was so even if our definition was more strict than usual, requiring at least 2 attacks during the last year," they note.

NSAIDs Preferred Over Triptans?

Seventy percent of neurologists surveyed believed that migraine was underdiagnosed, and 68% thought it was undertreated, yet less than half of the neurologists said that they used triptans to treat their migraine pain; most used over-the-counter medications instead.

This finding suggests that they had "fairly mild migraines," Dr. Alstadhaug told Medscape Medical News, or that they may prefer to use nonsteroidal anti-inflammatory drugs (NSAIDs) for their own migraines.

Dr. Alstadhaug noted that although several studies have documented a higher prevalence of migraine among neurologists, "in all of them, the study populations were highly selected." He said his study "also probably suffers from selection bias, but even if all of the nonresponders were migraine-free, the prevalence of migraine in neurologists would be higher than in the general population."

Dr. Evans said that selection bias might have been a factor in a 2003 survey of 220 US neurologists conducted by his team, which also found a higher prevalence of migraine in neurologists relative to the general population, because the neurologists surveyed were attending a headache course.

"However, in the same [article], we also reported a second survey of 45 neurologists attending a general neurology review course and found a similar prevalence of migraine," he said.

As previously reported by Medscape Medical News, a 2011 report from the World Health Organization (WHO) concluded that worldwide, headache disorders are prevalent but are not sufficiently recognized, diagnosed, and treated.

The authors have disclosed no relevant financial relationships. Dr. Evans is a member of the Medscape editorial advisory board.

Headache. Published online July 23, 2012. Abstract

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