Patterns of health care utilization for migraine in England and in the United States.
OBJECTIVE
To assess patterns of medical consultation, diagnosis, and medication use in representative samples of adults with migraine in England and the United States.


METHODS
Validated computer-assisted telephone interviews were conducted in the United Kingdom (n = 4,007) and the United States (n = 4,376). Individuals who reported six or more headaches per year meeting the criteria for migraine were interviewed.


RESULTS
Patients with migraine in the United Kingdom were more likely to have consulted a doctor for headache at least once in their lifetime (86% vs 69%, p < 0.0001), but also were more likely to have lapsed from medical care (37% vs 21%, p < 0.001). In the United States, patients with migraine who had consulted made more office visits for headache and were more likely to see a specialist. In the United States, but not in the United Kingdom, women with migraine were more likely than men to consult doctors for headache. Patients with migraine in the United Kingdom were more likely to receive a medical diagnosis of migraine (UK 67%, US 56%; p < 0.05). Patterns of medication use were similar in both countries, with most people treating with over-the-counter (OTC) medications. Substantial disability occurred in a high proportion of those who never consulted (UK 60%, US 68%), never received a correct medical diagnosis (UK 64%, US 77%), and treated only with OTC medication (UK 72%, US 70%).


CONCLUSIONS
Medically unrecognized migraine remains an important health problem both in the United States and the United Kingdom. Furthermore, there may be barriers to consultation for men in the United States that do not operate in the United Kingdom.
Lipton
R B
RB
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA. Rlipton@aecom.yu.edu
Scher
A I
AI
Steiner
T J
TJ
Bigal
M E
ME
Kolodner
K
K
Liberman
J N
JN
Stewart
W F
WF
D000293:Adolescent; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D004363:Drug Utilization / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy*; D004366:Nonprescription Drugs / Q000627:therapeutic use; D009819:Office Visits / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D017678:Sex Distribution; D012737:Sex Factors; D014481:United States
D004366:Nonprescription Drugs