We have worked to build public awareness about the impact of headache as a serious disorder that can disrupt quality of life and, at its worst, destroy quality of life for chronic sufferers. Over the course of the decade, doctors, patients and their families have come to understand that migraine and other forms of headache develop because of biological, not psychological, differences. Still, missed diagnoses and inadequate treatment are common in North America, compared, for example, to Sweden, where 90% of migraine patients have been diagnosed.
The American Headache Society (AHS, formerly the American Association for the Study of Headache), our parent organization, has made considerable efforts in this regard. Leading medical educators have been invited to AHS educational meetings and provided with resources for teaching young doctors about the major headache disorders. This long-term initiative will pay off over the years by better preparing doctors to recognize and treat headache disorders. For doctors already in practice, AHS will launch preceptorships across the country, to supplement continuing education programs already in progress at specialty centers and nationwide training programs for primary care physicians.
Through our acclaimed newsletter and web site, ACHE makes a wide range of educational resources available to physicians, patients, families, schools and employers. We are continually expanding our outreach and our ability to educate those in need. Our support groups–50 in all–have flourished over the years in locations throughout the nation. AHS advisors are available as consultants to ACHE’s support groups, helping them to address the questions and needs of participants.
Major scientific advances have been achieved in uncovering the step-by-step mechanisms of headache and its genetic underpinnings. From the perspective of acute care, we’ve witnessed the launch of the second generation triptans, along with improved formulations of DHE and sumatriptan. Truly these agents have profoundly contributed to our ability to treat migraine effectively and quickly. Future research will continue the search for even more effective agents with improved tolerability and safety. Advances in preventive strategies have also occurred with the approval of valproate for the prevention of migraine and with studies of related agents such as gabapentin. Research into more effective preventive strategies with greater tolerability is also underway. Studies with non-drug agents such as vitamin B2 (riboflavin) and magnesium are also promising.
Most recently, AHS and ACHE have focused attention on the needs of women with hormonally linked headache conditions. In conjunction with AHS’s Women’s Issues Group, we are currently working on the development of a special section of ACHE’s web site devoted to women’s issues.
The development of easy-to-use disability instruments such as the Migraine Disability Assessment Scale (MIDAS) and the Headache Impact Test (HIT) may be very useful in helping doctors recognize the impact of headache on the patient’s daily life. We hope these new tools will improve doctor-patient communication and treatment. The MIDAS survey is now available here on the ACHE web site.
Finally, both AHS and ACHE continue to attempt to work with managed care organizations to improve access to care and appropriate therapy.