A narrative review on the burden of migraine: when the burden is the impact on people’s life

BACKGROUND: The burden of headache disorders, and of migraine in particular, is multifaceted and fragmented. The aim of this narrative review is to provide a description the main topics underlying the concepts of burden and impact of migraine disorders. MAIN RESULTS: MedLine has been searched for publications covering the period 1990–2018 dealing with the terms burden or impact of migraine, including both episodic and chronic migraine. The main results and themes are reported in a descriptive way, and were grouped by similarity of content into overarching categories. A total of 49 papers, published over 25 years (1994–2018), were retained for the qualitative analysis. Six main themes were identified: prevalence of migraine disorders, overall impact of migraine disorders, impact on work or school activities, family impact, interictal burden, and disease costs. Majority of included studies concluded that patients with migraine reported an higher burden or impact in one or more of the six main themes herein identified, compared to non-headache patients or to patients with tension-type headache, with a tendency towards worse outcomes consistently with higher headache frequency. CONCLUSIONS: The results of this narrative review show that the meaning of a sentence like “migraine is a burdensome condition” is not univocal: rather, it may refer to different concepts and meanings. In our opinion, future research should focus on understanding and facing the impact of migraine on work-related activities and on everyday life activities, as these aspects are highly connected to some tangible (i.e. cost) and less tangible (i.e. interictal burden and reduced quality of life) facets of migraine burden. Disease-specific measures have been implemented and should be exploited to enhance our understanding of migraine burden. This approach would allow to better understand the real impact on people’s life of such a burdensome disease.