Understanding Research: What is the American Migraine Prevalence and Prevention (AMPP) Study and what have we learned from it?
By: Dawn C. Buse, PhD
When reading about headache research, you may have heard of The American Migraine Prevalence and Prevention (AMPP) Study. Even if you have not heard of the study, you may already know some of the findings such as the fact that migraine affects about 12% of adults in the United States. In order to be a careful consumer of research, it is important to know the background, methods and funding of a research study.
The AMPP study is a longitudinal, population-based study of individuals from the United States with “severe” headache. Longitudinal means that the data were collected over a period of time, rather than just once (which would be called a “cross-sectional” study.) The AMPP study was designed by the “primary investigator”, Richard B. Lipton, MD and a team of expert advisors including physicians and scientists (called the “Advisory Board”). I am a “co-investigator” on the AMPP study. The AMPP study was approved and monitored by the Albert Einstein College of Medicine, Institutional Review Board. The study was funded by a grant from Ortho-McNeil Pharmaceuticals to the National Headache Foundation. In 2009, Ortho-McNeil Pharmaceuticals donated the database to the National Headache Foundation in 2009 so that researchers could continue to learn from the database. After 2009, several different pharmaceutical companies came together to support the research, although the research was always conducted and written by Dr. Lipton and his colleagues.
In 2004, questionnaires were mailed to 120,000 households in the US. The questionnaires contained questions about headache occurrence, symptoms, medication use, and missed time from work because of headache along with many other questions. The surveys were developed and based on questionnaires used in two previous, large-scale studies of migraine in the United States: the American Migraine Studies 1 and 2 and also included other instruments and questionnaires. The instructions stated that the “head of the household” should complete the survey. Three additional household members with headache were also asked to complete the survey. Surveys were returned by 77,879 households which included 162,756 household members age 12 and older. 30,721 respondents reported that they experienced “severe headache” and 28,261 had experienced “severe headache” in the preceding year. These responses allowed researchers to determine that almost 12% of people in the United States experience migraine (about 17% of adult women and almost 6% of adult men).1 They were also able to determine that almost 1% of people in the US experience chronic migraine (a diagnosis of migraine with headache on 15 or more days per month).2 From those data they were also able to determine that people with chronic migraine missed more work and school and were more likely to have depression, anxiety and other medical conditions than people with episodic migraine (or migraine with less than 15 headache days per month on average).
For “Phase 2” of the study, researchers selected 24,000 of the people who reported that they had “severe” headache in the preceding year from the 2004 survey and asked them to complete additional surveys once a year from 2005-2009. These surveys were much longer and contained a broad array of questions which have allowed researchers to learn much more about the lives of individuals who live with severe headache. Some of the things that we have learned from the AMPP Study so far include:
- Migraine occurs in about 12% of people age 12 and older in the United States (17% of women and 6% of men). It is about three times more common in women than men. It is most common in midlife, and rates decrease after age 60.
- Almost 1% of people in the US experience chronic migraine, which equals 1.5 million women and more than more than half a million men in the United States who experience migraine more days than not, some of whom live with migraine every day. Chronic migraine is most common in women, in midlife, and in households earning less income.
- Depression and anxiety are about twice as common in people who have migraine compared with those who do not. And even more common in people with chronic migraine. Having depression makes it more likely that someone with episodic migraine will develop chronic migraine.
- Almost half of people with episodic migraine have nausea with their headaches half the time or more. These people have more symptoms associated with their migraine headache, are more likely to miss work or school because of migraine, and more likely to be “on disability”.
- Almost 20% of people in the AMPP database have tried opioids for headache management, but it is associated with many problems. A small percentage of opioid users developed dependence. They were also more likely to use healthcare resources for headache more including the emergency department, were more likely to be depressed or anxious, and more likely to be “on disability”.
There are also published manuscripts from the AMPP database on the prevalence of allergic rhinitis, allergies, rates of childhood abuse and maltreatment, use of the emergency department for headache, and cost of migraine and other severe headaches to individuals, employers and society among other topics. To date, there have been more than 40 manuscripts published and about 200 presentations given at scientific meetings (called “abstracts”) from the AMPP database. More research is currently underway examining new topics. Through this research we hope to continue to learn more about migraines and other severe headaches, which allows for a better understanding of the effect of these headaches on the lives of people who live with them. A complete list of the AMPP Study scientific articles is available at: http://dawnbuse.com/ampp.html. Article abstracts (summaries) are available by clicking on the title.
1. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 68(5):343-9, 2007.
2. Buse, D.C., Manack, A.N., Fanning, K., Serrano, D., Reed, M.L., Turkel, C.C., Lipton, R.B. Chronic Migraine Prevalence, Disability, and Sociodemographic Factors: Results from the American Migraine Prevalence and Prevention Study. Headache 52(10):1456-1470, 2012.
Dawn C. Buse, PhD is the Director of Behavioral Medicine for the Montefiore Headache Center, in New York, NY, an Associate Professor in the Department of Neurology of Albert Einstein College of Medicine and an Assistant Professor in the Clinical Health Psychology Doctoral Program of Ferkauf Graduate School of Psychology. She is also a co-investigator on the American Migraine Prevalence and Prevention (AMPP) Study.