[49] Prospective studies of children with headache have indicated an increased risk for both headaches and somatic and psychiatric symptoms in adulthood.[110] Research into the possible mechanisms underlying these associations, however, remains limited. Studies examining the order of onset and cross-transmission of migraine and psychiatric disorders in controlled family

studies have been unable to clearly distinguish between causal and common etiological models of association.[111, Crizotinib in vivo 112] Comorbidity has a major impact on migraine sufferers’ quality of life and disability, and is associated with a poorer course and outcome of migraine. As such, comorbidity may comprise an index of severity of migraine. For example, simultaneous investigation of somatic and psychiatric comorbidity in headaches and migraine has demonstrated greater health care utilization and negative health perception among those with comorbidity.[49, 54] In fact, about 65% of migraine-associated disability can be attributed to comorbid physical and mental disorders. These recent community studies have confirmed previous evidence regarding the enormous personal and social burden click here of migraine in terms of both direct and indirect costs. Over 80% of those with migraine report some degree of disability. The finding that young

adults with migraine suffer from migraine for an average of 1 month of every year across 30 years of prospective follow up highlights the cumulative impact of migraine during the peak period of attainment of educational, occupational years, and social milestones of adult life.[28] In the U.S. AMPP study, one third of those with migraine had 3 or more attacks per month, and more than half reported severe

impairment requiring bedrest.[113] Children with migraine have been consistently shown to have more recurrrent illnesses,[114] school absences, decreased academic performance, social stigma, and impaired ability MCE公司 to establish and maintain peer relationships.[8, 35, 55, 65, 76] In fact, the quality of life in children with migraine is impaired to a degree similar to that in children with arthritis or cancer.[115] Severe headaches and migraine not only have substantial impact on the affected individual but they also have major economic impact due to medical expenses and employer costs.[116-118] The direct costs of migraine in Europe have been recently estimated at 100 to 781 euros per subject,[116] with a total annual cost of migraine of 111 billion euros.[118] The European study of the impact of brain diseases revealed that migraine has the greatest health care costs of all of the neurologic disorders investigated including epilepsy, multiple sclerosis, Parkinson’s disease, and stroke.[119] Comparable direct (Hawkins[120]) and indirect (Hawkins[121]) costs of migraine have been estimated in the U.S. and in 2012, the estimated annual U.S. health care costs for migraine associated with: outpatient visits were $3.