HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

Correspondence to:

BRIEF COMMUNICATIONS: Randolph W. Evans, Richard B. Lipton, and Stephen D. Silberstein The prevalence of migraine in neurologists Neurology 2003; 61: 1271-1272 [Abstract] [Full text] [PDF]

Correspondence: Submit a response to this article

Correspondence published:

Reply to Sacks

Randolph W. Evans, MD, Richard B. Lipton, MD, Stephen D. Silberstein, MD   (3 December 2003)

The prevalence of migraine in neurologists

Oliver Sacks, MD   (3 December 2003)

Reply to Sacks 3 December 2003
Randolph W. Evans, MD 1200 Binz #1370, Houston, TX 77004, Richard B. Lipton, MD, Stephen D. Silberstein, MD Send Correspondence to journal: Re: Reply to Sacks rwevans{at}pol.net Randolph W. Evans, MD, et al.	We thank Dr. Sacks for his comments about our survey and the study by Alvarez [2]. Alvarez reports on 44 physicians with migraine interviewed at a medical convention. Eighty-seven percent had migraine aura without headache, a much higher proportion than reported by the neurologists in our survey. In addition, of 618 migraineurs seen in his specialty practice, 12% of the men and 0.7% of the women reported scotomas without headache. In a large well-designed Danish study, Russell et al [4] found a much lower lifetime prevalence of aura without headache (1% of males and 3% of females). The results of Alvarez are limited by the potential for selection bias and the lack of a well-specified case definition of migraine. We were also fascinated by Dr. Sacks’ personal history of rare migraine auras leading to his interest in neurology. Though the burden of migraine and other headaches on employment is enormous [5], this anecdote indicates an important previously unrecognized benefit. Although the prevalence of migraine is 66.6% among the authors of this publication (RWE and SDS), we believe that our career choices were independent of our personal medical histories. References 4. Russell MB, Rasmussen BK, Thorvaldsen P, Olesen J. Prevalence and sex-ratio of the subtypes of migraine. Int J Epidemiol 1995;24:612-618. 5. Stewart WF, Ricci JA, Chee Elsbeth, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA 2003;290:2443-2454.
The prevalence of migraine in neurologists 3 December 2003
Oliver Sacks, MD, Neurologist New York, NY Send Correspondence to journal: Re: The prevalence of migraine in neurologists kateedgar{at}oliversacks.com Oliver Sacks, MD	I was fascinated by Evans et al's article [1] but surprised to find no reference to Alvarez's 1960 paper on the prevalence of migraine scotoma in physicians. He observed, in a group of 44 physicians, that no less than 87% had experienced "many solitary scotomata with never a headache," whereas in the general population (here he studied more than 600 patients) no more than 12% reported having experienced scotomata. [2] Speculating on the possible reasons for the prevalence of migraine in neurologists, and particularly headache specialists, Evans et al. wonder, among other possibilities, whether "a personal history of migraines might stimulate an interest in neurology and headache as a subspecialty." For myself, with a personal history of classical migraines (and, more often, isolated visual ones) going back to childhood, the extraordinary phenomena of the aura (which for me included transient or partial achromatopsia, akinetopsia, as well as visual agnosias, alexias, etc), excited an interest in the brain, and especially in visual processing, at an early age. These migraines were certainly one of the reasons I was attracted to neurology, why I chose migraine as the subject of my first book, and why I devoted a large part of this book to illustrating the varied presentations of visual auras in my patients. [3] References 1. Evans RW, Lipton RB, Silberstein SD. The prevalence of migraine in neurologists Neurology 2003; 61: 1271-1272. 2. Alvarez, WC. The Migraine Scotoma as Studied in 618 Persons. Amer. J. Ophthalmology 1960, 49: 489. 3. Sacks, OW. Migraine. University of California Press, 1970. see esp. pp 72-115.