Demographic profile of respondents
The electronic survey received 170 total responses. Only 131 (77.1%) of the total responses were complete, emanating from the United Kingdom (84.0%), Germany (2.3%), Austria (1.5%) and the United States (12.2%); Table 1. The majority (92.4%) of respondents were female. Respondents had a median age of 39 years (IQR 29–51) with a range of 18 to 74 years. Eighty-three percent were educated to a university degree or higher, and 60.3% were employed. More than half (51.9%) were married, 20.6% were in a domestic relationship, and 17.6% were single. The majority (90.8%) identified as white ethnic background.
Table 1
Respondent characteristics
| N | (%) |
Age band (years) |
18–29 | 34 | 26.0 |
30–39 | 34 | 26.0 |
40–49 | 28 | 21.4 |
50–59 | 24 | 18.3 |
60–69 | 9 | 6.9 |
70–79 | 2 | 1.5 |
Gender |
Female | 121 | 92.4 |
Male | 8 | 6.1 |
Other | 2 | 1.5 |
Country |
United Kingdom | 110 | 84.0 |
Germany | 3 | 2.3 |
Austria | 2 | 1.5 |
United States | 16 | 12.2 |
Ethnicity |
White | 16 | 55.2 |
Mixed/Multiple ethnic groups | 0 | 0.0 |
Asian/Asian-British | 10 | 34.5 |
British Black/African/Caribbean | 1 | 3.4 |
Other | 2 | 6.9 |
Education |
A levels/ College | 13 | 10.0 |
Secondary School | 8 | 6.2 |
University Degree or higher | 109 | 83.9 |
Missing | 1 | - |
Employment |
Employed | 79 | 61.2 |
Self-employed | 17 | 13.2 |
Unable to work | 20 | 15.5 |
Unemployed | 7 | 5.4 |
Retired | 6 | 4.7 |
Missing | 2 | - |
Marital Status |
Divorced | 7 | 5.4 |
Married | 68 | 52.3 |
Separated | 1 | 0.8 |
Widowed | 3 | 2.3 |
In a domestic relationship | 27 | 20.8 |
Single | 23 | 17.7 |
Other | 1 | 0.8 |
Missing | 1 | - |
Migraine characteristics and impact
Eighty-nine percent of respondents had experienced migraine for over five years. Whereas 26% of respondents experienced migraine once or twice per week, 26% once or twice per month, and 3.8% once or twice per year, 44.3% indicated they had chronic migraine (15 + days per month). At the time of survey completion, 77.1% of respondents had experienced their last migraine attack during the last seven days. Migraine attacks usually lasted several days (42.0%), the whole day (35.9%), or over an hour (19.9%). The most common diagnoses in the cohort were migraine with no aura (38.9%) and migraine with aura (29.0%). A quarter (25.2%) indicated they had been diagnosed with a different migraine type or that they did not know the type of migraine they experienced. Respondents were asked to rate on a scale of 0 to 5, where 0 is no effect, and 5 is an extreme effect, the extent to which migraine affected their physical, emotional and social wellbeing. An extreme detrimental effect on physical wellbeing with a score of 4 or more was most frequently reported (73.3%), compared to 64.9% for social wellbeing and 59.5% for emotional wellbeing.
Migraine prevention
Respondents were divided into "users" (Fig. 1) and "non-users" (Fig. 2) of each migraine prevention activity based on whether or not they had indicated they used the activity for the prevention of migraine attacks and maintenance of physical and emotional wellbeing. Users of each prevention strategy generally rated them more positively than non-users, except for "Headache Diary" which was viewed as ineffective by both users and non-users. Table 2 shows the subjective ratings of all prevention strategies in more detail.
The most popular migraine prevention strategy was 'staying hydrated', with 87% of respondents selecting that they partake in the strategy (Fig. 1). The next most popular prevention strategies, in descending order, were taking prescription medication (70.2% of 131 respondents selected), diet changes and/or supplements (64.9%), using migraine relief products (63.4%), and lifestyle adaptations such as regular breaks or avoiding screen time (80%).
Staying hydrated was the highest-rated strategy by its users with nearly 94% describing it as "probably effective". The next best-rated prevention strategies by user rating were lifestyle adaptations and exercise, with 91.3% and 89% of their respective users rating them as "probably effective". Keeping a mood diary (3.1%) was the least frequently selected strategy for prevention of migraine attacks. Keeping a headache or mood diary was the lowest rated ("probably ineffective") prevention strategy amongst both users and non-users of the strategies (Fig. 1, Fig. 2).
Although mental health support "Counselling, Cognitive behavioural therapy, other mental health support" was the second least frequently selected strategy for migraine prevention (15.3%), it was highly rated by its users, with 75% of respondents who used this strategy (n = 20) describing it as "probably effective" at preventing migraine.
Figure 1 shows the subjective rating of prevention strategies from those who actively use the strategy (= users).
Figure 2 shows the subjective rating of prevention strategies from those who have never used or have stopped using the strategy (= non-users).
Table 2
Rating of prevention strategies stratified by users and non-users of the strategy
Strategy | Rating | TOTAL, n (%) | Non-users, | Users, | P value |
| n (%) | n (%) | |
Headache Diary | Probably ineffective | 32 (24.4) | 17 (26.6) | 15 (22.4) | 0.727 |
No Change | 56 (42.7) | 28 (43.8) | 28 (41.8) | |
Probably effective | 43 (32.8) | 19 (29.7) | 24 (35.8) | |
Mood Diary | Probably ineffective | 42 (33.1) | 41 (32.3) | 1 (25.0) | * |
No Change | 65 (51.2) | 62 (48.8) | 3 (75.0) | |
Probably effective | 20 (15.7) | 20 (15.8) | 0 (0.0) | |
Lifestyle adaptations | Probably ineffective | 11 (8.5) | 7 (13.7) | 4 (5.0) | 0.004 |
No Change | 12 (9.2) | 9 (17.7) | 3 (3.8) | |
Probably effective | 107 (82.3) | 34 (66.7) | 73 (91.3) | |
Mental Health Support | Probably ineffective | 25 (19.7) | 24 (21.6) | 1 (5.0) | 0.090 |
No Change | 36 (28.3) | 32 (28.8) | 4 (20.0) | |
Probably effective | 66 (52.0) | 51 (45.9) | 15 (75.0) | |
Relaxation | Probably ineffective | 12 (9.2) | 10 (15.9) | 2 (2.9) | 0.022 |
No Change | 18 (13.8) | 11 (17.5) | 7 (10.3) | |
Probably effective | 100 (76.9) | 42 (66.7) | 58 (85.3) | |
Exercise | Probably ineffective | 13 (10.1) | 12 (20.7) | 1 (1.4) | < 0.001 |
No Change | 17 (13.2) | 10 (17.2) | 7 (9.6) | |
Probably effective | 99 (76.7) | 34 (58.6) | 65 (89.0) | |
Diet changes and/or supplements | Probably ineffective | 16 (12.2) | 12 (26.1) | 4 (4.7) | < 0.0001 |
No Change | 26 (19.8) | 13 (28.3) | 13 (15.3) | |
Probably effective | 89 (67.9) | 21 (45.7) | 68 (80.0) | |
Staying Hydrated | Probably ineffective | 3 (2.4) | 2 (11.8) | 1 (0.9) | < 0.0001 |
No Change | 8 (91.3) | 3 (17.7) | 5 (4.4) | |
Probably effective | 116 (91.3) | 9 (52.9) | 107 (93.9) | |
Migraine Relief Products | Probably ineffective | 13 (10.2) | 11 (22.9) | 2 (2.4) | < 0.0001 |
No Change | 18 (14.1) | 10 (20.8) | 8 (9.6) | |
Probably effective | 97 (75.8) | 25 (52.1) | 72 (86.8) | |
Percentages are shown as percent of respondents who were users or non-users of the specific strategy. Percentages may not add up to 100% as 'Unknown' categories are not shown. P-values correspond to those of Pearson's chi-squared tests. * There were too few users of the Mood Diary strategy to perform a chi-squared test.
Acute migraine management strategies
Respondents were divided into "users" (Fig. 3) and "non-users" (Fig. 4) for each migraine management activity based on whether they used the activity to manage signs and symptoms of migraine when they occur. Most management strategies were rated positively by users, whereas non-users were more often doubtful as to the effectiveness of each strategy. Table 3 shows the subjective ratings of all prevention strategies in more detail.
The most popular acute management strategies by several users were 'staying hydrated' and 'use of migraine relief products', with both being used by 104 (79.4% of 131) users. Taking prescription medication was also popular, with 74.8% of respondents selecting it as a management strategy.
Staying hydrated and taking prescription medication were the most highly rated management strategies, with 82.7% and 82.7% of their respective users rating them as "probably effective" at managing signs and symptoms of migraine in that same order.
Using a mood diary to manage signs and symptoms of migraine attacks was the least popular strategy, with only 4 (3.1%) respondents selecting it.
Exercise and OTC medication received the highest proportion of "probably ineffective" ratings of all management strategies as rated by non-users, users of the strategies much more positively, with 71.9 and 70.9% rating them as "probably effective", respectively.
Figure 3 shows the subjective rating of acute management strategies from those who actively use the strategy (= users).
Figure 4 shows the subjective rating of acute management strategies from those who have never used or have stopped using the strategy (= non-users).
Table 3
Rating of acute management strategies stratified by users and non-users of the strategy
Strategy | Rating | Total, n (%) | Non-users, n (%) | Users, n (%) | P value |
Prescription medication | Probably effective | 103 (79.8) | 22 (66.7) | 81 (82.7) | 0.241 |
Probably ineffective | 12 (9.3) | 4 (12.12) | 8 (8.2) | |
Unsure | 14 (10.9) | 6 (18.18) | 8 (8.2) | |
OTC medication | Probably effective | 74 (57.4) | 13 (28.9) | 61 (70.9) | < 0.001 |
Probably ineffective | 32 (24.8) | 19 (42.2) | 13 (15.1) | |
Unsure | 23 (17.8) | 11 (24.4) | 12 (14.0) | |
Relaxation | Probably effective | 73 (56.2) | 29 (42.0) | 44 (71.0) | 0.009 |
Probably ineffective | 20 (15.4) | 14 (20.3) | 6 (9.7) | |
Unsure | 37 (28.5) | 25 (36.2) | 12 (19.4) | |
Exercise | Probably effective | 48 (37.2) | 25 (25.3) | 23 (71.9) | < 0.001 |
Probably ineffective | 38 (29.5) | 33 (33.3) | 5 (15.6) | |
Unsure | 43 (33.3) | 39 (39.4) | 4 (12.5) | |
Staying Hydrated | Probably effective | 102 (79.1) | 16 (59.3) | 86 (82.7) | 0.058 |
Probably ineffective | 9 (7.0) | 4 (14.8) | 5 (4.8) | |
Unsure | 18 (14.0) | 6 (22.2) | 12 (11.5) | |
Migraine relief products | Probably effective | 95 (74.8) | 13 (48.2) | 82 (78.9) | 0.014 |
Probably ineffective | 9 (7.1) | 3 (11.1) | 6 (5.8) | |
Unsure | 23 (18.1) | 9 (33.3) | 14 (13.5) | |
Percentages are shown as percent of respondents who were users or non-users of the specific strategy. Percentages may not add up to 100% as 'Unknown' categories are not shown. Abbreviations: OTC – over the counter. P-values correspond to those of Pearson's chi-squared tests.
Self-tracking of wellbeing and symptoms
Twenty-two respondents (16.8%) tracked both their physical and emotional wellbeing, whereas 73 (55.7%) stated they neither tracked their physical nor emotional wellbeing and symptoms.
Over a third (39.7%) of respondents stated they kept track of their physical wellbeing and symptoms. Respondents used the data they collected about their physical wellbeing and symptoms to identify triggers (65.8%), show reports to a healthcare professional (59.6%), understand when they must take medication (48.1%), track improvements (67.3%), or to track deteriorations (67.3%).
The likelihood of a respondent to keep track of their physical wellbeing and symptoms was not found to be associated with migraine duration, frequency, or type, in univariable logistic regression analyses (p > 0.05 for all).
Nearly all (92.4%) respondents stated that their mood or emotions could be a trigger for their migraine attacks. Mood or emotions was a trigger most or all of the time for 36.6% of respondents. Less than a quarter (19.1%) of 131 respondents stated they keep track of their emotional wellbeing and symptoms. Respondents that tracked emotional symptoms often tracked physical symptoms – 88% of respondents who tracked their emotional wellbeing and symptoms also tracked their physical wellbeing and symptoms, but only 42.3% of respondents who tracked their physical wellbeing and symptoms also tracked their emotional wellbeing and symptoms.
Respondents used the data they collected about their emotional wellbeing and symptoms to identify triggers (76%), show reports to a healthcare professional (44%), understand when they have to improve their emotional wellbeing (72%), track improvements (52%), and track deteriorations (13%). Migraine duration, frequency, and type were not found to be associated with the likelihood of tracking emotional wellbeing and symptoms.