In my office, headache higher math begins with the patient who suffers four headaches a week lasting three days apiece. Even after being out of math for some years, I still recall my lower times tables and recognize these kinds of inconsistencies.In the literature, it has become fashionable to employ much higher numbers (greater than my number of fingers and toes) in the pursuit of truth. In the NFO study, Migraine in America, they sent out 30,000 questionnaires and interviewed 1184 patients. Dr. James Adelman interviewed 1307 patients in his research. Lipton reviewed 25 large studies in his paper including thousands of headache sufferers.The total number of migraineurs appears to fluctuate with the tides. There were 21 million in the Migraine in America study, 24 million in Stewart and Lipton's study, 20-25 million in Zeneca data, and 40 million in Taking control of Your Headaches. By any calculation, the population of some European nations.In all of this work, we begin to develop a global sense of the problem- the social significance and economic burden. That is naturally of great interest to the pharmaceutical industry and to those of us who lecture excessively and need to incorporate some preliminary remarks to knock everybody off their seats. Numbers like millions and billions are always best.Personal statistics, taking the problem down to the individual, are really more interesting than millions and billions however.Stang and Osterhaus would say one in ten of us have migraine and that the average migraineur loses 2.2 days a month totally or suffers with some significant headache and loss of productivity 5.8 days a month (5). Thus, at any moment, the probability that any person in America photographed by a Russian satellite would be suffering some kind of migraine would be .10 x .16= .016. If they could see the ‘beds' of America, the probability might be about .008 we would find a migraineur there in agony.( I thank Mrs. Showalter, my 6th grade teacher for the ability to do this calculation-14) If the satellite could focus in ONLY on midlife women, the probability would be much higher.(7)Every headache specialist has their favorite statistics, designed to impress their audience. Now that we've statistically identified the sufferer, we begin to characterize the poor soul. The under-diagnosis and under-treatment of severe headache patients is well recognized. No one disputes the female predominance of three to one in America, another male plot according to one of my feminist colleagues. In the Migraine in America study, just over half had been diagnosed with the migraine label by their doctor. Only one in five was currently seeing their doctor about headache, but 2/3 had seen a doctor for headache sometime in the past.What's between the lines of those numbers? The patients described above apparently were seen by their doctors and often not diagnosed as migraine by their doctors. On the surface they were misdiagnosed and, therefore, not treated appropriately. In the real world, that means a midlife woman went to a primary care doctor (PCP's see 90% of the headache patients) and had a 10-15 minute visit. She may or may not have emphasized the significance of the problem or she may have tried to slip it in during a revisit for bronchitis, sinus infection or refill of BC pills. Or the migraine complaint could have been what we call a Zinger in our office, the mention of an EXTREMELY important topic as the patient in the hallway is departing. Later on, as the patient is describing her treatment, it all may not come out this way.The implication to me is NOT that the PCP was necessarily uninformed or insensitive. The fortunate 2% of headache people who see a headache specialist get a whole hour and aren't allowed to talk about bronchitis. In the headache specialist's office, a headache is not an add-on or a zinger. It's the whole show. How are our migraineurs being treated? In the Migraine in America study, it is also noted that o
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机译：在我的办公室里，头痛程度更高的数学始于这个病人，他每周遭受四次头痛，持续三天。即使已经失学数年了，我仍然记得我的较低时间表并意识到这种不一致之处。在文献中，采用更高的数字（比我的手指和脚趾的数量更大）已成为一种时尚。真相。在美国偏头痛的NFO研究中，他们发出了30,000份问卷，并采访了1184名患者。詹姆斯·阿德尔曼（James Adelman）博士在其研究中采访了1307名患者。立顿（Lipton）在其论文中回顾了25项大型研究，其中包括成千上万的头痛患者。偏头痛的总人数似乎随着潮汐而波动。 “美国偏头痛”研究中有2100万，斯图尔特和利普顿的研究中有2400万，Zeneca数据中有20-25百万，“控制头痛”中有4000万。无论如何，要计算一些欧洲国家的人口。在所有这些工作中，我们开始发展出对问题的全球意识-社会意义和经济负担。这自然对制药行业以及我们这些演讲过多并且需要结合一些初步的言论以使每个人都离开座位的人都非常感兴趣。数以亿计的人总是最好的。将问题归结于个人的个人统计数据确实比数以十亿计的人更有趣.Stang和Osterhaus会说我们十分之一的人患有偏头痛，而平均偏头痛的人损失了2.2天一个月或一个月遭受5.8天的严重头痛和生产力下降（5）。因此，在任何时候，俄罗斯卫星在美国拍摄的任何人都会遭受某种偏头痛的可能性为.10 x .16 = .016。如果他们能看到美国的“床”，则可能性可能约为0.008，我们会在痛苦中找到一个偏头痛的人。（我感谢我的六年级老师Showalter夫人，能够进行此计算14）。卫星仅关注中年女性，发生的可能性就会高得多。（7）每个头痛专家都有自己喜欢的统计数据，旨在打动听众。既然我们已经从统计学上确定了受害者，我们就开始刻画可怜的灵魂。严重头痛患者的诊断不足和治疗不足是众所周知的。据我的一位女权主义同事称，在美国，没有人对女性比例为三比一的情况提出异议，而在另一男性情节中，则是这样。在“美国偏头痛”研究中，他们的医生诊断出偏头痛标签超过一半。目前只有五分之一的人正在看头痛病的医生，但过去的某个时候，有2/3的人曾看过头痛病的医生。上述患者显然是由他们的医生看过的，并且通常没有被他们的医生诊断为偏头痛。从表面上看，它们被误诊了，因此没有得到适当的处理。在现实世界中，这意味着一名中年妇女去了初级保健医生那里（PCP看到90％的头痛患者），并进行了10-15分钟的拜访。她可能未曾强调该问题的严重性，或者可能在尝试复查支气管炎，鼻窦感染或补充BC药片时试图将其滑入。或偏头痛的抱怨可能是我们办公室里的Zinger，在走廊上的病人离开时，提到了一个极其重要的话题。后来，当患者描述她的治疗方法时，一切都可能不是这种方式。对我的暗示不是PCP一定是不知情或不敏感的。幸运的是，有2％的头痛患者到了头痛专家那里就花了整整一个小时，并且不允许谈论支气管炎。在头痛专家的办公室里，头痛不是附加物或烦恼。这是整个节目。我们的偏头痛如何得到治疗？在《美国偏头痛》研究中，还注意到
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