14 Chapter 1 Accurate diagnosis necessitates the use of (electronic) headache diaries. Patients with migraine often struggle to retrospectively estimate the number of migraine days per month accurately. When there are fewer than eight migraine days per month, the frequency is often underestimated, while with more than eight monthly migraine days, there is an overestimation.6 This distinction is particularly important for distinguishing episodic from chronic migraine.6 For the diagnosis of menstrual migraine, keeping a headache diary that also tracks the menstrual cycle is essential. When asked, around 80% of women believe they have menstrual migraine.9 However, when these women maintain a headache diary for at least three months, only two-thirds are confirmed to have menstrual migraine. Conversely, among women who think they do not have menstrual migraine, about two-thirds also meet the criteria for menstrual migraine when keeping a headache diary.9 This underscores the unreliability of self-diagnosing menstrual migraine and demonstrates the utility of an (electronic) diary for accurate diagnosis. PREVALENCE AND BURDEN OF MIGRAINE In the Netherlands, the prevalence of migraine is around 10%, but this varies depending on age and sex.14 Migraine is three times more common in women than in men. Approximately 1 in 3 women will experience migraine at some point in their lives. Among children, the prevalence is equal between boys and girls, but around menarche, the prevalence among women increases. The peak age for migraine is between 30 and 40 years, and after the age of 50, the prevalence gradually decreases, although women remain more frequently affected than men (Figure 2). Notably, before menopause, about two-thirds of women with migraine experience menstrual migraine. Migraine ranks among the top 10 most disabling diseases, as identified by the World Health Organization (WHO).15 For young women, it even occupies the second position. These are often the years when building a career, starting a family, and/or engaging in other social activities play a major role. The burden that patients experience in daily life occurs both during an attack (ictal) and between attacks (interictal). The ictal burden is related to the experience of migraine headaches and accompanying symptoms. During a migraine attack, a patient’s ability to function in daily life is limited. The interictal burden of migraine is particularly evident in planning activities due to the potential onset of a migraine attack and the fear of having another attack (anticipatory anxiety). Compared to men, women more frequently report reduced
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