The Need for Routine Migraine Screening in Women’s Health Care
Migraine Is Common, Disabling, and Often Overlooked
Migraine is the second leading cause of disability worldwide and the leading cause among women under 50. It affects one in five women and most commonly occurs between the ages of 25 and 54. Despite its widespread impact, it remains underdiagnosed and undertreated.
A New Recommendation: Routine Screening Across the Lifespan
The American Headache Society (AHS) now recommends routine diagnostic screening for migraine in females beginning in adolescence and continuing until menopause. This recommendation reflects the high prevalence of migraine and the significant unmet need for screening in this population. Annual screening can help ensure earlier diagnosis, timely treatment, and reduce delays in care.
According to AHS, “This guidance is not intended to exclude screening in boys and men, but to highlight the significant unmet need for screening in girls and women.”
Why Migraine Meets Criteria for Routine Screening
Conditions that warrant routine screening generally meet the following criteria:
- High prevalence in the general population
- Significant morbidity
- Substantial financial and social costs if left untreated
- Reliable, valid, safe, and easy-to-use screening tools are available
- Effective treatments available
Migraine meets all of these criteria, with supporting evidence summarized from the consensus statement below.
Reason 1: Migraine is Common in Females
Migraine is very common in the general population, especially among women.
- Lifetime cumulative incidence: 43% among women, 18% among men
- Globally: 1.16 billion people with migraine; 40 million in the USA
- One-third of patients seen in primary care have migraine
- It is most prevalent between the ages of 25 and 54
Due to the high prevalence of migraine in females, this is why the position statement recommends screening in women.
Reason 2: Migraine Carries a Significant Personal and Societal Burden
Migraine is associated with substantial personal, societal, and economic burden.
- Migraine is the leading cause of years lived with disability among women under 50.
- Globally, approximately 1 in every 20 years lived with disability is due to migraine.
- 22% to 42% of people with migraine report moderate to severe migraine-related disability.
- Migraine is associated with lower educational attainment, reduced career opportunities, and decreased financial success in women.
- The annual economic burden of migraine in the United States is estimated at $78 billion.
Earlier diagnosis and treatment have the potential to reduce disability, improve quality of life, increase productivity, and lessen the financial burden.
Reason 3: Migraine is Underdiagnosed and Undertreated
Migraine continues to be both underdiagnosed and undertreated, underscoring the importance of routine screening. In the United States:
- Only 26.3% of people with episodic migraine and at least mild migraine disability consulted a healthcare provider, received an accurate diagnosis, and were prescribed migraine-specific acute medications.
- Among patients with chronic migraine, just 4.5% consulted a healthcare provider, received an accurate diagnosis, and were prescribed both migraine-specific acute and preventive treatments.
These statistics highlight an important opportunity for earlier identification and intervention. Incorporating routine migraine screening into clinical practice can help with timely diagnosis, improve access to appropriate treatments, and ultimately lessen the burden migraine places on individuals and society.
Reason 4: Reliable, Quick Screening Tools Are Available
Fast, reliable, and easy-to-use screening tools based on established diagnostic criteria are available. The AHS recommends ID Migraine™, a validated, self-administered three-question questionnaire that was tested among adolescents and adults in primary care settings. A person answers “yes” or “no” to the following questions about headaches experienced in the past 3 months:
- Did your headaches limit your ability to work, study, or do what you needed to do on at least 1 day?
- Did you feel nauseated or sick to your stomach?
- Did light bother you much more than usual?
Answering “yes” to two or three questions indicates a positive screen for migraine. The tool takes less than 2 minutes to complete and can be easily incorporated into clinical workflows.
A large review of 13 studies, including nearly 5,900 participants, found that ID Migraine:
- Correctly identified about 84% of people who have migraine (sensitivity)
- Correctly ruled out migraine in about 76% of people who don’t have it (specificity)
These results demonstrate that the screener is reliable and effective for identifying migraine in a wide range of people. It is available in other languages such as Spanish and Portuguese.
Reason 5: Accurate Diagnosis and Treatment Reduce Burden
Accurate migraine diagnosis is necessary before initiating treatment. Early and accurate diagnosis is associated with lower healthcare costs, including fewer emergency department visits, outpatient visits, inpatient admissions, and prescription costs. It not only improves care but also reduces the financial burden on patients and the healthcare system.
Workplace migraine screening — combined with education programs and/or treatments in others — has been shown to improve quality of life and productivity, while reducing migraine-related disability, missed workdays, headache days, and total costs. These findings highlight that screening programs can benefit both patients and employers.
How to Integrate Migraine Screening into Clinical Practice
ID Migraine™ can be incorporated into clinical workflows in several ways:
- Pre-visit questionnaires
- Waiting room assessments
- During the clinical encounter
If the screener suggests that a migraine diagnosis is likely, providers can document the results in the medical record and:
- Discuss the diagnosis with the patient
- Initiate treatment
- Schedule follow-up
- Refer to a specialist if needed
The consensus statement notes: “It is important to remember that screening is not a definitive diagnosis. Follow-up of those who screen positive should include the identification or exclusion of secondary headache disorders and a diagnostic assessment.”
What This Means for Healthcare Providers
While not currently mandated by state or federal policies, the American Headache Society’s position statement highlights the potential benefits of routine migraine screening. This screening can help identify and treat women from adolescence through menopause, and men should not be excluded. Given the widespread impact of migraine in the United States and globally, routine screening offers an important opportunity to close a significant gap in care. Early identification of migraine through validated screening tools allows healthcare providers to initiate appropriate treatment sooner, reduce disease burden, and improve patients’ quality of life.
Read the full American Headache Society Consensus Statement here.
References
- Schwedt TJ, Starling AJ, Ailani J, et al. Routine migraine screening as a standard of care for Women’s health: A position statement from the American Headache Society. Headache. Published online December 10, 2025. doi:10.1111/head.70023
Author
Vera Gibb serves on the Board of Directors of Coalition for Headache and Migraine Patients (CHAMP) and the Advisory Board of The First Contact – Headache in Primary Care Program of the American Headache Society. She’s actively involved in improving headache education for current and future providers across different healthcare disciplines.
