The Global Burden of Migraine: From Headache Days to Migraine-Affected Days—A Real-World Perspective on the Human and Societal Impact of Migraine

Migraine research counts prevalence, migraine days, headache days, attack frequency, years lived with disability and disability-adjusted life years. People living with migraine experience something wider: pain, nausea, sensory intolerance, cognitive slowing, cancelled arrangements, lost working time, disrupted family life and the anticipation of the next attack. This review examines the distance between what is measured and what is lived and asks how many days of life migraine actually affects and how many can be recovered. We summarise the epidemiological foundation provided by the Global Burden of Disease Study 2021, then set out a conceptual framework in which total migraine burden is the sum of attack burden, recovery burden and functional burden. We describe the attack as a multi-phase event running from premonitory symptoms through headache and associated features into postdrome and functional recovery and review the interictal burden of anticipation, avoidance and unpredictability, which affects days on which no pain occurs. Occupational, economic, family and social consequences are considered alongside the treatment gap that keeps burden high despite therapeutic progress. Galcanezumab is used as an illustrative treatment example to examine how reductions in migraine frequency may relate to broader functional and patient-reported outcomes in clinical trials and routine practice. Interictal burden correlates only negligibly to weakly with monthly migraine headache days, which suggests that interictal burden represents a dimension that is not fully captured by migraine-headache-day frequency and highlights the importance of measuring, reporting and interpreting complementary patient-reported and functional outcomes alongside frequency. The proposed “migraine-affected days” construct is presented as a conceptual and hypothesis-generating framework, rather than as a validated clinical or psychometric measure, diagnostic criterion, or established treatment endpoint.