Assessing the relationships between migraine and driving risks, challenges and coping strategies.

Driving is a multitasking activity that requires sustained attention, multisensory integration, and rapid reaction capacity. This study aims to assess the under-recognized disability experienced during driving in individuals with migraine, the outcomes of symptoms triggered during driving on safety, and the coping strategies employed. This cross-sectional study included individuals between the ages of 18 and 65 diagnosed with migraine according to the International Classification of Headache Disorders-3 criteria. A structured form, based on the "Driving Habits Questionnaire," was applied to patients by 57 neurologists face-to-face. It covered parameters such as demographics, headache characteristics during driving, sensitivity to driving, coping strategies, the Headache Impact Test-6, driving cessation, and traffic accidents. The patients were divided into diagnostic subgroups: those with/without aura, episodic/chronic, and those with and without vestibular migraine by headache experts. Additionally, we employed a Structural Equation Model (SEM) to identify the variables that influence driving cessation and accidents. Of the 2,522 patients evaluated, 1,333 (mean age: 36.75 ± 9.53 years; 64.4% female) had an active driving history. Patients experienced headaches in 13% of their active driving sessions, and 70.6% had experienced a headache while driving at least once during their active driving sessions. Due to migraine, 1.7% of the patients ceased driving, and 9.2% reduced their driving frequency. The mean age of the drivers who had an accident was younger [35.3133; 95% CI: 34.1677-36.4589, p = 0.007]. Headaches during driving were mainly associated with decreased attention (69%), restlessness (66%), and nervousness (56%). To cope with headaches, drivers most often preferred to use analgesics/triptans (58.8%), turn off the music (51.9%), and wear sunglasses (47.7%). SEM revealed causal relationships between migraine subtypes, symptoms, road conditions affecting driving sensitivity, the impact of headaches on driving, direct and indirect cessation of driving, and accident probability. Our findings demonstrated that driving is an underrecognized factor that can cause insidious disability in patients with migraine and may pose a threat to driving safety, often underappreciated in clinical care and traffic regulations. Raising awareness about migraine-related driving impairments and enhancing coping mechanisms may reduce preventable risks and improve the quality of life for affected individuals.