Migraine – why are we all suffering in silence?
Reported June 14, 2008
To many people migraine is a big word for a headache, used to emphasise that it is not a self-inflicted hangover but a genuine illness. Yet those who suffer – I am one of them – know that there is much more to it than that.
The crippling pain of migraine, which is often accompanied by nausea and visual or speech disruptions, can be incapacitating. The World Health Organisation ranks a severe attack as being as disabling, albeit temporarily, as quadriplegia or dementia. The condition is also common, affecting about nine million people in Britain, three quarters of them women. Its annual cost to the economy is estimated at £4 to £5billion in England alone.
Despite this burden, migraine is commonly misunderstood, and not only by those who do not have attacks. As Professor Peter Goadsby, a specialist from the Institute of Neurology in London, said this week, patients and doctors often lack a full appreciation of the condition, and of what can be done about it.
For many migraineurs, as sufferers are known, the triptan family of drugs, which alter brain chemistry, significantly reduce the duration and intensity of attacks. These include Imigran, available over the counter, and the prescription-only Zomig. There are also three preventive options for those who suffer often. These are all prescription only: beta-blockers, such as Propranalol, serotonin antagonists, such as Pizotifen, and anti-convulsants, such as Topamax, normally prescribed for epilepsy. None is ideal, not least because many have serious side-effects. But for many people, these drugs can control headaches that respond poorly to standard painkillers, such as ibuprofen.
The problem is that many patients who could be helped fall through the net. As migraine is so common, and almost always runs in families – 92 per cent of migraineurs have a family history – sufferers often fail to seek medical advice, assuming that because their mothers or sisters have not been treated effectively, nothing is available.
Those who do see a doctor are often misdiagnosed: migraine is missed in 40 per cent of women sufferers and 50 per cent of men. Instead patients are told that they have problems such as tension headache. The result is that only 8 per cent of British migraineurs take a specialised drug, compared with 33 per cent in Sweden.
There is clearly a need for greater awareness of migraine prevalence. But there is also a need for more research. As the experience of Viagra for impotence has proved, the availability of an excellent drug with few side-effects can have a huge impact on people’s willingness to seek treatment, and on doctors willingness to prescribe.
None of the existing migraine drugs measures up to that benchmark, though some promising new therapies are on the horizon. New classes for preventing and treating attacks, known as gap-junction blockers and CGRP-inhibitors respectively, are in clinical trials.
Migraine, however, remains an under-researched and under-managed disorder. In particular, little is known about its genetic origins. Most cases are probably influenced by common genetic variants that each slightly raise risk, in similar fashion to type 2 diabetes and heart disease.
Over the past couple of years, a new technique for detecting such genes, known as genome-wide association, has found dozens of variants that affect diabetes, cardiovascular diseases and cancers. Migraine could almost certainly benefit from the same approach, but it has not yet been applied in this field.
Studies of this sort should be more of a priority. Migraine control not only transforms lives, but also reduces the cost to employers and society of countless sick days spent in darkened rooms. There needs to be wider access to today’s drugs and more basic research to inform the design of tomorrow’s.