The prestigious journal The Lancet has recently published a series of articles focused on the socioeconomic impact of migraine as well as the diagnostic and therapeutic advances that have been made in recent years in this field. The publications, led by the Danish Headache Center of the University of Copenhagen in collaboration with leading international neurologists in the study of migraine, have included the participation of Dr. Patricia Pozo Rosich, head of Section of the Neurology Service of Vall d'Hebron, head of the Headache and Neurological Pain group of the Vall d'Hebron Research Institute (VHIR) and director of the Migraine Adaptive Brain Center of Vall d'Hebron.
The series is based on three articles, all of them on migraine but from three different perspectives: epidemiology and systems of care; characterisation and biomarkers; and clinical management and treatments. Dr. Pozo is one of the authors who has participated in the writing of both the first and third publications.
Epidemiology of migraine and systems of care
It is estimated that 1 billion people around the world suffer from migraine and it is especially common between the ages of 35 and 40. This high prevalence is a significant burden on systems of care, which could be avoided as there are effective treatments for the treatment of this disease. Therefore, it is necessary to analyze the current management of migraine to correct current deficiencies and improve patient care.
“Migraine is the main cause of disability in people under 50 years old, and especially in women. This has serious health and socioeconomic consequences, since this is the age that corresponds to the highest productivity”, explains Dr. Pozo. Thus, migraine can negatively affect, for example, a person's professional career. In addition, the disease can also impact their family and social life, for example, affecting the relationship with their children or their partner. "Having a healthy workforce, and that includes migraine care, is necessary for us to advance as a society", says Dr. Pozo.
At an economic level, studies carried out in 2011 in Europe calculated that the costs associated with migraine could reach up to 111,000 million euros per year, about € 1,222 per person on average. Of these, 7% would be direct costs associated with treating the disease and 93% indirect costs, mainly due to losses in productivity at work of people with migraine. Thus, the authors of the review point out that more resources should be allocated to implement improvements in migraine care, something that would clearly be cost-effective or even save many expenses associated with the negative impact of migraine on the lives of patients. In this sense, and since there are currently effective treatments for migraine, the authors consider that it is even a question of ethics to be able to offer them when a patient needs them.
The article also presents the challenges that exist to offer the best care to patients with migraine. The authors highlight the importance of primary care, since 90% of migraine patients are diagnosed and treated there and do not need a specialist neurologist. Thus, only 10% would need a consultation with a specialist, in most cases due to the presence of other associated symptoms or resistance to standard treatments. However, on many occasions primary care physicians do not have the time or adequate training to offer the best care to these patients. Thus, more specific training for all health professionals in the field of headaches would be necessary to ensure global collaboration between the entire health system to improve care for these patients.
Multiple therapeutic options available for migraine
Currently there is a wide arsenal of drugs for the treatment of patients with migraine. Even so, there is a high percentage of them who do not take the appropriate medication since they are not diagnosed correctly.
There are two main groups of treatments: drugs for acute migraine attacks, and preventives. In the first group are widely known analgesics such as paracetamol or non-steroidal anti-inflammatory drugs, specific triptans for migraine and other drugs such as gepants or ditans that have been developed in recent years and are recommended only if the previous ones are not effective or contraindicated.
When acute treatments are not effective and migraine attacks are frequent and affect the daily life of patients, specialists may recommend other drugs to prevent the appearance of migraines. Among the repertoire of preventive drugs are beta-blockers (hypertensive) and antidepressants if the migraine is associated with depression or sleep problems, among others.
The authors of the publications recommend that treatment strategies be individualized to each person to meet the specific needs of each patient and that follow-up be offered to substitute one drug for another when it is not effective. The involvement of patients is also key, taking into account their characteristics, needs and preferences. "The main challenge is to adequately detect migraine patients to offer them the best treatment for them and optimize their effectiveness, tolerability, safety and adherence, and for this it is key to individualize their care", reflects Dr. Pozo.
These articles are accompanied by a third review in the same series that delves into the genetic and neurobiological factors of migraine, and the heterogeneity of the disease. It presents progress in the search for migraine biomarkers that will help develop precision medicine for patients with this disease.