A migraine is more than just a headache.
The third most common disorder in the world, migraine is a chronic disease of the brain that’s prevalent, frequent and disabling, said Elizabeth Leroux, a clinical associate professor at the University of Calgary’s department of clinical neurosciences, during a session at the Calgary Drug Trends Summit on Nov. 23. But there are significant gaps in diagnosis and treatment, according to Leroux.
“Migraine patients deserve better care than what they are getting. We need to do better,” said Leroux. “Migraine has a significant social cost for patients and also for their families and their employers. It goes way beyond individual loss of productivity. There is a significant cost to society.”
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Treatments for migraine attacks exist, but patients face limited access to appropriate diagnosis, medical care and preventative therapies. The direct cost of migraines in terms of actual medical treatments isn’t the main problem, according to Leroux. The real cost comes from disability, with indirect costs making up three-quarters of migraine-related costs through loss of productive time due to both absenteeism and presenteeism.
Most patients who suffer from chronic migraines prefer to avoid preventative medications as they offer only partial efficacy and side-effects are common, said Leroux. Current options for migraine prevention originally targeted other illnesses, with none aimed at the specific mechanism of migraines.
According to Leroux, better migraine care starts with lifestyle, which she describes as an important part of a three-tier approach to treatment, together with the judicious use of medication as a preventive measure and to treat an episode. To that end, she emphasized the importance of educating patients about migraines and what they can do for themselves. Lifestyle adjustments that can lower migraine frequency include managing triggers, ensuring good sleep, exercising regularly, maintaining a healthy weight and mindfulness.
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And promising new medications are on the horizon. Different antibodies that have emerged in migraine prevention target a molecule with a mechanism of action specific to the condition. With few side-effects seen so far, patients appear to be tolerating them well and seeing positive results, said Leroux. “They could be life changing for a subgroup of patients,” she said.