Q How common is migraine ?
A Globally , Professor Ashina said , a staggering one billion people suffer with migraine . However , a clearer estimate can be derived from considering either the annual or life-time prevalence of headaches . For instance , he defined the mean one-year prevalence of migraine as affecting ‘ 15 % of the population ’ and while the method of data collection in self-reported surveys can vary , these figures are generally very reproducible . Migraines occur three-times more frequently in women but when considering the lifetime rather than one-year prevalence , the figure increases to around 25 % of the population . Typically , he says , migraines begin during the teenage years and the incidence increases further over the next 30 to 40 years though interestingly , after the age of around 60 , the incidence starts to decline . While far less common in children , professor Ashina mentioned that children as young as six can be affected . As he said , ‘ if we look at the data around children , it ’ s quite high and in fact it ’ s about 8 %’. Fortunately , migraine attacks in children are far less frequent than in adults and the duration of an attack is also shorter .
Q How does a migraine impact upon sufferers ?
A There is little doubt that migraines have a significant impact on quality of life . Professor Ashina discussed a recent paper published in the Lancet that examined the global impact of various disease on years lived with disability . While migraine was the second most common condition after low back pain , a closer look at the data on years lived with disability among the women aged between 18 and 50 years , revealed how migraine was the most common condition . Professor Ashina portrayed a typical chronic migraine sufferer as someone who experienced multiple attacks during the week . Furthermore , another factor that no doubt contributed to the disability associated with migraine he said , was how some of these patients rarely had pain-free days between attacks . At the other end of the disease spectrum , patients were more fortunate , perhaps only enduring one or more attacks per month or even just a few per year . The management of migraine therefore largely depends upon the number of attacks . For those with infrequent episodes , treatment is directed at stopping an acute attack whereas for those who suffer more frequent attacks , preventative therapy is designed to reduce the ‘ number , frequency and intensity and , in some cases , the duration of attacks .’
Q What are the economic burdens of migraine ?
A While migraines clearly have a huge effect upon patient ’ s quality-of-life , there is also a huge economic impact . To illustrate this impact , Professor Ashina portrayed a patient who had two days of migraine every week .
This , he said , amounts to 96 days every year and if the patient ’ s medication is ineffective and they decide to attend work , it is highly likely that their performance , and hence productivity , will be significantly impaired . Equally , if they stayed at home , there is still a huge economic impact in personal terms , in lost productivity and at a cost to their employer .
The economic burden also become apparent when considering treatment . Most patients will initially self-medicate with treatments purchased at a pharmacy and although these can help , for many , the medicines are ineffective , prompting a visit to the GP , and even then , some treatments will remain ineffective . Professor Ashina deems it necessary for migraine patients be assessed holistically , which is impossible within the limited time available in a GP consultation . Consequently , patients are ultimately referred to a neurologist , yet he feels that neurology services are insufficiently resourced in relation to the volume of migraine sufferers requiring a more in-depth assessment .
Q How effective are acute migraine treatments ?
A Professor Ashina thinks that acute , over-the-counter migraine treatments are probably effective in many cases but admits that as a neurologist , he only sees those whose disease has not responded to both over-the-counter and prescription medicines . He considers that many migraine sufferers can manage their condition with nonsteroidal anti-inflammatory drugs such as ibuprofen , aspirin etc . When these drugs fail to provide adequate relief , patients turn to the triptans , which are perceived as stronger medicines . Professor Ashina feels that this perception is incorrect as triptans are simply a class of drugs specifically designed to abort a migraine attack . But it is easy to understand a patient ’ s misconception when examining efficacy data , especially if assessed against the endpoint of 2-hour pain freedom . Using this scale , he said ‘ the triptans are better than non-steroidal anti-inflammatory drugs – there ’ s no doubt about that ’ and as a result , many patients report how ‘ triptans have completely changed their lives ’. While he welcomes the increased availability of triptans in countries where the medicines have OTC status , he also recognises a possible problem . As he says , ‘ when patients start taking too many triptans , they develop medication overuse headache ’. A further problem with over-the-counter medicines is that combination products , particularly those which contain caffeine , can be what he described as ‘ medicine overuse-inducing ’. He generally advises patients to limit the weekly use of such medicines but in cases where patients feel that they need better treatments , it is better to consider prophylactic agents .
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