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.