Migraine – a suitable case for treatment?

Migraine – a suitable case for treatment? Headache disorders are common, with a lifetime prevalence of over 90% in all populations where they have been measured. So common, in fact, that a Global Campaign to Reduce the Burden of Headache was launched in 2004 to educate health care providers, the general public, and national governments to recognize that headache disorders are not trivial, that effective treatments are available, and that the costs of treatment are small in comparison to lost productivity in the workplace (Steiner 2004). Thus, although headache rarely signals serious underlying disease, it is one of the most frequent causes for consulting family practitioners and neurologists – 1 in 6 and 1 in 3 respectively. In many countries, however, headache disorders are regarded as unimportant and self-limiting and not as proper disease entities. Allocation of health care resources is often minimal, despite the consensus conference of the American and International Headache Societies conclusion that migraine, for example, is under-diagnosed and under-treated throughout the world. Although tension-type headache is the most prevalent of the headache disorders, migraine is the most disabling (Rasmussen 1995). Migraine is a chronic neurological disorder characterized by recurrent attacks of headache and other symptoms, which may last for up to 3 days. The pain is moderate to severe and is accompanied by phonophobia, photophobia, nausea, and vomiting. Prodromal symptoms may include somnolence and mood changes, while some patients may experience aura which is a complex of focal neurological symptoms including visual disturbances, numbness, paraesthesia and speech difficulties. The current International Classification of Headache Disorders (IHSCC 2004) provides diagnostic criteria for up to 7 subtypes of migraine. It mostly affects people of working age but also occurs in older adults and children. European and American studies have shown a prevalence of about 18% among females and 6.5% among males, aged 12 years and older. Similar patterns are seen in Central and South America, but migraine appears to be somewhat less common in Asia and Africa (WHO/WFN 2004). The universally higher rate in women, at about 2–3 times that in men, is probably hormonally driven. The burden of migraine varies, with some individuals experiencing many more attacks and associated disorders while others may have no more than a monthly attack (Bigal et al 2004; Rasmussen 1995). At the top end, 35% of American women with migraine experience 1–4 severe attacks per month while a further 25% of them experience 4 or more severe attacks per month. Migraine places a considerable burden on the sufferer, their family and friends, and upon society as a whole, with 80% of American migraine sufferers reporting some form of disability. The economic and public health burdens of migraine are significant, and include reduced work and school productivity; lost work productivity alone is estimated to cost about US$13 billion annually in the USA (Hu et al 1999). Extrapolation for migraine prevalence and attack incidence data suggest that 3000 migraine attacks occur daily for each million of the general population, placing migraine 19th among all causes of years lost to disability (YLDs) (WHO 2001). Proper management of migraine is therefore of paramount concern, and treatment should be optimalized for individual patients. Different types of medicines are available for the pharmacological treatment of migraine, and can be seen as preventive, Roger M.Pinder