Expert Perspective

Migraine: Helping patients through a difficult journey

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Most clinicians who treat migraine know the statistics associated with this debilitating condition and can recite them almost verbatim. Likewise, we all know the long journey a patient experiencing headache can take before finding relief.

The question is, what can we do about it? It can sometimes feel easy to look at the statistics, accept them with little objection, and move on, but we must do the best we can for our patients in the face of the migraine challenge.

It’s a journey that I welcome you to take with me as we evaluate important migraine trends, treatments, and controversies, and figure out how to leverage these developments to improve outcomes and help our patients improve and feel and function better.

There are upwards of 39 million migraine sufferers in the US who are on a journey of their own that is often perplexing, frustrating, and can feel fruitless. According to the Migraine Research Foundation, most migraine sufferers do not seek medical treatment. More than half of patients who experience migraine are never diagnosed. Moreover, only 4% receive care from headache and pain specialists. Perhaps most disheartening, an estimated 5 million migraine sufferers, who we believe can benefit from preventive treatment, are not receiving it.

The patient journey can be extremely discouraging and often maddening. Results from the American Migraine Study show that nearly four in every 10 migraine patients suffer 3 years or more before being diagnosed. A cross-sectional study published in 2019 analyzed treatments, procedures, and follow-up approaches experienced by 456 migraine sufferers until their initial consult with a headache specialist. Patients reported an average headache frequency of approximately 16 days per month. More than half were found to have chronic migraine, and 3 in every 10 had migraine with aura. Despite these characteristics—which were apparently hiding in plain sight—it took patients in this study an average of about 17 years from pain onset to make the journey to an appointment with a headache specialist. That is hard to believe, let alone to understand. Along the way, many migraineurs—particularly those with chronic migraine—were subjected to unnecessary exams and treatments.

Results like these do not come cheaply for families, society, and the health care system. Migraine is estimated to cost more than $20 million per year in direct medical expenses and lost productivity in the US, according to the American Migraine Foundation. Others have estimated double that number. Sufferers, meanwhile, face the prospect of significant pain, stigma and ongoing disability. More than 8 in every 10participants in the American Migraine Study had at least some headache-related disability. More than half say their pain caused severe impairment, even requiring bed rest.

I believe we can help our migraine patients along this journey—and we can make it less arduous for them. We have education, tools, and treatments to help them. Learn how by joining me here each month. We will address the practical relevance of topics such as acute and preventive care (including the new gepants and CGRP-targeted treatments), new and more effective treatments for medication overuse headache, new treatment devices, behavioral approaches to migraine, and our role in headache advocacy, including stigma avoidance. We will not shy away from controversial topics such as the changing definition of chronic migraine, monoclonal antibody safety , high and low cerebrospinal fluid pressure syndromes, and more. See you next month.

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