Migraine is a significant neurological condition in the UK. Its prevalence and consequences extend beyond the patient, impacting the healthcare system and the wider economy. During Migraine Awareness Week, we reflect on the condition's complexity, examining the multifaceted nature of migraine, from its different presentations to its economic costs. We also consider recent advances in treatment, incorporating insights from Debbie Shipley and Oscar Harvey, of The Migraine Trust, shared during a recent CHASE Spotlight session. As they highlight, it is vital to remember that "migraine is a complex brain disease and not just a headache".
A migraine diagnosis encompasses a range of presentations, each requiring a distinct clinical approach. Understanding these variations is fundamental to developing effective, personalised treatment strategies.
The experience of a migraine attack itself is a multi-stage process that extends far beyond the headache phase. An attack can include a premonitory stage with non-pain symptoms, an aura stage for up to a third of people, the main headache stage, and a postdrome or 'hangover' stage that can last for days. This complexity is often misunderstood, with one patient noting,
I often hear 'oh it's a headache'... [but] it affects your mental health as you just want to be normal and do what everyone else does.
The impact of migraine on the UK is substantial, creating a significant burden on both the healthcare system and the national economy.
According to NHS data, migraine is one of the most common health conditions, affecting an estimated one in seven adults in the UK. This is equal to the number of people living with diabetes, asthma, and epilepsy combined. Despite its prevalence, migraine has been underinvested in and is often absent from NHS plans and public health strategies. This translates to millions of GP consultations and a considerable number of secondary care referrals, A&E presentations and hospital admissions annually.
The economic costs are extensive. Direct costs to the NHS are significant, but the indirect costs are greater. According to The Migraine Trust’s 'State of the Migraine Nation: Dismissed for too long’ 2021 report, migraine accounts for 43 million lost workdays each year, costing the UK economy between £6 billion and £10 billion annually through absenteeism and presenteeism.
The workplace impact is profound. A 2023 Migraine Trust survey found that 86% of women feel migraine has impacted their work, and a quarter of employees do not feel their manager takes the condition seriously. For the pharmaceutical and medtech industries, this unmet need represents a clear area for innovation to deliver both clinical and economic value.
Recent years have seen a material shift in the understanding of migraine pathophysiology, leading to the development of new therapeutic approaches. The focus has moved towards targeted mechanisms that interrupt the migraine process.
A continuing challenge in migraine management is medication overuse headache (MOH), where the acute treatment itself begins to cause attacks. As Oscar Harvey of The Migraine Trust explained, people can end up in a "vicious cycle" where "the acute treatment stops actually treating the pain and starts causing the migraine attack symptoms instead". This issue underscores the need for effective preventative treatments and better patient education to break the cycle of medication dependency.
Migraine Awareness Week provides a platform for the healthcare community to focus on this condition. For professionals across the pharmaceutical, medtech, and clinical sectors, it is an opportunity to drive conversations and support the work of organisations like The Migraine Trust. By sharing resources and contributing to policy discussions, the industry can play a role in improving patient outcomes and highlighting the need for continued research and access to innovative migraine treatments.
Migraine is a complex neurological condition with diverse presentations and a significant societal and economic impact. Recent advances in understanding its pathophysiology have led to a new era of targeted treatments, from CGRP antagonists to neuromodulation. However, significant gaps in care persist. As the Migraine Trust's Debbie Shipley noted, there are thought to be only "around 80... GPs with a special interest in migraine across the UK". As the industry continues to innovate, a multifaceted approach involving clinicians, researchers, and policymakers is needed to address the burden of migraine and improve the lives of the millions affected in the UK.
1. What is the most effective treatment for migraine headaches? The effectiveness of any migraine treatment is patient-specific. Clinical strategy differentiates between acute (abortive) treatment, which aims to stop an attack, and prophylactic (preventative) treatment, which seeks to reduce the frequency of attacks. While triptans are established for acute use, the significant development has been in prophylaxis, particularly with the introduction of CGRP pathway inhibitors, which have demonstrated high efficacy in clinical trials.
2. Can chronic migraine be cured, or only managed? A definitive "cure" for chronic migraine does not currently exist. Therefore, the goal of chronic migraine treatment is effective long-term management aiming for remission. Advances in both pharmacology and neuromodulation have enabled treatment plans that can significantly reduce headache day frequency, often to the point where an individual no longer meets the diagnostic criteria for the chronic form of the condition.
3. How does the treatment approach for vestibular or ocular migraine differ from a typical migraine? While the foundational prophylactic treatments are often similar, specific considerations apply. Vestibular migraine treatment may be supplemented with vestibular rehabilitation therapies to help manage symptoms of vertigo and dizziness. For ocular migraine treatment, and specifically retinal migraine, the diagnostic priority is to exclude other potential causes of transient monocular vision loss. In both cases, preventive strategies remain the primary focus for reducing the frequency of attacks.
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