Friday, June 21, was World Migraine Solidarity Day. This neurological disease is common and affects an average of 15% of the world’s population, including 20% of women, 10% of men and 5% of children.
There is no migraine gene, but rather a genetic susceptibility. “A migraine sufferer has a hyperexcitable brain that is sensitive to pluses and minuses: more sleep, too little sleep, more stress, less stress, a fatty meal, hypoglycemia, hormonal variations in women,” explains Dr Christian Lucas, a neurologist in Lille, interviewed by the association La Voix des migraineux, which is launching, with the pharmaceutical group Lundbeck, the Combat Migraine campaign.
How to recognize a migraine?
Migraine is characterized by a repetition of attacks (at least 5) moderate to severe, which last between 4 and 72 hours, without treatment or with ineffective treatment, explains Inserm. The clinical examination is normal, as is medical imaging.
“During these attacks, the headache is often unilateral, pulsating in tone, moderate to severe in intensity and worsens with routine physical activities or leads to avoidance of these activities,” details the French Federation of Neurology.
This pain may be accompanied by sensory hyperesthesia – discomfort with noise (phonophobia), light (photophobia), odors (osmophobia) – and digestive disorders such as nausea and/or vomiting.
An invisible neurological disease
Migraine is a neurological disease that affects the trigeminal nerve. “This nerve is made up of three branches. One branch innervates the forehead and also the meninges. This so-called trigeminovascular system is activated during migraine attacks. (…) The hypothalamus also seems to play a major role in triggering migraines,” explains Dr Demarquay, a neurologist in Lyon, who responded to the Voice of Migraineurs.
Migraine is invisible. It is not caused by a brain lesion that would be visible on medical imaging but by an electrical and inflammatory disorder that standard imaging does not “see”. “Apart from certain specific tests, a CT scan or an MRI is normal. Some patients tell me that they would like us to find something because they would like us to believe them. (…) This invisible side is very often a source of suffering for patients.”
What is severe migraine?
Among the 10 million French migraine sufferers, many patients suffer from severe migraine. This is diagnosed in patients suffering from 8 or more days of migraine in a month and in any patient having clearly disabling attacks or obtaining a score of 60 or more on the HIT-6.
This six-question test measures the impact of migraine on patients’ quality of life. From a score of 60, the impact is considered severe.
In 1 to 2% of the general population, migraine is chronic. “We talk about chronic migraine from 15 days per month, but we know that between eight and twelve days per month, there can already be an extremely significant handicap in daily life,” explains Dr. Geneviève Demarquay.
With significant consequences on the quality of life. “Patients report a strong impact on professional life with 51% of them having missed one or more days of work at least once in the last 3 months due to an attack,” notes the association in a press release. 13% of them even give up working because of migraine.
Other figures put forward by the association, this time concerning the private and family sphere: 83% of migraine sufferers say they suffer from sleep disorders while only 7% of them say they were able to take care of their children without difficulty. “More than 48% of patients suffer from anxiety and more than 73% from depression.”
What follow-up for patients?
Feeling of illegitimacy among these severe migraine sufferers, poor knowledge on the part of caregivers, many patients are not regularly monitored for their migraine. According to a survey by the Voice of Migraineurs, it takes an average of 7 years to be diagnosed.
Then, you need to find a doctor who knows the disease and then a treatment that suits the patient. Severe migraine sufferers need to be followed by a specialist, a pain doctor or neurologist. But the first caregiver involved in the care pathway is the treating physician.
Several medications, including triptans, are indicated to calm migraine attacks. A basic treatment is also prescribed, in order to reduce the frequency of attacks and their intensity.
