Everyone gets headaches. Not everyone gets migraines. For those who have never suffered a severe migraine attack, it can be very difficult to understand the difference, or to realize just how disabling they can be.
A migraine is more than a headache. According to Dr. Elizabeth Leroux, Neurologist and Chair of Migraine Canada, “a migraine is disabling not only due to the pain, but also because of the other symptoms. If you’re hypersensitive to light, nauseous, or if you’re experiencing vertigo, then of course you won’t be able to function.”
A truly disabling disease
Though those who don’t suffer from migraine, including many employers and health care providers, often underestimate the severity of the condition, the leading experts worldwide speak with a single voice. Migraine attacks are a serious disability. “The World Health Organization recognizes severe migraine attacks as being as disabling as major conditions like schizophrenia, paralysis, and terminal cancer,” says Dr. Leroux. “You simply cannot function during a severe migraine attack.”
If we’re going to provide better quality of life for people with migraine in Canada, it has to start with expanding the general public understanding. “Only by sharing, spreading awareness, and explaining the condition can we move past this lack of understanding,” says Dr. Leroux.
We need to recognize that migraine represents a significant cost to our economy and our society.Dr. Elizabeth Leroux, Neurologist
Each migraine is a unique constellation of factors
Migraines come in many different forms. One migraine sufferer could have frequent episodic migraines that present with anxiety and visual interference (aura), another could suffer from menstrual migraines accompanied by nausea and vomiting, and a third could be living with chronic migraines featuring neck pain and insomnia, disabling them 20 days out of every month.
“The variability of migraines is important to recognize,” says Dr. Leroux. “Not all migraines are the same. And not all treatments will work equally well for everyone. There’s genetic variability and variability of triggers, which of course means that there needs to be variability in treatment. There’s no one-size-fits-all quick fix for migraine.”
Thousands of Canadians with migraines, thousands of individualized treatment plans
When developing a personalized therapeutic plan for chronic or episodic migraine, there are three primary axes of treatment that need to be considered. The first is behavioural changes to adapt your lifestyle, the second is acute intervention to stop the attacks and allow a return to daily activities, and the third is preventive intervention, using medications to decrease the frequency of attacks. It’s this last category that has seen some of the most promising development in recent years.
“There are a lot of options for prevention today,” says Dr. Leroux. “We have a number of drugs that weren’t originally designed for migraine, but which have proven effective in about 50 percent of patients. The newest therapies are designer drugs specifically targeted at migraine prevention and they tend to be much better tolerated with fewer side effects. This is a big advancement.”
It’s important to remember that, even as more specialized treatments become available, there’s still no silver bullet. If migraines are impacting your life, it’s essential to speak with a health care provider and work together to find the treatment plan that works for you.
The truth is that migraine doesn’t cost a lot to the health care system, so the health care system doesn’t see it as a big problem.Dr. Elizabeth Leroux, Neurologist
Building a better future for people with migraine
As the scientific insight into migraine continues to broaden, and new acute and preventative treatments continue to be developed, the biggest hurdle to a brighter future is not medical, but systemic. “The truth is that migraine doesn’t cost a lot to the health care system, so the health care system doesn’t see it as a big problem,” says Dr. Leroux. “But we need to recognize that migraine represents a significant cost to our economy and our society. And we need to work together to find ways to reduce that cost. Improvement can only happen through changes in our health care system. The majority of migraine could be dealt with in primary care if there was sufficient education, knowledge, and time. The problem is that this education and time-effective approaches are simply not there.”
As with any systemic change, the more voices making themselves heard on the issue of migraines, the more likely we are to see results. “To make progress, we need to involve more people,” says Dr. Leroux. “We need to create the political will to address the problem of migraine in Canada.”