One of the reasons for the underdiagnosis of migraine is the trivialization that has always been attached to the disease. Samuel Diaz Insa, from the Headache Unit of the Neurological Service of the Hospital Universitario y Politécnico La Fe in Valencia, believes that headaches have traditionally been managed in a trivial way, without a category of pathology, to not do certain things. Migraine is a disease in itself and a way of exaggerating the brain’s response to stimuli that are only disturbing to migraine sufferers. These patients are mostly women, and migraines can be disabling for the pain.
“During a migraine attack, your head is pounding, lights bother you, noises, even smells are unpleasant. Head movements are very annoying, this is the so-called rattling sign. The patient improves only in the supine position, without noise and light. In addition, one of the triggering mechanisms of migraine is stress, which often makes it incompatible with the world of work. It’s a really debilitating disease,” says Dr. Diaz Insa.
Trivializing a migraine means a persistent delay in diagnosis in these patientsbecause many times it is not considered a serious pathology, neither by society nor by the doctor. Many people who have migraines have not had access to a neurologist or a headache unit, where neurologists or cephalologists (as they are called among themselves) work and as a result have not been able to benefit from new drugs. “The treatments that are done in general neurology or in the computer are not comparable to what we currently have in headache units; It’s like heaven on earth. We have many more therapeutic options such as infiltrations and new drugs that allow us to improve the quality of life for our patients“, assures the specialist.
One of the challenges facing this pathology is that of Training that the neurologist should conduct. “Senior professionals are not trained in headache techniques. We need to recycle neurologists who have not done specific rotations through the headache units to know the therapies that give such good results in our patients”, the expert points out.
“The role of the nurse is another major point in our patient’s follow-up, -says Díaz Insa- because it helps us not only in diagnosis, but also in follow-up: check the calendars of headache episodes, help with the administration of drugs, in addition to monitoring the patient to see how he responds to treatment. What is done in several centers should be extended to every general neurological consultation”.
Samuel Diaz Insa insists on you must implement headache units throughout the Spanish territory. “In recent years, we have experienced a revolution in the treatment of these patients with anti-CGRP monoclonal antibodies. These preventive medicines change their quality of life and we carry out these therapies in our wards, which is why their implementation in all autonomous communities is so important. Patients should have the same treatment options no matter where they live. There are autonomous communities that don’t even have a headache unit. Having more wards will make all patients much more equal in accessing the treatments we have,” says Diaz Insa.
The use of monoclonal anti-CGRP is the third revolution in the treatment of migraine. First there were triptans, then botox, and now progress is being made with anti-CGRP monoclonal antibodies such as eptinezumab, which has been shown as a therapeutic alternative in various studies and where its efficacy and speed of action stand out, thanks to the intravenous route of administration.
New therapies such as monoclonal antibodies represent a real paradigm shift in treatment, although as Dr. Diaz Insa points out, “we have more than 450 patients who have started using them, but there are provinces that only have 10 patients with these new treatments, because so far access to anti-CGRP is very limited“.
In any case, there is still a percentage of people with migraines who do not respond to any treatment. “We are working on new research to develop drugs that can provide improvement in those patients who have not had results with existing drugs.”
Adherence is another of the unsolved challenges of this disease. Until the introduction of botulinum toxin, and especially before monoclonal drugs, adherence to treatment was very low. Most of the patients stopped the therapy because of its ineffectiveness or because of side effects.
Regarding what remains to be done in the preventive treatment of migraine with anti-CGPR, the specialist commented on the importance of expanding its use to the entire population that needs it. “We need to expand the use of these drugs that have shown great benefit both in the general population and in clinical trials.” They are better than before. We must also try to make neurologists, primary care physicians and the public aware that these drugs exist and that they can demand them.
On the other hand, there is a percentage of migraine patients who do not respond to these treatments. “In the new research, we see a lot of drugs that can do something good for patients. It is important that this knowledge and treatment reach all patients who need it,” says Dr. Diaz Insa.
“Fortunately, we look forward in the coming months and years to the inclusion of new drugs to help migraine patients resistant to current treatments.” One of these new treatments is eptinezumab, an anti-CGPR monoclonal antibody that is administered intravenously every 3 months, which has shown in clinical trials a high rate of action, even for the treatment of migraine attacks and, above all, for the prevention of crises from the moment of its application. Its efficacy, speed of action and sustained response over time make it very attractive for improving the quality of life of migraine patients who often suffer from debilitating migraine attacks,” concludes the expert