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Contents
Introduction
Migraine is as old as human history and clear descriptions
of it can be recognised in Babylonian manuscripts dating back
to 3000 BC, and even more clearly in Egyptian papyri from
1550 BC. It is a very common condition, affecting one person
in ten during their lifetime in the UK, or an estimated 5
to 6 million people. Most patients experience migraine attacks
with intervals in between, when they are completely well,
though the number of attacks each year varies enormously from
person to person. So it is an episodic disorder rather than
a chronic illness. It does not cause continuous disability
in most people and is not generally associated with a reduced
life expectancy. For these reasons, it has not been taken
as seriously as it should have been, either by the medical
profession or the general public.
- This picture has begun to improve in the past decade,
driven by a number of developments, including:
- the introduction by the International Headache Society
of carefully constructed criteria for diagnosing migraine
and other types of headaches,
- studies which show the serious impact that migraine has
on those who experience it,
- the proof that blood flow patterns to the brain change
during an attack,
- the discovery that there are genetic factors linked to
migraine, and
- the development by the pharmaceutical industry of specific
and effective medicines for migraine.
Migraine must not be underrated. It is a cause of considerable
human suffering, has a real impact on performance at work,
and can seriously disrupt family and social relationships.
The attacks are responsible for inhibited careers, restricted
social lives and broken relationships. A study of migraine-related
disability has shown that it equals or exceeds the functional
impairment caused by other common chronic illnesses such as
high blood pressure, osteoarthritis, diabetes and depression.
Many people who have migraine find that it affects them between
attacks as well – for example, because they worry that they
may let other people down, or that they may lose their jobs,
or simply because of the fear of the next attack coming.
The current annual financial burden of migraine in the UK
is said by the Migraine Action Association and the Migraine
Trust to be about £750 million a year. Only 4 to 5 per cent
of this is direct medicines costs, and hospitalisation is
relatively uncommon for migraine. Rather, the bulk is due
to lost time – some 18 million days a year estimated for the
UK – and decreased efficiency at work.
A large study carried out in the USA found that migraine
sufferers miss an average of four to eight days’ work a year
because of their attacks. The efficiency of those at work
fell by up to two-thirds. This burden could be greatly reduced
with the appropriate use of modern medicines and it is disappointing
that the new Department of Health computerised decision support
system for doctors – Prodigy – lists only one of the new class
of medicines, the triptans, for the treatment of migraine,
despite the existence of several medicines with different
properties. A wider choice of migraine medicines is important
in improving the quality of life for sufferers. Even if cost
is the most important factor, studies have clearly shown that
the cost of prescribing these new medicines would be more
than offset by a gain in productivity.
It is hoped that this booklet will contribute to both patient
and public awareness of migraine, and engender a greater degree
of understanding towards those affected by it. It should also
provide a non-technical insight into what is currently known
about the causes of migraine and what is being done in the
pharmaceutical industry to improve the available treatments.
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