Migraine attacks can be extremely debilitating
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Have you been troubled by a persistent painful headaches for weeks
but are worried about bothering the doctor, because you think it is
just down to stress?
Maybe you should take a trip to the surgery, because the major cause of persistent headache is migraine.
However, many patients struggle through without ever seeking help.
And those that do may find they get short shrift.
Migraine is estimated to affect about 15% of the population, and is three times more common in women than men.
But experts believe that doctors miss the condition in as many as 40% of women and 50% of men who seek professional help.
Professor Peter Goadsby, a migraine expert from London's Institute of
Neurology, said lack of awareness from patients and doctors is partly
to blame.
"If you break your leg, people give you a lot of sympathy, you get a cast, and people sign it," he said.
"But if you have migraine, you do not get a medal, or a cast - you look normal."
But although it is not always easy to diagnose, migraine can be
extremely debilitating. The World Health Organization rated the effect
a severe migraine attack on a par with being psychotic or quadriplegic.
The cost to the UK economy is estimated to be as much as £5bn a year.
Brain chemistry
Drugs are available to treat migraine attacks, and to reduce the
risk of recurrence, but Professor Goadsby said they were not used
enough.
It is estimated that just 8% of patients in the UK receive
triptans which alter brain chemistry to ease the symptoms of an attack.
And figures from the US suggest just 15% of patients are using
preventative medications - when nearly three times that number could
potentially benefit.
Part of the problem is that most anti-migraine drugs carry a risk of side effects, such as drowsiness, weight gain and rashes.
About one in five patients who take Topiramate, one of the newest of the preventative drugs, experiences cognitive problems.
And of even more concern is that fact that drugs such as
triptans constrict the blood vessels - raising the risk of heart attack
and stroke in vulnerable patients.
This means that patients must weigh up the benefits against the
risks - although most decide they are willing to take a chance to
relieve the misery of their condition, even though some drugs only work
in about half of cases.
Nerve cells
However, Professor Goadsby said new drugs were currently in
development which promised to take migraine medication to the next
level.
On the preventative side, early clinical trials are under way
of a drug called tonabersat, the first of a new class called gap
junction blockers, which work in a completely new way, influencing the
chemistry at crucial points where nerve cells talk to each other.
Nobody knows quite how the drugs work, but it is thought they
may be able to dampen down the nerve cell over-activity associated with
migraine.
Professor Goadsby said it was too early to draw any firm
conclusions about tonabersat, but he is hopeful that because it has a
completely new method of action, it could represent a great advance.
New drugs are also being developed to ease migraine symptoms - and crucially they do not constrict the blood vessels.
These drugs work by blocking a chemical - calcitonin
gene-related peptide (CGRP) - which is found at higher levels in the
brains of people with migraine.
Results of the trials of the latest of these drugs, due be to
unveiled at a meeting of the American Headache Society later this
month, show that not only are they safer than currently available
alternatives, they double the chances that a patient will stay
headache-free for at least 24 hours.
"It is quite exciting being in the migraine business at the moment," said Professor Goadsby.
"A lot of new things are coming along based on entirely new
mechanisms that have a sporting chance of making people's lives
better."
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