New Generation of Migraine Treatment Requires a Shift in Thinking

In anticipation of the 2019 European Headache Federation Congress, our guest blogger is the organization’s new President, Professor Zaza Katsarava.

For far too long, migraine has been dismissed by many as nothing more than a bad “headache”. As any migraine sufferer will tell you, this is far from the truth. Migraine is in fact a complex neurological disease that can significantly damage a person’s health, social, work and family life. Due to the high prevalence and burden, these so-called “bad headaches” are actually the second leading cause of disability globally.1

The dismissal of the consequences of migraine is of real concern as it fuels misunderstanding and misconceptions. This in turn can leave patients being unfairly stigmatized, as well as delay diagnosis and optimal care. This is particularly worrying when we are talking about a disease that affects approximately one billion people worldwide.

Fortunately, we are in the midst of a revolution in the treatment of migraine. A revolution that is bringing new research, new innovative medicines and, importantly, new attention to this debilitating neurological disease. This all means we now have a unique opportunity to fundamentally alter the way we support and manage the millions of women and men across Europe2 that still suffer from migraine.

For us to capitalize on this moment in time, I think there are three critical steps.

Firstly, we need a real-world shift in clinical practice so that there is consistency in how we understand, diagnose and treat migraine. This shift must be rooted in today’s science, treatments and knowledge of the disease. To support this the European Headache Federation3, have recently published new expert-led treatment guidelines. We hope to see these guidelines being adopted throughout Europe, including the comments made after the initial publication with additional evidence provided.

Secondly, we need clinical pathways that support the timely development of migraine treatment plans that are tailored to the individual needs of patients. No longer should those living with the disease continue to churn through health care systems where late or delayed diagnosis and limited choice of medicines are commonplace. We must make sure that when a patient isn’t achieving their treatment goals, they are able to quickly move to alternative interventions in the pursuit of optimal outcomes. This should include newer preventative options, where clinically appropriate.

And last, but certainly not least, we need a cultural shift in the way we think about migraine. This means unhelpful stigmas need to be challenged to create greater empathy for the wide-ranging impact that the condition can have on peoples’ lives.

This needs to occur in the workplace, our own social circles and throughout the health care systems. There are still too many examples of people living with migraine who have been discriminated against simply because those around them don’t understand – or don’t acknowledge – the consequences of their disease.

It is imperative that my fellow physicians, policymakers and industry leaders, move quickly to ensure that we don’t lose the opportunity to do more for people living with migraine. Better treatment of migraine is not just a clinical issue, it’s a societal one too.

1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 95 countries, 1990-2016. Lancet 2017; 390:1211-59.
2. Steiner TJ, et al. Migraine: the seventh disabler. The Journal of Headache and Pain 2013; 14:1.
3. Sacco S, et al. European Headache Federation guideline on the use of monoclonal antibodies acting on the calcitonin gene-related peptide or its receptor for migraine prevention. The Journal of Headache and Pain 2019. 20:6
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