Fatima Del Reino Iniesta (Alicante)
In Spain, less than 3.5% of candidate patients receive treatment with monoclonal antibodies for migraine, according to data published in the Overcome studio published in 2023 in the magazine Pain and Therapy. This was highlighted by the Dra. Sonia Santos, neurologist at the Lozano Blesa University Clinical Hospital in Zaragoza, during the seminar Lundbeck Migraine: in every chapter of lifeheld last Friday in Alicante.
“Despite recent advances in migraine treatment, one third of patients do not respond to symptomatic treatment (of pain) and not everyone does preventive treatment. Furthermore, in our country, access to new treatments for migraine is not easy, and it is received less than 3.5% of patients candidates. Furthermore, they need more monographic consultations of headaches that guarantee quality care, and better coordination with the different levels of care involved in the management of these patients”said Dr. Santos.
Beyond the pain
During her presentation, Dr. Sonia Santos highlighted that migraine It’s not just a headache. In this sense, he explained that migraine is a chronic neurological disease that continually affects those who suffer from it. “Pain is only the most visible and acute phase of this condition. However, the migraine patient faces persistent symptoms for days or even weeks.”, he assured.
Migraine is the leading cause of disability in women under 50 years of age
The symptoms of this condition range from sensitivity to light and sounds to nausea and extreme fatigue, which limits the ability to concentrate and performance in both the work and personal spheres. Furthermore, this pathology is leading cause of disability in women under 50 years of age and the second in adults of all ages. However, despite its high prevalence, present in one in four homes in our countrymigraine remains a poorly understood and underestimated disease
13 million days lost per year
One of the most significant aspects is the economic and social burden that represents this pathology. It is estimated that, in adults, absences from work due to migraine They amount to 13 million days lost per year. During her intervention, Dr. Santos shared experiences of patients and professionals who have made incorrect work decisions due to the pain or exhaustion caused by this disease, and stressed that working under a migraine attack not only compromises productivity, but also safety. at work.
“Migraine represents the loss of 13 million working days per year in Spain”
“Patients with migraine report difficulty concentrating and thinking clearlywhich increases the risk of work errors, often with serious consequences,” Santos added. In some cases, migraine can cause overload in work environments, as other employees must take on the tasks of those who are frequently absent due to the illness.
Migraine and stigma: a barrier to diagnosis and treatment
Social stigma and lack of information about migraine are significant barriers for those seeking medical help, according to Dr. Santos. “Many people see migraine as a simple excuse to miss work, and this deeply affects patients, who already suffer physically and emotionally.”, he pointed out. This stigma leads many people to avoid talking about their migraine at work and at home, delaying diagnosis and appropriate treatment.
Dr. Santos explained that stigma is not only external, but also internal, which generates in patients a feeling of guilt for having a migraine and anticipatory anxiety about the possibility of a new attack. Therefore, “education and patient involvement in their care are fundamental pillars in the treatment of migraine”highlighted the neurologist. The chronic migraineone of the most severe forms of this pathology, represents 2.4% of cases in the general population and profoundly limits quality of life.
Chronic migraine, one of the most severe forms of this pathology, represents 2.4% of cases in the general population and profoundly limits quality of life.
Hormonal factors, stress and changes in sleep
Dr. Santos also addressed the multiple triggers of migraine in adults. Stress, which increasingly affects the population in modern life, is one of the most common and difficult to control triggers. Changes in sleeping routine, physical and mental exhaustion, and hormonal alterations, especially in women, are also causes that patients identify as factors that aggravate their symptoms.
“In addition to stress and hormonal alterations, other factors such as the consumption of certain foods or atmospheric changes can trigger an episode. The problem is that, in most cases, migraine is the result of a combination of these factors, which makes preventing attacks complex.”, he indicated. Faced with this situation, Dr. Santos warns that each patient must find their own triggers and avoid reorganizing their life around them, since there is no common pattern.
The average duration of the migraine attack is shorter in men (32.1 hours) than in women (36.7 hours and 44.4 hours during menstruation). In them, photophobia, sonophobia, nausea and abnormal perception of pain are more frequently associated, while aura is more common in men.
“The characteristics of migraine in women can be modified, not only during menstruation, but also during pregnancy, menopause, with the use of contraceptive drugs or hormone replacement therapy”
In the words of the Dra. Sonia Santos “In women, the characteristics of migraine can be modified, not only during menstruation, but also during pregnancy, menopause, with the use of contraceptive drugs or hormone replacement therapy. “All of this seems related to the fluctuation and fall of estrogen levels.” He 18-25% of women have migraines during menstruation and between 8-13% describe their first migraine attack during the climacteric.
“During menstruation, women have longer migraine attacks and of greater intensity. Most experience a great improvement during pregnancy, especially from the second and third trimester. In the puerperium, recurrence is the norm. Up to a third of women worsen again during the first week and more than 50% in the first month, in relation to the drop in estrogen levels, greater stress and less rest. Finally, there are many women whose migraine improves as they approach menopause, although this is not always the case.”, concluded Dr. Santos.
