The Physical and Economical Impact of Migraines

What Is a Migraine?

Over the years, many theories have evolved surrounding the nature of migraines. Today, it is understood that hormones such as serotonin and estrogen play a major role. A trigger event will stimulate nerve cells in the brain producing waves of electrical activity spreading throughout the brain. Depending on affected brain regions, various bodily functions (i.e. vision, balance, speech) can be disturbed before the onset pain. This is known as an aura. Only about 25% of migraine suffers will experience an aura.

Chronic migraines have a greater impact on a person’s quality of life given their frequency.

Chronic migraines have a greater impact on a person’s quality of life given their frequency.

What Are Some Common Symptoms of Migraine Sufferers?

Once the electrical activity stimulates the trigeminal nerve, the person feels varying degrees of throbbing pain on one or both sides of the head. Quite often, this pain can be debilitating. It typically escalates over several hours and becomes worsened with light, physical activity, sounds and certain odors. Usually, the migraine sufferer will also experience accompanying symptoms such as nausea, vomiting, and sensitivity to light.

What Are Treatment Options?

Unfortunately, migraines cannot be cured. This is why effective treatment of acute migraines is so important. It cannot be determined which treatment option will be the most effective in any given migraine sufferer. As such, it is very important for the person to trial more than one medication. The goals of treatment are to achieve rapid, consistent pain relief within 2 hours and relieve any associated symptoms such as nausea and vomiting.

The chart below describes the major classes of medications that can be used as abortive therapy. There are various dosage forms (i.e. tablets, nasal sprays) that can accommodate the user’s preference.

Class

Examples of Specific Drugs

Comments

Triptans

Sumatriptan, Naratriptan, Rizatriptan, Frovatriptan, Zolmitriptan

Not to be used in people with a history of stroke, vascular disease, uncontrolled high blood pressure. Additionally, Ergot Alkaloids should not be used in pregnant women

Ergot Alkaloids

Ergotamine

Analgesics (Pain Killers)

Acetaminophen, Ibuprofen, Indomethacin, Aspirin, Diclofenac, Naproxen

Caution should be exercised with respect to the frequency of use given the risk of developing medication overuse headaches

Can Migraines Be Prevented?

Chronic migraines have a greater impact on a person’s quality of life given their frequency. Ideal candidates for preventative therapy include those who:

  1. have more than 3 moderate to severe headache days per month or
  2. have more than 8 headache days per month or
  3. do not respond to medications to treat their headaches, as described above

An adequate trial is a minimum treatment of 2 months. After about 6 to 12 months, the person can speak with their physician about tapering down the dose or discontinuing therapy. The primary goal is to have a decrease in the frequency of migraines by at least 50% and/or a decrease in the intensity and related physical disability that is often accompanied by migraines. The secondary goal is to avoid the development of “medication overuse headaches” which often occurs when someone is taking medication to treat migraines more than 10-15 days per month. In this case, as the treatment begins to wear off, the body produces rebound or withdrawal headaches.

The chart below describes the major classes of medications that can be used as preventative therapy. It is important to note that most of these medications were designed to treat other conditions. It is always important to let your pharmacist know the reason why you are taking these medications.

Class

Examples of Specific Drugs

Comments

Beta Blockers

Propranolol, Nadolol, Metoprolol

Generally used as first line therapy

Antidepressants

Venlafaxine, Amitriptyline

Amitriptyline is generally considered the most effective within this class

Calcium Channel Blockers

Amlodipine, Diltiazem, Nifedipine

Limited evidence for effectiveness

Anticonvulsants

Gabapentin, Valproic Acid, Topiramate

Valproic Acid and Topiramate are to avoided in pregnancy

In addition to preventative medication, it is also very important to identify the most common migraine triggers and work towards reducing or eliminating them. In general, stress, missing meals, weather changes, lack of sleep and hormonal changes associated with a women’s menstrual cycle are the most common triggers.

Is there an Economical Impact?

According to a 2010/2011 Statistics Canada report, an estimated 8.3% (2.7 million) Canadians disclosed that they had been diagnosed with migraines. Given that other research has shown that the majority of migraine sufferers do not seek medical help, this number is a likely a large underrepresentation. The majority of migraine sufferers also reported symptoms of depression where 63% were classified with minimal or mild depression and 20% with moderate to severe depression.

Given the preceding statistics, it comes by no surprise that migraines can impart a significant economical impact. Not only do migraines impact daily activities (see Figure 1), they can also have a significant impact on the person’s employment (see Figure 2). Furthermore, more than half of migraine sufferers reported out-of-pocket medical expenses in the past 12 months for which they would not be reimbursed.

Figure 1: Migraine’s Impact on Daily Activities

migraines impact on daily activities

Figure 2: Migraine’s Impact on  Employment

Migraine’s impact on Employment

Keep a Migraine Diary

An example of a migraine tracker can be found at Migraine Canada and is an essential tool for identifying patterns or triggers.

References:

  1. Erclik, M. (2014). Pharmacology of Migraine [PDF document]. Retrieved from the University of Toronto Leslie Dan Faculty of Pharmacy Lecture Notes Online.
  2. Arora, V. (2014) Neuroscience Concepts And Clinical Presentation of Migraine. Retrieved from the University of Toronto Leslie Dan Faculty of Pharmacy Lecture Notes Online.
  3. Statistics Canada. (Last Updated November 2015). Prevalence of migraine in the Canadian household population. Retrieved from: http://www.statcan.gc.ca/pub/82-003-x/2014006/article/14033-eng.htm.
  4. Silberstein, S. Migrains. Merck Manual Consumer Version. Retrieved from https://www.merckmanuals.com/en-ca/home/brain,-spinal-cord,-and-nerve-disorders/headaches/migraines#v12816271

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This article was provided by the clinical pharmacy at Rx Infinity. Rx Infinity provides optimal and sustainable patient management solutions through customized programs, innovative technology and added value services that improve the overall patient experience; while helping payers and plan sponsors achieve sustainability in the management of drug plans expenditures.

This information is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions about your medical condition. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.