Migraine: identify and relieve it

Sixty-year-old Sabine Debremaeker has lived with migraine for more than half a century. My first memories of migraine pain, mainly visual hallucinations and digestive disorders, date back to when I was 6 years old, she says. But like many people of my generation, those around me didn’t take me seriously. I was having liver attacks, and it didn’t go any further. » She will wait until the age of 19 to learn that she is a migraine sufferer and until she is 30 to know that it is in fact a migraine with aura, most often characterized by visual disturbances heralding the migraine, because of 2 to 3 crises per month which immobilize him for a little more than a week each time. In the meantime, the symptoms evolved: the abdominal manifestations gave way to aphasia (speech disorder) and numbness of the left part of his body. From her journey that will lead her in the mid-2010s to give up her professional activity, she draws the conclusion that it is necessary to create a structure that brings together migraine patients and informs them about their disease: this will be La Voix des Migraineux, founded by four patients.

Half of the patients do not consult

There are two essential problems, namely the lack of training of doctors, with a diagnostic error estimated at around seven years, and sometimes much more, and the prejudices that still exist about this disease, explains the president of the association. Everyone has had a headache at some point, so migraine sufferers tend to be seen as sissys. I, for example, sometimes have to walk around with sticks, a hat and sunglasses, or even noise-cancelling headphones, which earns me unpleasant remarks, such as, the glasses are outside or Everest, it’s not there… It’s a bit of a double jeopardy. » The corollary of this trivialization results in an under-diagnosis. Half of the patients do not consult and self-medicate, and among those who seek medical advice, many consult only once, for lack of sufficient explanations or miracle treatment », reports Pr Anne Ducros, neurologist and specialist in migraines and headaches at the University Hospital of Montpellier. If migraine is a complex neurological disease, treatments exist which, in at least 80% of cases, relieve patients », assures the expert. Must we first know how to recognize it.

Well-defined criteria

Migraine, which generally appears before the age of 40, meets specific criteria. The headache lasts between 4 and 72 hours, is rather unilateral and throbbing, increases with movement, and has a moderate to severe intensity that impacts daily life. Pain is associated with digestive disturbances and/or hypersensitivity to noise and light », explains Professor Ducros. There are two types of migraine: migraine without aura (2/3 of cases), the definition of which corresponds to the symptoms described above, and migraine with aura, formerly called ophthalmic migraine, which, if it takes up the previous clinical picture , is accompanied by fully reversible transient neurological disorders. The frequency of seizures varies from person to person, as does their intensity. It takes at least five identical seizures to make a diagnosis, excluding any other cause », emphasizes Anne Ducros. Chronic migraine, which is characterized by incessant migraines (more than every other day), affects between 1 and 2% of the general population. One last figure: 20% of women are migraine sufferers against 8% of men. While this pathology has a genetic component, other causes are environmental and include hormonal status.

Complementary therapies in support

Non-compliance with rhythms and schedules, stress or climate change are a risk factor that can trigger a migraine attack, which is why it is important to have as regular a lifestyle as possible. », observes Sabine Debremaeker. Let us also mention a sedentary lifestyle, or on the contrary an excess of physical activity, dehydration or an unbalanced diet. However, leading an ascetic life or depriving oneself of holidays will not prevent crises. And a gap should not induce a feeling of guilt », adds Sabine Debremaeker. Anticipating and accompanying a change in habits is useful for limiting the use of analgesics, the overconsumption of which can be counterproductive. With this in mind, complementary therapies are a valuable aid for patients. Relaxation techniques (meditation, hypnosis, acupuncture, etc.) or behavioral and cognitive therapies (CBT), not to mention physical activity, have proven their effectiveness in reducing the number of seizures and lowering their intensity. These approaches also allow the patient to better control his disease. I do 15 to 20 minutes of exercise bike every day, I also walk. These daily efforts are important for self-esteem, but also for recovery, because we lose a little with each crisis. »testifies Sabine Debremaeker.

Two types of treatments

The management of migraine is based on two stages: crisis treatments, to be taken as soon as the first symptoms appear – always have them with you –, and long-term medicinal treatments which are, whenever possible, combined with non-drug preventive therapies. During an attack, an NSAID or non-steroidal anti-inflammatory drug (ibuprofen, etc.) is prescribed first and immediately, in the event of severe migraine and in the absence of contraindications, a triptan which is an anti- specific migraine sufferer. The earlier the treatment is taken, the faster the relief », says Professor Ducros. If for three months, the patient has had 2 days of migraine each week or badly relieved migraines which impair their quality of life, a disease-modifying treatment will be offered to them to reduce the frequency of attacks and prevent the risk of chronicization of the disease. In first intention, it will be a beta-blocker or, if the person is not eligible for it, another antihypertensive antimigraine (Candésartan) or an antidepressant antimigraine (Amitriptyline) or an antiepileptic (Topiramate) – except in pregnant women or who have a pregnancy plan. If these treatments fail, other drugs will be prescribed, such as Nocertone or Sibelium. With regard to migraine refractory to these classic treatments, the therapeutic arsenal was enriched in 2021 with the arrival of two specific monoclonal antibodies, called anti-CGRP, at the rate of one subcutaneous injection per month. They have demonstrated their effectiveness, patients have been able to return to their full-time work, and yet, laments Professor Ducros, they are not reimbursed. » Respective price of the bulb: 245 and 270 euros. The French National Authority for Health judged that the improvement in the service provided by these anti-CGRPs was not sufficient, on the basis of the results of existing clinical studies.

However, migraine remains the only neurological disease that tends to disappear with age. After age 65, the incidence drops to 2% of the population and the difference between the sexes fades considerably.

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