Migraine is the second most debilitating disease after back pain according to the World Health Organization. It requires specific support. A public conference on the subject is organized in Toulouse on June 9.
How many migraine sufferers go under the diagnostic radar? Hard to say. “But a study carried out in Nice by general practitioners and neurologists showed that 25% of patients who come to consult in a general practice have migraine, and among them, 60% have never been diagnosed before. representative of the situation,” points out Cédric Gollion, neurologist at the Toulouse University Hospital and organizer of a conference on the subject (1).
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“With this disease there is a lot of diagnostic wandering: both with people who over-diagnose themselves and others who, on the contrary, do not identify themselves as migraineurs. Among patients who have an active migraine , only 20% benefit from appropriate care; even though this disease is considered the 2nd most debilitating after back pain, by the World Health Organization (WHO)”.
The reason ? Many prejudices and patients who do not always feel taken into account.
An easy diagnosis, basic treatments that relieve
The International Headache Society (ISC) has set out specific criteria for making a diagnosis of migraine and considers that having five migraines in your life is enough to say that you are a migraine sufferer.
“A migraine affects only one side of the skull, it is throbbing, accentuated by the slightest effort and often accompanied by nausea, discomfort with light and noise. While a banal headache can pass by doing something else, a migraine worsens with the slightest effort”, describes Dr. Cédric Gollion.
In the panoply of migraines, there are also migraines with aura. They are accompanied by a visual disturbance, sometimes a flashing light spot and can affect a third of migraine sufferers. Another major difference with a headache, a migraine can last from 4 to 72 hours and it becomes chronic in patients who suffer from it more than 15 days a month for more than three months.
“Paracetamol rarely overcomes a migraine”
If the first care begins with the general practitioner, do not hesitate, in the event of severe and recurrent attacks, to consult a neurologist.
“In fact, paracetamol and self-medication rarely overcome a migraine”, points out the specialist. Because migraine is a disease that affects neurons. It is triggered when the nerve cell membrane becomes hyperexcitable and releases serotonin. “In crisis treatment, anti-inflammatories, triptans, are prescribed. Developed specifically for migraine, these drugs block the CGRP receptor, a molecule released by the trigeminal nerve that dilates the arteries during a migraine attack. .”
Then basic treatments are offered to patients to reduce the frequency of seizures. These are hypertension drugs (beta-blockers), prescribed as first-line therapy, and sometimes also antidepressants and anti-epileptics. Finally, injectable monoclonal antibodies have proven themselves but they are not reimbursed by health insurance.
“I came out as a migraine sufferer”
“My first migraines date back to childhood, but at the time we only talked about a headache. Yet I had all the symptoms: nausea, great fatigue, hemi-cranial pain, always on the left side for me…” , testifies Christine Vixege.
“I self-medicated daily, with paracetamol, ibuprofen, aspirin; then in 2017, at the age of 52, after a very debilitating period, I consulted a neurologist. He explained to me what was the migraine and how it was treated. After weaning, he offered me a beta-blocker treatment.
Since then, I have done what I call “my coming out as a migraineur”, and joined the association the voice of migraineurs because it is a real disease that needs to be talked about.”