Welcome to today's presentation on migraine, a neurological condition that reaches far beyond just headaches. As we delve into this topic, we'll explore the prevalence, unmet needs, and the immense burden this condition places on both individuals and healthcare systems. Migraine isn't merely a headache. It's a complex disorder affecting millions worldwide, impacting daily lives, productivity, and our communities. Join us as we uncover the layers of this condition and its profound implications. I have nothing to disclose. The objectives of this micro-lecture are to evaluate the unmet clinical needs within migraine management and assess the disease burden of migraine, economic impact, and gaps in care. Migraine is a complex disorder influenced by genetics, marked by recurring episodes of moderate to severe headaches. These headaches often occur on one side and come with nausea, sensitivity to light and sound. However, it's also common to have pain on both sides, often in the front and back of the head. The pain tends to throb and gets worse with activity. Migraine attacks are intricate brain events that unfold over hours to days in a recurring pattern. The most common type, seen in 75% of cases, is without aura. In understanding migraines, it's essential to explore their neurological roots. These headaches involve intricate brain processes. Chemical messengers like serotonin, dopamine, and CDRP play vital roles here, influencing blood vessels and causing inflammation that triggers migraine pain. During a migraine, the brain becomes more sensitive, heightening responses to light, sound, or touch and intensifying the pain experience. Brain imaging studies demonstrate distinct activity changes during migraines in regions linked to pain, senses, and emotions. Migraine ranks among the most prevalent global diseases and significantly contributes to disability. This results in substantial challenges both clinically and economically for individuals and society as a whole. Despite available data outlining its impact, migraine remains frequently undiagnosed and subsequently undertreated. This situation might lead to an underestimation of the true scale of this public health issue. Additionally, the profound effect on the daily lives of patients and their families often doesn't receive the attention it deserves. Migraine's impact stretches far beyond its physical symptoms. It significantly affects the lives of those experiencing it. The burden goes beyond the pain. It affects daily functioning, productivity, and quality of life. Nearly half of those with migraines experience a 50% drop in productivity during attacks. Understanding the personal toll helps us grasp the gravity of this condition on individuals. Migraine affects around 15 to 18% of people globally, impacting both men and women. It's a highly disabling condition, ranking eighth worldwide and fourth among women in terms of its impact. In the United States alone, about 44.5 million adults have experienced migraines, with 18% being women and 6% men. Caucasians tend to have a higher prevalence, especially among those aged 18 to 44, while some view migraines as a mere inconvenience. The World Health Organization lists it among the top 40 disabling conditions globally. In general practice, headaches account for 4.4% of all medical consultations, while in neurological outpatient departments, they make up around 20% of consultations. Now let's discuss the economic burden. Patients with migraine bear a significant financial burden, with an average annual cost roughly $8,924 higher than similar individuals without the condition. This includes expenses for outpatient services, medications, hospital visits, and emergency room trips, along with indirect costs like missed workdays due to illness. Around 74% of this total cost, roughly $6,575 per patient, accounts for direct healthcare expenses. The rest represents indirect costs due to an average of 8.9 more missed workdays attributed to migraine-related needs. These figures were derived from observations of migraine patients matched with a non-migraine group in a 12-month study using the Truven HealthMarketScan research database. Understanding the true cost of migraine is vital for advocating increased research funding. Despite the National Institute of Health allocating $15 to $20 million yearly for migraine research, this study's updated estimate suggests the actual burden surpasses $28 billion. Current funding falls significantly short of what's needed to effectively address this condition. Such findings are crucial in urging policymakers to allocate sufficient resources for tackling this disease. Despite its prevalence and economic burden, the needs of those suffering from migraines often remain unmet. Many face challenges in obtaining adequate diagnosis, treatment, and support. There's a persistent gap between what's available in migraine care and what's truly required. This discrepancy highlights the urgency for improved strategies in addressing the diverse needs of individuals dealing with migraines. We will now discuss the unmet needs that have been identified in these gaps in care. Recent survey-based studies provide crucial insights into the unmet needs of individuals seeking acute migraine treatment. One comprehensive survey examined various aspects of unmet treatment needs among 4,553 women and 1,058 men dealing with episodic migraines. This survey covered areas such as headache disability, treatment dissatisfaction, excessive use or dependence on opioids or barbiturates, emergency care visits, and cardiovascular events. More than 40% of respondents faced at least one unmet treatment need, with 14.4% experiencing two or more gaps in their treatment. Among those with unmet needs, almost half had moderate to severe headache-related disability, over a third were dissatisfied with their current treatment, and about a third reported excessive use or probable dependence on opioids or barbiturates. Moreover, over a quarter had a history of cardiovascular events, and 5.7% had more than two emergency or urgent care visits due to headaches within a year. The CAMEO study provides additional insights into unmet needs. The CAMEO study, involving 13,624 participants, investigated prescription medication use among migraine sufferers. Results showed that 64.5% never used migraine headache medications, 22.9% were current users, and 12.6% had stopped. Concerns for non-use included prioritizing other treatments and concerns about medication tolerability, while those who stopped often switched to alternatives due to inefficacy or safety concerns. Current users of prescription meds in CAMEO experienced more severe migraine symptoms and higher disability levels compared to those who stopped or never used medication. This highlights a significant gap in treatment despite active medication usage. Additionally, nearly an equal percentage of current medication users use triptans as opioids or barbiturates. This raises questions about the appropriateness of medication choices by health care providers. Given these unmet needs and gaps in care, physical medicine and rehabilitation physicians may play a vital role in migraine care through their multifaceted contributions. They conduct comprehensive evaluations, exploring musculoskeletal factors, posture, and physical stressors to tailor personalized treatment plans, collaborating closely with other specialties. They develop holistic strategies integrating physical therapy, exercises, and non-pharmacological interventions. Moreover, their focus extends beyond symptom relief. They aim to restore function, enhance quality of life, and reduce disability caused by migraines through targeted intervention. Physical medicine and rehabilitation physicians' holistic approach addresses diverse needs emphasizing functionality, pain relief, and overall well-being for those managing migraines. In summary, the prevalence of migraine is substantial, yet unmet needs persist and its burden on both individuals and society is profound. Recognizing these aspects is fundamental in advocating for better research, resources, and care strategies. Join us as we delve deeper into the complexities of migraine and explore avenues for improvement in managing this condition. Thank you for listening.

migraine

neurological condition

economic burden

personalized care

research funding