Let’s dismantle the obstacles to treating migraine disease

Every year in June during National Migraine and Headache Awareness Month, we take the opportunity to bring attention to migraine disease, which affects more than 39 million Americans, according to the American Migraine Foundation. Yet, the number of people suffering from migraine disease is likely much higher as so many people endure their debilitating headaches in silence — not getting the treatment they need and often not even knowing how to ask for treatment. And most turn out to be women.  

In fact, three times more women than men live with migraine disease. The associated medical costs are significant. A 2018 Washington Post article noted that migraine attacks cost this country about $78 billion every year, with women making up 80 percent of the direct medical and lost labor costs.

Women need to be empowered, especially during National Migraine and Headache Awareness Month, to understand what migraine disease is and to learn about and be able to access available treatments.  

Migraine attacks are more than just a bad headache but rather are part of migraine disease, which is “a disabling neurological disease,” that can last for hours and even for several debilitating days once triggered. Migraine attacks are genetic though they can show up differently for each individual affected. Some of the most common symptoms include problems with vision, nausea, sensitivity to light, noises and smells, head pain that increases with physical activity, throbbing or pulsating pain sensations and pain so severe you must miss work, school or other activities.

 
It is important to know that migraine attacks come in two types, classic and common. Classic migraine attacks, also known as migraine with aura, are those where in addition to the headache attacks people also experience symptoms such as vision changes, blind spots or light flashes as well as tingling in the hands or face. Common migraine attacks usually don’t come with these sensory disturbances but are just as agonizing.

Although scientists don’t have all the answers yet as to why women are more affected, hormones play a significant role in the disorder, which might explain the difference that starts to appear at puberty, when the rates for females increase significantly to the male peers.  

For some women, the fluctuation of their estrogen levels around menstruation and menopause can trigger a migraine attack. For others, it can dampen the intensity. Not much is known about why this happens and why it’s so different for most people. Researchers are working hard to try to figure the fluctuation connection out. Because estrogen is responsible for controlling pain sensation, it has been shown that taking certain types of birth control and also menopause can help ameliorate the severity of a migraine attack. Yet for some women, the exact opposite happens. Thankfully, for most women, migraine symptoms improve post-menopause. 

It has been shown that getting regular exercise, even just moving your body for 30 minutes several times a week, and improving what you eat can help. Some experts say that eating regular meals — at consistent intervals and times — as well as eating foods that help to fight inflammation, can help prevent migraine attacks. And, not surprisingly, in small amounts, caffeine can relieve migraine pain in the early stages or enhance the pain-reducing effects of acetaminophen (Tylenol) and aspirin.

The good news is that there are treatments available for people with migraine disease, including several different kinds of oral medications, such as ibuprofen. Some target the pain of migraine and inflammation in the brain; others are nasal sprays, injections or infusions to stop pain from migraine attacks. To prevent the onset of a migraine attack in the first place, there are also oral medications, injections, infusions, and even a neuromodulation device that changes the way nerves pass information onto the brain.  

The challenges to accessing medication are the barriers imposed by insurance carriers and pharmacy benefits managers that require you to try other, not prescribed therapies first, and fail, or switch the therapies non-medically, and don’t allow you to accumulate copays to get over exorbitant out-of-pocket maximums. All of these utilization management practices could be addressed by Congress through various pieces of legislation that are before them. Migraine patients, along with all patients, would benefit enormously.

Bottom line, if migraine disease is affecting you and your quality of life, don’t endure it alone. Take the time to get more information about the condition and talk to your healthcare provider about the treatment options available to you. While migraine disease can certainly be debilitating, effective treatment is available. Find what’s right for you and work with your provider to make sure you get what you need.

Martha Nolan is senior policy advisor at HealthyWomen, a nonprofit that educates women to make decisions about their health care.