A migraine attack is much more severe than a headache because it comes with a lot of other symptoms, according to Dr. Elizabeth Leroux, a neurologist, president of the Canadian Headache Society and chair of Migraine Canada, speaking during a session supported by Abbvie at Benefits Canada‘s Chronic Disease at Work event in February.
Migraine, which affects 12 to 15 per cent of the population, can be very disabling. According to the World Health Organization, it’s the most prevalent neurological disorder, second leading cause of global disability and third most prevalent medical illness. In addition, severe migraine attacks can be as disabling as acute psychosis or quadriplegia.
Patients may also experience nausea, hypersensitivity to light, sound and smells, neck and facial pain, vision loss, vertigo, as well as brain fog or difficulty concentrating.
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Patients with more than 15 migraine days per month can be severely disabled and unable to work, said Leroux. Research shows migraine is the third leading cause of presenteeism based on percentage of workers affected (after allergies and hypertension) and has a similar impact on short-term disability, long-term disability and sick days as other chronic conditions such as depression, diabetes, back pain and rheumatoid arthritis.
While patients can treat and prevent migraine with lifestyle management, avoiding triggers and stabilizing the brain with good sleeping and eating habits, they’ll often need medications, she said.
Older oral drugs that are taken daily to lower the frequency and intensity of migraines were originally intended to treat epilepsy, hypertension and depression and were serendipitously found to be effective for migraines. Unfortunately, the associated side-effects made patients reluctant to continue using them. They might have had fewer migraines, said Leroux, but treatment side-effects included hypertension, drowsiness, weight gain, sexual difficulties. As result, after a year, “80 per cent of patients stopped taking the drugs because they were just not worth the side-effects.”
Since then, there’s been a big revolution in the understanding of migraines, said Leroux, noting “we now have treatments that are scientifically based,” which include two new classes of drugs; CGRP antibodies, which are available in Canada, and Gepans, which are expected to be launched in 2022.
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CGRP antibodies are monthly injections that decrease the number, frequency and severity of migraine attacks. Gepans are oral treatments that can be used to treat migraine attacks or preventively to decrease their frequency and intensity.
However, not all patients respond to the new treatments, noted Leroux, but when a patient is a super responder, “they come back to me and they say, ‘I have my life back. . . . That’s a pretty amazing feeling to see such success. . . . Those drugs have changed my practice.”
Employers can support employees with migraines by providing education, support and workplace accommodations, in addition to access to effective medications. Leroux also suggested that plan sponsors ensure their prior authorization criteria isn’t too rigid. A 30 per cent response for a patient who had 12 to 15 migraine attacks per month “makes a massive difference on their ability to function, including work.”
She also recommended an adequate trial period of three to six months for new drugs to determine if they’re effective. And, once a treatment works for a patient, “please do not tell us to stop them . . . because with hypertension, epilepsy, diabetes — if a drug works, you don’t stop it.”
Read more coverage of the 2022 Chronic Disease at Work conference.