Migraines Being Undertreated

The Lancet April 3, 1998
Dr. Michel Ferrari
Leiden Univ, Medical Centre, Dept of Neurology
Leiden, Netherlands

"More than two-thirds of patients either have never consulted a physician or have stopped doing so," said Dr Michel Ferrari, in an article updating recent research on this disorder.

Dr Michel Ferrari blames undertreatment on fatalistic expectations, poor experiences with older drugs, lack of physician empathy or misdiagnosis."

There are two main types of Migraine: Classic Migraines, which are preceded by an Aura, like seeing flashing lights and other strange neurological symptoms; and Common Migraines, which do not have Auras.

About 75 percent of Migraine sufferers have common Migraines, though 33 percent have both types of headaches.

Recent research suggests that Migraines occur when physiological conditions in the Brain exceed a certain threshold level, Ferrari said.

"Genetic factors, possibly involving ion-channel function, appear to set the individual threshold; internal and environmental factors such as Hormonal Fluctuations, Fatigue, Relaxation after Stress, Meteorological Changes and Substance Misuse may modulate this set-point," he said.

Three drugs, the AdrenoRceptor blockers Propranolol and Metoprolol (and probably Atenolol, Timolol and Nadolol) and the AntiEpileptic drug Sodium Valproate have been shown to be effective in preventing attacks, Ferrari said. Mild attacks can be treated with Non-Steroidal Anti-Inflammatory drugs or Anti-Nausea medicines.

"The use of narcotics is highly-controversial," Ferrari said, adding that it is not supported by strong medical research. "Most patients who require narcotics are misusing Analgesics or Ergots [another class of Migraine drugs.]"

Disabling attacks respond better to specific Anti-Migraine drugs such as Sumatriptan, he said.

    Ferrari added future research will hopefully answer outstanding questions, such as:
  • What are Migraine-specific triggers and what are the thresholds
  • What is the role of Genetics and Ion-channel dysfunction in setting and modulating the threshold for Migraine triggers
  • Is it possible to design more specific, and thus more effective and better tolerated preventive drugs for Migraine?

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