Understanding and addressing migraines: A perspective for healthcare professionals

Migraines are profoundly misunderstood, underestimated, and stigmatised, despite being the second-highest disabling neurological condition globally, as recognised by The Lancet (2019). The devastating impact of migraines extends beyond individual experiences, impairing productivity, contributing to substantial economic losses, and diminishing the quality of life for millions worldwide. Exploring advancements and challenges in migraine care reveals critical strategies to improve patient outcomes globally.

The global burden of migraines

Migraine disproportionately affects individuals during their most productive years, from ages 15 to 49, creating a critical intersection of vulnerability and economic impact. This disability significantly disrupts workplaces, with presenteeism—being physically present but unable to work effectively—occurring three to five times more frequently than absenteeism among migraine sufferers. A study conducted in Malaysia highlighted this phenomenon which contributes to notable economic losses. In Europe, migraines cost an estimated €100 million annually in GDP, while in India, the estimated economic burden reaches $40 million, amounting to 4 per cent of the country’s GDP.^1&2

However, these figures fail to account for the broader societal implications, including delays in diagnosis and widespread misunderstanding of the condition. Up to 50 per cent of migraine sufferers worldwide receive an incorrect diagnosis. Studies in Thailand show that 70 per cent of patients required over a year to receive an accurate diagnosis, while patients in Italy experienced an average delay of five years.

Historically, migraines have been dismissed as psychosomatic due to the absence of visible structural abnormalities on imaging scans like MRIs. This perception has perpetuated stigma, trivialising migraines as “just headaches.” Such misunderstandings often lead to skepticism from healthcare providers, families, and employers, compounding the social and emotional burden on patients.

Migraine is best understood as a functional disorder, in which disruptions in brain function rather than structural damage, cause symptoms. Yet, the trivialisation and stigmatisation of migraines persist, with patients often facing dismissive encounters that undermine the complexity and severity of their condition.

Addressing fragmented treatment journeys

Despite advancements in treatment options, fragmented care remains a major challenge in migraine management. Many patients experience disjointed treatment journeys, cycling through multiple providers and medications without achieving meaningful relief. This issue stems from delayed or incorrect diagnoses, insufficient patient education, and an over-reliance on acute symptom management.

Frequently, migraines are treated as episodic rather than progressive conditions. Without adequate preventive measures, migraines can intensify over time, evolving from occasional headaches to chronic migraines. Many healthcare professionals (HCPs) focus solely on short-term relief through acute medications, neglecting the disease’s long-term progression, often resulting in medication overuse and a “vicious cycle” where acute medications exacerbate headache frequency and severity, leading to medication-overuse headaches.

Breaking this cycle requires a holistic approach to migraine care. First, HCPs must recognise migraines as progressive neurological diseases and prioritise preventive therapies. Second, patients need to understand that preventive treatments may take time to show results but are essential to reducing long-term disease burdens. Third, clear communication about treatment timelines, side effects, and adherence can foster trust and minimise fragmentation in care.

The future of migraine management: Toward precision medicine

While CGRP therapies have revolutionised treatment, they are not silver bullets. The future of migraine care lies in precision medicine, which tailors treatments to individual patients based on their unique biological profiles. Emerging research into alternative neurotransmitters, such as PACAP (Pituitary adenylate cyclase-activating polypeptide) and VIP (Vasoactive Intestinal Peptide), provides hope for developing therapies targeting unexplored pathways in migraine mechanisms.

In countries like India, where affordability poses significant challenges, precision medicine will require collaboration between healthcare providers, pharmaceutical innovators, and policymakers. Expanding access to affordable, effective treatments will be key to improving outcomes for underserved populations. India is gradually moving toward advanced migraine therapies, paving the way for more targeted, cost-effective solutions.

A revolution in migraine treatment: The role of calcitonin gene-related peptide (CGRP) therapies

Recent advancements in migraine-specific therapies have transformed the landscape of care. Traditionally, treatments relied on non-specific medications such as antihypertensives, anti-seizure drugs, or psychiatric medications. These options were not designed to treat migraines directly and often delivered limited efficacy, accompanied by significant side effects. This lack of specificity and tolerability frequently led to low adherence rates and widespread patient dissatisfaction.

The discovery of CGRP as a major neurotransmitter responsible for migraines marked a turning point in treatment. CGRP plays a central role in triggering vascular dilation, neurogenic inflammation, neurotransmission and the progression from episodic to chronic migraines. Targeted CGRP therapies, including monoclonal antibodies and gepants, directly address the underlying physiological processes of migraines. These therapies are highly specific, impacting only migraine-related mechanisms without affecting other regions of the brain, thereby minimizing side effects.

CGRP therapies have significantly improved efficacy and tolerability, fostering higher adherence rates compared to older treatments. Studies highlight that patients are more likely to continue these therapies, underscoring their effectiveness in reducing the disease burden and improving patients’ quality of life.

Helping patients return to function

The ultimate goal of migraine treatment extends beyond merely reducing headache days—it is about restoring meaningful lives and a ‘return to function’. Many patients express aspirations to return to daily activities, whether rejoining the workforce, caring for family, or pursuing hobbies or social engagements without the fear of debilitating pain. Addressing these emotional and social needs is as crucial as managing physical symptoms.

To achieve this, healthcare professionals must adopt a patient-centric approach, emphasising education and adherence while providing holistic care. By listening to patients and tailoring treatments accordingly, HCPs can help rebuild lives and restore a sense of normalcy.

Innovating for the future

The global challenge of migraines requires both innovative solutions and systemic change. Advancements in CGRP therapies and the promise of precision medicine bring hope for managing migraines effectively, coupled with overcoming barriers such as stigma, cost, and fragmented care. As healthcare professionals, the impact we can make extends beyond prescribing medication. By advocating for systemic changes, empowering patients, and embracing innovative solutions, we can transform the narrative around migraines.

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