Let’s start with the basics: what is migraine and what are the characteristics of chronic migraine?
doctor n.med. Magdalena Boczarska-Jedinak: Migraine is the most common neurological disease, affecting approximately 12% of the general population. This is not a whim, as previously thought, but an extremely unpleasant disease, which we know a lot about today. Migraine is a genetically determined brain disease in which family predispositions play a very important role - the inherited predisposition of nerve cells to respond with a headache attack to adverse factors, such as smell, changes in temperature, weather, or even food. In these unfavorable situations, a certain group of brain nerve cells sends impulses along the trigeminal nerve, which innervates the meningeal vessels, and a chain of events begins, leading to a very strong, pressing, throbbing headache in the patient. Often this headache is combined with nausea, vomiting, increased sensitivity to light, touch, sounds, and practically disables the patient. Patients usually try to stay calm in a dark, quiet room to control migraine symptoms. Often, untreated or ineffectively treated pain can last up to 3 days, which practically excludes the normal functioning of the patient throughout this time. If it is possible to give the patient effective drugs, then the pain is reduced to a few hours, and although the patient after that feels very overwhelmed, he somehow functions and tries to forget about this event.
This is different from chronic migraine, in which such attacks occur at an increased frequency. In fact, this headache starts and does not stop or lasts with short breaks. Clinically, a patient with chronic migraine has more days with a headache than without a headache. More precisely, such a patient must have had a minimum of 15 days of headache, of which at least 8 days are typical severe migraine attacks and this condition must last for at least 3 months. Chronic migraine has nothing to do with the number of years a patient is sick because you can have episodic migraine attacks for 20 years and not have chronic migraine.
Today we know exactly which proteins are mediators of pain and cause migraine pain. We can say with confidence that we have beaten migraine because we have medicines designed specifically for this disease.
What has been the treatment of chronic migraine so far and what are the current therapeutic options for patients with chronic migraine?
Before we figured out where migraine comes from, what neural pathways are responsible for it, we tried to treat migraine in all other ways, most often borrowing drugs from other diseases. For many years we have been using drugs designed to treat, for example, epilepsy, depression and hypertension. True, many of these drugs are still used, but their effectiveness is low. They also have many side effects. In chronic migraine, amitriptyline, which is an antidepressant, remains the main oral drug, as well as topiramate and valproic acid, two antiepileptic drugs.
As for modern methods of treatment, they are based on the impact on certain neurotransmitters. The first drug, which was introduced 12 years ago, is botulinum toxin, or the well-known Botox. This is a drug with proven effectiveness, but only in the case of chronic migraine. The second group of drugs is monoclonal antibodies, i.e. molecules that are designed to trap a protein and neutralize it, or block the receptor for that protein. These are drugs with comparable efficacy to Botox, but they can be used in both episodic and chronic migraine patients.
Which patients can benefit from Preventive Treatment of Patients with Chronic Migraine? Where should patients go for treatment?
The new drug program, which is the first program for migraine patients, is designed for patients with chronic migraine. Patients who have been diagnosed with chronic migraine and who have previously been treated with conventional oral medications but have failed and are documented may be eligible to enroll in this program. First, for the first line treatment, which is botulinum therapy, and then, if the first line is ineffective, for the second line treatment, with monoclonal antibodies. In every voivodship there are at least several centers - neurological outpatient clinics, where a chronic migraine treatment program will be implemented and patients can already apply there. For now, you can check the NFZ website to see which centers have such a program, but the competition process is still ongoing and we are still waiting for a list of all active centers that we can present to patients.
How do I prepare for a program eligibility visit?
To qualify for the program, you must first keep a migraine diary for at least three months. This diary should include, first of all, information about the number of painful days in a given month, the number of medications taken and other symptoms that appeared during migraine attacks. If someone is looking for a template for such a diary, they can find it on the Polish Headache Society Facebook profile and use it. Secondly, we need to collect previous medical records. This is a prerequisite for the inclusion of a patient in the program. Such documentation should include information on the type of drugs used, their doses, duration of treatment and the effects of therapy. The patient can make a photocopy of this information in the clinics where he was previously treated, and can also get a certificate from the attending physician with information about the diagnosis and the full path of treatment.
How long does chronic migraine treatment take?
First of all, it should be noted that the goal of the treatment of chronic migraine is the return of migraine to episodic conditions. Unfortunately, we are not able to completely cure a migraine patient. Treatment for chronic migraine usually lasts several months. According to the drug program, the duration of therapy with botulinum toxin is 15 months, and with monoclonal bodies - 12 months. Each of these treatments is followed by a 12-month period of close observation of the patient. If after this time the chronic migraine returns, the patient can be re-enrolled into the program and return to the previously mentioned treatments. This period of treatment and observation of the patient over time shows how long it takes the brain to unlearn from such adverse functioning. The goal of treatment is to return to a situation where even if the patient has a migraine attack, it will be a rare, short attack that is easily treatable with medication.
Are patients already receiving treatment under the drug program?
There are patients in several cities in Poland, such as Torun, Bydgoszcz and Warsaw, who are already undergoing such treatment, and it is hoped that more and more patients will be included in this program.
doctor n.med. Magdalena Boczarska-Jedinak - neurologist, anaesthetist, President of the Polish Society of Headaches, works at the Institute of Health Dr. Boczarska-Jedinak in Auschwitz.
Source: Wprost
