Migraine: Against the background of Europe and the world, Polish women are in a bad situation

Migraine is often downplayed and treated as a simple headache. Where in this patient pathway, from first symptoms to receiving effective treatment, does the system fail the most?

First of all, the system is failing in recognition and reporting. Patients are indeed embarrassed to talk about migraine, but on the other hand, we also have doctors who think it is not a serious enough topic to ask about. That's why I most encourage people to admit, talk about the problem and seek advice and help, because if a patient doesn't ask, he or she will most often not be asked.

In addition, many women believe that since their mother, aunt and grandmother had such headaches, it is part of life. Very often they are met with the answer: "it's just a headache, you have to get over it." Unfortunately, they also hear such advice from doctors. And it's not like we have to suffer. Migraine is not just a headache - it's really a lot of suffering that affects the whole brain. It's hypersensitivity to stimuli, difficulty adapting to new and difficult factors, and severe attacks of pain accompanied by nausea, vomiting and hypersensitivity to light, sounds or smells. These symptoms exclude one from normal professional, family and social functioning, and even affect one's life career.

The first thing: note the symptoms, don't abuse medications on your own, and confirm the diagnosis. There really is a lot of training for PCPs today, so they should be able to recognize migraine. Meanwhile, we continue to encounter situations where patients are not even given basic medications to interrupt a migraine attack without a certificate from a neurologist - which is an exaggeration.

What is migraine treatment like in Poland, and are there any barriers to accessing effective treatment?

The biggest barrier is access to a neurologist - a very long path, not to mention headache clinics. There is also a financial barrier, although it is worth noting that patients often spend a lot of money on unproven supplements, various "miracle" therapies or visits to specialists who are not always needed. Against this background, the cost of attack-interrupting drugs does not seem to be the biggest burden. The problem, however, is that we are clearly lagging behind in Europe. Poland is one of the infamous exceptions, where virtually no migraine attack interrupting drug is reimbursed, and access to modern preventive therapies is very limited.

Maybe 5% of patients with the most severe migraines will reach the B133 drug program, approved by the National Health Service, where they can have free access to new therapies. Paid access gets relatively cheaper, because also doctors can prescribe such therapies, which are administered once a month or once every three months, but their cost is about PLN 1,200-1500 a month.

In such a situation, not everyone will be able to afford such treatment. How big a problem is this? Because it is also used to say about migraine that it is a rare disease, but I guess that is not the case....

It is one of the most common reasons for medical visits, especially to neurologists. Migraine affects at least 15-20% of women and about 7% of men. Men are often ashamed to talk about migraines at all even when they are severe, and they affect very young men, starting even as early as preschool age. It is also necessary to pay attention to comorbidities such as motion sickness, hypertension, anxiety disorders or depression, which are associated with migraine and can result in severe headache attacks.

Probably among those thousands of people you mentioned, this migraine has different faces?

In Poland, this is a problem for at least 3 million people. If we add men, we are talking about a significant part of the population. These are the people at the age of greatest activity in life and work - starting families, raising children - so the scale of the problem is huge. It is also worth noting peri-menopausal migraines and the fact that more than 50% of attacks occur during the perimenopausal period. This is an important area for cooperation with gynecologists and family doctors, but also for educating women. They should not take medications "blindly," as it is easy to become addicted, and drug abuse can lead to kidney, liver and other complications.

And what is chronic migraine?

It is a condition in which there are more than 4-6 migraine attacks, in addition to other headaches, and when the patient experiences headache for more than 15 days a month. This affects about 5% of people with migraine. For this group there is a B133 drug program, currently available in about 40 centers in Poland. But it's a program that's difficult to get into, it also has its requirements, and as far as I know, it's been encountering big problems lately, because it's very limited, and often patients who have had a great response to treatment are denied the opportunity to continue it.

That is, there are many more of these barriers to accessing treatment, and they are often dictated by the limitations of the drug program....

Yes, drug programs have many limitations - this is a problem all over the world. But I want to say that against the background of Europe and the whole world, Polish women are not in a good situation. I think they should fight for their rights: to diagnosis and to access to effective treatment. We have really very fast developing new drugs and new therapies that are extremely promising.