Effective Migraine Care: Gaps and Barriers
Imagine a severe throbbing pain, pounding inside your head, four hours in a row. Or sensory disturbances and nausea for as long as three days. These are some of the classic signs of a migraine.
As a chronic neurological disease, migraine leads to crippling headaches, affecting roughly 15% of the adult population worldwide. Despite being a very common headache disorder and a major public health problem, migraine remains poorly understood and under-diagnosed. In a previous study, about 50% to 60% of migraineurs were reported undiagnosed, despite recurrent headaches. With fear of contracting Covid-19 infection and difficulty in accessing in-person care, people are avoiding seeking medical help for the condition, instead attributing symptoms to associated co-morbidities, such as stress or depression.
Evidently highlighting an urgent need for immediate efforts to raise awareness about the condition and implement migraine health care policies to reduce the disease burden in India.
However, there remain several barriers to timely migraine diagnosis, including poor awareness amongst the general public about the severity of migraines. With busy schedules, paired with the fear of contracting Covid-19 infection and difficulty in accessing in-person care, people avoid seeking medical help for the condition, instead attributing symptoms to associated co-morbidities, such as stress, depression or even menstruation at times. Many neglects their symptoms, writing off the pain as ‘just a regular headache’. Thus, many resort to home remedies or short-term solutions instead of consulting health practitioners. Driving the recognition of red flags and the need to seek consultations promptly is necessary to overcome this gap.
Obstacles to diagnosis also include limited knowledge about migraine among general health care providers, who receive minimal information on headache disorders during their medical training or undergraduate, post-graduate, and post-doctoral courses. The lack of knowledge about headache disorders deprives physicians of the ability to confidently tackle these problems. There is a clear need for education programmes catering to medical practitioners, including paediatricians -- given the early onset of the condition, to have the latest evidence-based information on migraines. In addition, guidelines and specific recommendations on migraine care delivery can equip health care practitioners with the knowledge needed to streamline diagnosis and treatment. Another problem to overcome is with regards to treatment delays, with a study suggesting less than 5% of chronic migraine patients finally reach a tertiary care centre to receive optimal treatment, often delayed due to multiple barriers.
At the clinic, giving time to patients with primary headache complaints, instead of dismissing such symptoms, is a quintessential pillar of support for those afflicted with migraines. Enabling such prompt identification of risk factors is a necessary aspect of health care with regards to this patient population.
Another area with gaps to bridge is epidemiology. Globally, migraine receives less research funding than all other diseases that are identified as high burden by the Global Burden of Disease study. In India, there is a dearth of local research and epidemiological studies on migraine. Data that is available on migraine is typically from studies involving a generalised assessment of headache disorders and neurological conditions. There is a need to promote India-specific migraine research to boost our understanding of local risk factors, thus streamlining local diagnostic criteria and ensuring effective, individualised treatment of migraine patients. This can have numerous benefits, and improving the quality of life of the young workforce of the country produces intangible benefits that go far beyond any numbers.
The piece has been authored by Dr Debashish Chowdhury, professor and head of neurology, G B Pant Institute of Post Graduate Medical Education and Research (GIPMER) and in-charge, Headache Clinic, GIPMER, New Delhi