For migraine sufferers, picking the right medication can be a real headache.
When the twinkle of pain behind your eye turns into a crippling migraine, you're left with two options: riding it out, or taking drugs with side-effects that could make you even more sick. For many of us dealing with the chronic pain of migraines, navigating treatments can feel like stomping through a minefield.
Anyone who has ever been prescribed migraine medication knows that it's a crapshoot. Often, doctors will use trial-and-error to land on a treatment that works best for you. But this imperfect system leaves many patients dissatisfied with their pain regimen, as a new national survey from Health Union reveals.
According to the study, which polled 3,900 individuals who experience migraines, only 40 percent of patients are happy with their medication. While the results suggest that no two migraine sufferers are alike, they also highlight a pharmaceutical industry that has ignored the demand for better, safer drugs.
Currently, three categories of migraine medication exist. They are abortive, preventative, and rescue. The most popular of these, as reported by the study, are abortive treatment options, which are used by 66 percent of migraineurs who depend on prescription pain relief. Drugs like Imitrex and certain nasal sprays are popular because they can stop a migraine from progressing if you've already started to feel its effects.
But even the most preferred and well-studied migraine treatments aren't always perfect. Triptans, which are a class of abortive drugs, and have received the most scientific evaluation, work by binding to serotonin receptors in the brain. They constrict the swelling of blood vessels, which can prevent the painful evolution of a migraine. In 2014, a comparative study of triptans found that when most effective, they provide two-hour pain relief 68 percent of the time, and 24-hour pain relief 54 percent of the time.
And the side-effects of triptans are myriad, leaving many patients feeling dizzy, nauseous, numb, or weak; and not everyone can use them. When taken by people who are also on antidepressants, a life-threatening reaction called "serotonin syndrome" could occur, causing toxic levels of the chemical to flood the body.
One of the reasons why migraine drugs are so unpredictable has to do with the disease's variability. According to the Health Union survey, migraine triggers range from barometric pressure changes to overpowering smells to stress, and even sunshine. Symptoms run the gamut, too, including pain, sensitivity to light, fatigue, and irritability. While 97 percent of people are aware of their triggers, the study notes, most admit that avoiding them is next to impossible.
Earlier this year, a paper published in the journal Headache accused pharmaceutical researchers of failing to study the impact of migraine drugs on a wide array of sufferers. As the authors pointed out, clinical trials for certain treatments can exclude some categories of migraineurs—either assuming that all types of migraines are the same, or failing to investigate the different effects that a drug might have on different subsets of migraines.
"There are not enough medicines out there to appropriately manage migraine headaches," author Brad Klein, a doctor and medical director of the Headache Center at Abington Hospital-Jefferson Health, said in a statement. "At a time in history when an unprecedented number of people are getting hooked on narcotic opiates by way of prescribed medications—as is the case with migraine sufferers as well—we owe it to ourselves as physicians to try medications that could work without the risk of addiction."
As a result of poor migraine treatments, as well as a general misunderstanding of what migraines actually are, patients can become overwhelmed by more than just pain. When asked how migraines affect their personal lives, 64 percent of respondents were constantly worried about disappointing people in the struggle to manage their symptoms. Approximately 46 percent were embarrassed about their disease, and 41 percent of participants confessed to hiding their migraines from others.
In the past couple of years, there has been more of an effort to destigmatize migraines, though some campaigns are more eager to promote drugs than awareness. Researchers are now looking at experimental medications to stop migraines before they start, however, it could be years until newer, safer treatment options reach market.
"No one took my symptoms seriously until I was in my 20s. I have had chronic migraine since I was age 11, but was not diagnosed until I was 25. When I was kid, most people thought I was making excuses to skip school," said Kerrie Smyres, a patient advocate for the community website Migraine.com.
"In all those years that my symptoms were dismissed, I internalized the stigma of migraine. I'm nearly 40 and, after three years of intense therapy, have finally stopped questioning if my symptoms were as severe as I believe them to be."
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