"World Brain Day,” an event dedicated adopted since 2014 to bringing more attention to the importance of brain health and the prevention of brain diseases, a largely underestimated health problem. Each year on July 22nd a particular brain health theme is emphasized to create Awareness .
In 2019 the Theme of ’ World Brain Day (WBD) on JULY 22 is
MIGRAINE: THE PAINFUL TRUTH
-PROF DR.M.A.ALEEM M.D., D.M.,(NEURO)
EMERITUS PROFESSOR OF NEUROLOGY
THE TAMILNUDU DR.M.G.R. MEDICAL UNIVERSITY
PAST PRESIDENT TAMILNADU PONDICHERY ASSOCIATION OF NEUROLOGISTS
FORMER OF VICE PRINCIPAL HOD& PROFESSOR OF NEUROLOGY KAPV GOVERNMENT MEDICAL COLLEGE& MGM GOVERNMENT HOSPITAL
CONSULTANT NEUROLOGIST AND EPILEPTOLOGIST (TRAINED AT INSTITUTION OF NEUROLOGY QUEEN`S SQUARE . LONDON.UK.) ABC HOSPITAL, ANNAMALAI NAGAR , TRICHY -620018
DIRECTOR ABC HOSPITAL TRICHY
drmaaleem@hotmail.com
Migraine is the most common brain disease in the world, affecting 1 in 7 people worldwide.
It is a major, disabling disease that can severely impact every aspect of your life.
Migraine is under-recognized, under-diagnosed and under-treated neurological condition.
It is a disease where the majority of sufferers will never get the help they need.
Migraine receives less research funding than any of the world’s most burdensome diseases.
Facts And Figures About Migraine
Prevalence
Migraine is the third most common disease in the world (behind dental caries and tension-type headache) with an estimated global prevalence of 14.7% (that’s around 1 in 7 people).
Migraine is more prevalent than diabetes, epilepsy and asthma combined.
Chronic migraine affects approximately 2% of the world population.
Migraine affects three-times as many women as men, with this higher rate being most likely hormonally-driven.
Research suggests that 3,000 migraine attacks occur every day for each million of the general population. This equates to over 190,000 migraine attacks every day in India
More than three quarters of migraineurs experience at least one attack each month, and more than half experience severe impairment during attacks.
Migraine often starts at puberty and most affects those aged between 35 and 45 years, but it can trouble much younger people including children.
About 4% of boys and girls in pre pubertal age suffer from migraine. As children get older there is a predominance among girls.
Painful Truth About Migraine
Migraine is ranked globally as the seventh most disabling disease among all diseases (responsible for 2.9% of all years of life lost to disability/YLDs) and the leading cause of disability among all neurological disorders.
The estimated proportion of time spent with migraine (i.e. experiencing an attack) during an average person’s life is 5.3%.
It is estimated that the Indian population may loses 25 million days from work or school each year because of migraine.
Severe migraine attacks are classified by the World Health Organization as among the most disabling illnesses, comparable to dementia, quadriplegia and active psychosis.
Migraine/chronic headache was found to be the second most frequently identified cause of short-term absence (47%) for non-manual employees.
Absenteeism from migraine alone costs many millions per year in India, calculated on the basis of 25 million lost days.
Migraine is estimated to cost mostly from the costs of prescription drugs investigations and doctors visits.
The financial burden of migraine is also high in our country . These including the the costs of healthcare , lost productivity through both absenteeism and presenteeism, and disability.
Research into migraine is the least publicly funded of all neurological illnesses relative to its economic impact.
Anxiety and depression are significantly more common in people with migraine than in healthy individuals.
Cause
Migraine is a disorder that almost certainly has a genetic basis.
An older theory on the causation of migraine included that migraine is primarily a disease of the blood vessels. It is now accepted that migraine is not related to any vascular pathology and brain mechanisms are more likely involved in the development of migraine attacks.
Diagnosis and management
Migraine remains undiagnosed and undertreated in at least 50% of patients, and less than 50% of migraine patients consult a physician.
In the India 3% of physicians consultations and 30% of neurology consultations are for headache, with migraine the most common diagnosis.
The greatest single advance in migraine management in the last half of the 20th century was the triptan class of drugs, which emerged in the 1990s and the first (sumatriptan) was developed at Glaxo in Stevenage, UK.
One of the most frequently cited health problems treated with alternative therapies is headaches.
Worldwide, just four hours are committed to headache disorders in formal undergraduate medical training, and 10 hours in specialist training.
Headache teaching is not on the curriculum for approximately 75% of the undergraduate medical schools.
Despite the evidenced clinical and cost efficacy of specialist nurses, there are only around 12 trained headache specialist nurses for the whole of England.
Less than 50% of migraine patients are satisfied with their current treatment. The majority self-medicate using non-prescription (over-the-counter) medication and do not seek medical help.
Historical
In prehistoric times migraine was treated with trepanning, a surgical procedure that involves drilling a hole into the skull with one aim being to release evil spirits.
The word migraine derives from the Greek word ‘hemicrania’ (imikrania; ημικρανία) which means ‘half the skull’. In 400 BC Hippocrates described in detail the occurrence of migraine attacks, including the visual disturbances during migraine aura and the relief from vomiting. The word ημικρανία was later established by the Greek physician Κλαύδιος Γαληνός (Galen of Pergamon).
Migraine and other headache disorders were first comprehensively classified in 1988 by the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (IHCD-3) beta was published in 2013. It is recognised by the World Health Organization and researchers and clinicians worldwide refer to its diagnostic criteria.
Key facts
Headache disorders are among the most common disorders of the nervous system.
It has been estimated that almost half of the adult population have had a headache at least once within the last year.
Headache disorders, which are characterized by recurrent headache, are associated with personal and societal burdens of pain, disability, damaged quality of life, and financial cost.
Worldwide, a minority of people with headache disorders are diagnosed appropriately by a health-care provider.
Headache has been underestimated, under-recognized and under-treated throughout the world.
What are headache disorders?
Headache disorders, characterized by recurrent headache, are among the most common disorders of the nervous system. Headache itself is a painful and disabling feature of a small number of primary headache disorders, namely migraine, tension-type headache, and cluster headache. Headache can also be caused by or occur secondarily to a long list of other conditions, the most common of which is medication-overuse headache.
How common are headache disorders?
Globally, it has been estimated that prevalence among adults of current headache disorder (symptomatic at least once within the last year) is about 50%. Half to three quarters of adults aged 18–65 years in the world have had headache in the last year and, among those individuals, 30% or more have reported migraine. Headache on 15 or more days every month affects 1.7–4% of the world’s adult population. Despite regional variations, headache disorders are a worldwide problem, affecting people of all ages, races, income levels and geographical areas.
What is the burden due to headache disorders?
Not only is headache painful, but it is also disabling. In the Global Burden of Disease Study, updated in 2013, migraine on its own was found to be the sixth highest cause worldwide of years lost due to disability (YLD). Headache disorders collectively were third highest.
Headache disorders impose a recognizable burden on sufferers including sometimes substantial personal suffering, impaired quality of life and financial cost. Repeated headache attacks, and often the constant fear of the next one, damage family life, social life and employment. The long-term effort of coping with a chronic headache disorder may also predispose the individual to other illnesses. For example, anxiety and depression are significantly more common in people with migraine than in healthy individuals.
Types of headache disorders
Migraine, tension-type headache and medication-overuse headache are of public health importance since they are responsible for high population levels of disability and ill-health.
Migraine
A primary headache disorder.
Migraine most often begins at puberty and most affects those aged between 35 and 45 years.
It is more common in women, usually by a factor of about 2:1, because of hormonal influences.
It is caused by the activation of a mechanism deep in the brain that leads to release of pain-producing inflammatory substances around the nerves and blood vessels of the head.
Migraine is recurrent, often life-long, and characterized by recurring attacks.
Attacks typically include:
headache, which is:
of moderate or severe intensity
one-sided
pulsating in quality
aggravated by routine physical activity
with duration of hours to 2-3 days
nausea (the most characteristic associated feature);
attack frequency is anywhere between once a year and once a week;
and
in children, attacks tend to be of shorter duration and abdominal symptoms more prominent
Migraine headaches are one of the most common neurological disorders in the world with an estimated global prevalence of one in seven people.
Despite such high prevalence, migraine continues to be an underdiagnosed and undertreated disease in India, resulting from myths and misconceptions surrounding the illness including incorrect diagnosis. While migraine can be effectively managed, awareness and understanding of migraine, its triggers and potential treatment options remains low.
Evidence shows that migraine reduces family, social, and recreational activities. Many patients have had to give up their careers as they are not able to cope. Personal and family lives also get adversely impacted. There are many cases where recurrent headaches and disability has led to self-harm because of the co-morbid depression that is seen with migraine.
Migraine is a chronic, disabling neurological disorder that affects more than 150 million people in India. It is often misdiagnosed as sinus associated headache or as being due to a refractive eye problem or as stress related
"Migraine is a treatable disorder, where the headache frequency and severity can be effectively controlled. To achieve that goal, one needs to avoid self-medication with harmful over-the-counter pain-killers and be rightly diagnosed and treated with specific anti-migraine treatment prescribed by consulting doctor.
The causes and symptoms of migraine -it is characterised by recurrent attacks of moderate to severe head pain that is throbbing or pulsating and often strikes one side of the head, though both sides may ache.
Other common symptoms are increased sensitivity to light, noise, odours and nausea and vomiting. Routine physical activity, movement, or even coughing or sneezing can worsen the headache.
An untreated migraine attack usually lasts from 4 to 72 hours.
Most people who suffer migraine headaches have a family history of headaches suggesting a strong genetic susceptibility. Migraine in women often relates to changes in hormones. The precise cause of migraine headaches in unclear, but there is general agreement that blood flow changes in the brain are a key factor.
Around one billion people worldwide are affected by migraine.
Triggers of migraine:
A trigger is a condition that acts as a precursor to set off a migraine attack. These triggers can be unique for each patient. Environmental factors appear to play a significant role in triggering a migraine attack however, other things may also act as triggers.
Some of the common triggers of migraine are:
- Foods such as aged cheeses, salty or processed foods
- Food additives such as sweetener aspartame and monosodium glutamate (MSG)
- Drinks including alcohol and high caffeine beverages
- Stress at work or home
- Sensory stimuli such as bright lights, sun glare, loud sounds, and strong smells like that of perfume, paint thinner, passive smoking
- Changes in wake-sleep pattern including lack of sleep or too much sleep
- Physical exertion
- Changes in the environment such as change of weather or barometric pressure
- Medications such as oral contraceptives and vasodilators
It is important for patients to seek help from a headache specialist or neurologist and complete their migraine treatment as prescribed by the consulting doctor.
Social and economic burden of headache
Headache disorders are a public-health concern given the associated disability and financial costs to society. As headache disorders are most troublesome in the productive years (late teens to 50s), estimates of their financial cost to society – principally from lost working hours and reduced productivity – are massive. In the United Kingdom, for example, some 25 million working- or school-days are lost every year because of migraine alone; this financial cost may be matched by TTH and MOH combined. Headache is high among causes of consulting medical practitioners: one-third of all neurological consultations were for headache, in one survey.
Yet, many of those troubled by headache do not receive effective care. For example, in the United States of America and the United Kingdom, only half of those identified with migraine had seen a doctor for headache-related reasons in the previous 12 months, and only two-thirds had been correctly diagnosed. Most were solely reliant on over-the-counter medications.
Treatment
Appropriate treatment of headache disorders requires training of health professionals, accurate diagnosis and recognition of the conditions, appropriate treatment with cost-effective medications, simple lifestyle modifications, and patient education. The main classes of drugs to treat headache disorders include: analgesics, anti-emetics, specific anti-migraine medications, and prophylactic medications.
Barriers to effective care
Lack of knowledge among health-care providers is the principal clinical barrier. Worldwide, on average, only 4 hours of undergraduate medical education are dedicated to instruction on headache disorders. A large number of people with headache disorders are not diagnosed and treated: worldwide only 40% of those with migraine or TTH are professionally diagnosed, and only 10% of those with MOH.
Poor awareness extends to the general public. Headache disorders are not perceived by the public as serious since they are mostly episodic, do not cause death, and are not contagious. The low consultation rates in developed countries may indicate that many affected people are unaware that effective treatments exist. Half of people with headache disorders are estimated to be self-treating.
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