“There are four stages to my migraine; prodrome, aura, headache and postdrome. In my case, I have symptoms of all four stages simultaneously, non-stop. I’m like this every day, every hour, without fail. It has now been eight years since I’ve been having complex, intractable, non-stop migraines”

Migraine patient quoted in ‘Migraine, Lifting the burden’

Those were the harrowing words of a migraine patient that were highlighted in the disease-focused session entitled ‘Migraine, Lifting the Burden’ that took place in the Teva-sponsored Digital Transformation Zone at the NHS Health and Care Innovation Expo in September 2019.

The session, presented by David Bloomfield, Chief Executive of the National Migraine Centre (NMC), together with Arjun Sikand and Jonathan Massey from Health Innovation Manchester, took a detailed look at the burden of migraine and considered ways of improving the management of this disabling, yet under-recognised, condition.

Pictured: Arjun Sikand, David Bloomfield and Jonathan Massey take questions after their presentation

David explained that migraine is a neurological condition that people don’t know much about but it can be completely debilitating.

Although migraine affects around 20% of adults, clinically, it is often undiagnosed, misdiagnosed and mistreated, particularly in children.

Prevalence and symptoms

Migraine has been recognised for thousands of years and tends to run in families. It is more prevalent in women than in men (3:1) and there is a strong correlation with mental health.

There are four stages of migraine and the duration can last from hours to days. Headache is only one possible symptom and may not always be present. Other symptoms include vertigo, sensitivity to movement, loss of movement, nausea and vomiting and sensitivity to light and smell.

Impact of migraine1-3

  • 23% of the adult population have migraine. Almost six million people suffer.
  • It is estimated that it costs the NHS over £150 million per year and that 25 million days are lost from work or school each year because of migraine.
  • The cost of migraine annually is £10 billion, mostly arising from indirect lost productivity.
  • Not all staff report migraine to their employers: many that do feel unsupported.
  • There’s a strong relationship between mental health and migraine: 24% of migraineurs in a recent survey reported experiencing suicidal feelings or have self-harmed as a result of their migraine.

David commented that migraine makes life a misery for millions. It has a significant impact on society: there is a large, but hidden business cost to employers and a huge cost to the nation. Clinically, migraine is also considered a low priority: clinicians tend not to receive training in migraine management, there are no diagnostic tests available and scans simply rule out other conditions. Furthermore, historically, medications have not been designed specifically to tackle migraine.

Management of migraine

Management should reduce the frequency and severity of a migraine attack. David added that the NHS needs to find time to train clinicians and to take clinical histories. It also needs to integrate better with charities and pharmaceutical companies, both of which have recently taken an enhanced interest in the condition.

Arjun Sikand noted that Health Innovation Manchester has worked with innovators to discover, develop and deploy new solutions that improve the health and wellbeing of people in Greater Manchester. He talked about a cross-industry initiative to support people who experience migraine in the Manchester area.

Arjun emphasised the need to understand the societal, economic, social and personal burden of migraine. Despite the level of impact, very few people who experience migraines are taking preventative medicines and the use of triptans is low. There’s also a sense that more could be done to support those individuals who are affected by migraine.

“Future considerations for Manchester are a toolkit for employers and an awareness raising campaign.”

Arjun Sikand, Health Innovation Manchester

He noted that Health Innovation Manchester’s future considerations are a toolkit for employers and an awareness raising campaign, in addition to the creation of a rapid access clinic model, supported by a redesign of the referral pathway.

Arjun suggested that it is essential to up-skill the interdisciplinary community workforce in decision-making abilities around diagnosis and management of migraine. This is being addressed by providing effective, transformative education through a series of active learning modules that can be commissioned as a package or individually.

All of these initiatives will ultimately be evaluated by measuring patient outcomes and experiences.