The phrase “crippling headache” is as accurate as it gets for millions around the globe -- a bad headache can get in the way of everything.
Last Thursday, a conference in Cairo was attended by several senior professors of neurology in collaboration with the private sector's pharmaceutical, Novartis , to discuss the burdens of migraines, the traditional treatments available to patients, and the importance of the new treatment in relieving their suffering.
Last year, the conference organisers also launched the hashtag #BalashSuda3 to raise public awareness of different kinds of headaches, their causes and their treatment options, with a special focus on migraines.
Dr. Mohamed Osama Abdelghany, the head of the Headache Chapter, explained that migraines are a neurological disease in which genetics and environmental factors appear to play a role, although the exact causes are still shrouded in mystery.
"Migraine in Arabic historically had a very significant name – el-shakeeka -- meaning 'what splits the head into two'. With such accuracy, our ancestors explained its effect,” he said.
"It is typically a severe throbbing recurring pain, usually on one side of the head, and is often accompanied by debilitating symptoms such as nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell.”
A common disease
Understanding the magnitude of the problem requires a look at the data.
“Migraine affects more than 10 percent of the global population and is two to three times more common in women than in men. Research suggests that 3,000 migraine attacks occur every day for each million of the general population. The disease is most common between the ages of 25 and 55,” said Abdelghany.
Comprehensive data is not available for the whole of Egypt, so experts tend to rely on two key studies conducted in the governorates of Assiut and Fayoum.
"A study on primary headache disorders in Fayoum on 2,600 patients and in Assiut on 5,000 patients revealed that more than 60 percent of respondents did not seek medical advice for their headaches, with the percentage higher in rural areas. Those people thought that over-the-counter pills could be a solution, and that migraines are incurable. The prevalence of symptomatic migraines reached 17.3 percent and peaked in middle age, according to the survey."
"Migraine is the third most common disease in the world, with an estimated global prevalence of 14.7 percent -- affecting nearly one in seven people," Abdelghany explained.
Finding a way out
The experts then turned to the topic of understanding the ailment and the treatments commonly used, as well as tackling the new scientific breakthroughs in the field.
The causes of the disease have long been unclear, and sufferers have often resorted to painkillers that are not effective. Doctors prescribed medications that are usually used for treating other medical problems like heart disease, depression and epilepsy, which could scare patients off and led them to discontinue treatment.
"Many factors contributed to under-recognition and under-treatment, some of which were the absence of specialised headache centres, underestimating ‘headache’ disorders by family members and even by health care practitioners, insufficient patient education and the availability of over-the-counter pain relievers," said Dr. Maged Abdel Nasser, professor and head of neurology at Kasr Al-Ainy, and general secretary of the Egyptian Society of Neurology, Psychiatry and Neurosurgery.
“Though migraine causes are not understood, genetics and environmental factors appear to play a role. Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway," he added.
This was until a new discovery surfaced.
"Clinical studies have proven that the a certain protein, CGRP, is associated with the migraines and plays an important and active role in causing an attack, and new treatments in the form of monthly shots made use of this scientific breakthrough, and paved the way for the first preventive medication to appear in Egypt when it comes to migraines,” Abdel Nasser noted.
Leading cause of disability
The day concluded with attendees drawing attention to the importance of raising awareness of the possibility of preventing and treating migraines, which take a huge toll on economies and societies.
The doctors explained that, between 1990 and 2016, migraines were classified globally as the second leading cause of disability.
They added that more than 90 percent of those who suffer from migraines are unable to work or lead normal lives, and up to 46 percent of migraine patients visit emergency rooms for treatment. Studies show that migraines with aura, a sensation that sufferers get before the onset of an attack, are associated with a twofold increased risk of ischemic stroke.
"In addition to that, migraine patients are at a greater risk of developing anxiety and/or depression than non-sufferers, and the disease is also associated with a high economic and societal burden,” Abdelghany said.
"The huge impact of migraine, which affects women three times more than men, on patients’ lives, translates into significant economic and social burdens," he stressed.
Commenting on the lack of proper awareness even among health care providers, Abdelghany, said: “Across medical schools all over the world, a minimal amount of hours are dedicated to migraine, despite the fact that severe headaches and migraines are highly prevalent among the younger segment of the population.
"Migraine remains under-diagnosed and under-treated in at least 50 percent of patients, and less than 50 percent of migraine patients consult a physician.
"Awareness should be raised in order for health care professionals, family members and friends to be able to identify the symptoms of migraine and understand that there are treatments, and yes, now there could be prevention," he concluded.