Another Look at the Current Migraine Scene

By Michael Jorrin, "Doc Gumshoe", October 8, 2020

Thinking about COVID-19 almost gives me a migraine, or at least a heavy and achy sensation in my noggin – perhaps not an actual migraine, thankfully, but threatening and unpleasant all the same.   Happily, thinking about migraines will not give me COVID-19.   But migraines are by no means a topic of no consequence, even when COVID-19 is on our collective minds.   Migraine has been characterized as the most painful non-fatal ailment.   And, make no mistake, migraine really is an ailment – an illness or disease – and certainly much more than a casual headache. 

The bit of news that steers me to thinking about migraines once again came from the results of the OVERCOME study, which looked at a nationally representative sample of 21,143 persons who had a diagnosis of either chronic or episodic migraine.   (Buse D. Neurology 4/14/20:15 Suppl)

This was a study in what is described as “acute treatment optimization,” which supposedly contributes to reduced disability and improved health-related quality of life.   What was surprising and disturbing about the OVERCOME study is the finding that a large percentage of persons with migraine, whether chronic or episodic, simply did not receive treatment – either acute treatment, meant to help to resolve a migraine headache in progress, or prophylactic treatment, meant to help prevent recurring migraine episodes.   These individuals were not just plain folks who had occasional bad headaches that they figured were probably migraines.   Most of them had received a migraine diagnosis from a health professional, and nearly all had fulfilled the diagnostic criteria of the American Migraine Study.   More than half had at least a mild migraine disability, meaning that migraine episodes had the effect of preventing them from living their normal daily lives – missing work, or keeping to their beds in a darkened room.   About a quarter had such migraine headaches at least four times per month.       

Rejection of medical treatment of any kind can be based on many different factors, some more rational than others.   For example, a person who experiences an occasional migraine might rationally decide that he/she prefers to tough it out than to take a drug that is supposed to prevent the migraine, but is linked to side effects of consequence.   And that person might also be reluctant to take a drug for the acute treatment of migraine if that drug is known to be associated with rebound – that is, after the initial palliative effect of the drug, the migraine returns.   However, the OVERCOME study found that only about 20% of the individuals who experienced 15 or more migraine headaches per month took preventive drugs.   The percentage of those severely affected individuals who took acute treatment drugs was higher – 35%.   But that still meant that about two-thirds of persons who experience migraine headaches very frequently – about every other da