On the occasion of World Pain Day, this October 16, two doctors take stock of the symptoms and management of this neurological pathology which is still little taken seriously.
- In France, migraine affects 12% of the adult population.
- A seizure occurs in several stages: first the prodrome, followed by the aura and headache, and finally the postdrome.
- Vydura (or Rimégépant), is a new treatment, which is now available in France. “This treatment is effective, but it is expensive and not reimbursed by Social Security.”
“It is the second leading cause of disability in the world. In France, migraine affects 12% of the adult population. Due to hormonal changes, women are two to three times more affected than men. This neurological disease is characterized by repeated attacks manifested mainly by intense headaches”, explains Dr. Jérôme Mawet, neurologist at Lariboisière Hospital. During a press conference, organized by the Pfizer laboratory and the patients’ association La Voix des Migraineux on October 13, the specialist specified that there are two main types of attacks: those without aura and those with aura. This means that the headache is preceded or accompanied by transient neurological disorders (visual, sensory and motor).
Migraine: “A crisis takes place in several stages”
“These neurological signs, such as blurred vision, tingling, difficulty finding one’s feet or even paralysis of the limbs on one side of the body, are often mentioned, but little is said about prodromes and postdromes. We must know that a crisis takes place in several stages”, declares Dr Jérôme Mawet. It can begin 24 hours before with the prodrome, namely a feeling of the beginning of a migraine. During this period, the patient presents fatigue, an uncontrollable desire to eat fatty, salty and sweet foods, a frequent need to urinate, difficulty concentrating even during a conversation, crying or unexplained anger.
“For some people with migraine, the prodrome is followed by the aura. Then, the headache, more precisely the pain (which is one of the essential components of this neurological pathology) occurs. The last phase is the postdrome”, explains the doctor. This stage manifests itself as a feeling of exhaustion, aches and difficulty concentrating. “During this period, which can last 24 or 48 hours, a tsunami of emotions arises. Patients are irritable, anxious, depressed,” points out Sabine Debremaeker, founder and president of the association The Voice of Migraine People.
According to the neurologist, several factors can trigger seizures. “We know that part of the causes are genetic. However, migraine sufferers are people intolerant to changes. Thus, lack of sleep, stress, exposure to the sun, noise or smells, consumption of certain foods or stimulants can cause a crisis”, he specifies.
“Caring for a person with migraine can be a real obstacle course”
Although migraine is debilitating, Dr Jérôme Mawet and Dr Valenton Raclot, general practitioner in Dijon, deplore the lack of consideration of this neurological disease which leads to a real lack of care. “40% of patients have never consulted and a third of patients resort to self-medication, which can lead to overconsumption of painkillers” and a chronicization of the condition, indicates the Dijon practitioner.
According to the two health professionals, “Taking care of a person with migraine can be a real obstacle course, because (…) there is a myth of incurability around the pathology. It is often discussed in the background or at the very end of the consultation at the cabinet door.” However, this disease requires a dedicated consultation. According to Dr. Valenton Raclot, 90% of adults with migraine can be treated by a general practitioner, 9% by a neurologist and 1% by specialized centers (for example those for pain).
Migraine: Vydura, a new “effective” but “expensive” treatment
As a reminder, there is currently a crisis treatment, namely non-steroidal anti-inflammatories or triptans, to relieve headache. “In case of symptoms, they must be taken directly”, advises Dr Jérôme Mawet. A basic treatment, consisting of antiepileptic medications or antidepressants, may also be prescribed. “Problem: there are several side effects. However, a new drug, Vydura (or Rimégépant), is now available in France. This treatment, which blocks CGRP (an active molecule linked to migraine) is effective, but it is expensive and not reimbursed by Social Security. During consultations, I am therefore embarrassed to offer it to migraine patients. In general, I talk about it in the event of intolerance or failure of other treatments.” continued the specialist.
