Magnitude of Migraine Burden Not Fully Recognized in Canada




    
            First Forum of Canadian Migraine Experts and Patients
                 Examines Barriers to Optimal Migraine Care
    

    CALGARY, Nov. 4 /CNW Telbec/ - Societal stigma, patient denial,
misdiagnosis and treatment confusion may be posing critical barriers to
optimal migraine management in Canada according to proceedings from The
Canadian Migraine Forum, published as a supplement in the November issue of
The Canadian Journal of Neurological Sciences.
    The forum, which brought together a multidisciplinary panel of 30
migraine experts and patients from across Canada, examined the country's
current state of migraine care and explored ways to improve the lives of
Canadians with migraine, specifically by reducing their migraine-related
disability. Panelists included neurologists, family physicians, nurses,
pharmacists, patients with migraine and other professionals who play a key
role in migraine management, including occupational therapists, healthcare
administrators, and psychologists.
    "Despite its remarkably high prevalence in Canada, migraine is not that
well understood and patients may be suffering unnecessary pain and disability
as a result," said Dr. Werner J. Becker, professor, Division of Neurology,
Department of Clinical Neurosciences, University of Calgary, Alberta, and lead
author of the Canadian Migraine Forum proceedings.
    "People, including many physicians, don't recognize or empathize with the
migraine experience. We must do better to educate healthcare professionals,
patients and the public- at-large that migraine is an under-recognized medical
problem requiring treatment."
    In Canada, the prevalence of migraines exceeds that of osteoarthritis,
diabetes and asthma. Recent lifetime migraine prevalence in women (24.9% in
2004(1); 26% in 2006(2)) and in men (10% in 1992(3); 7.8% in 1994(4)) suggest
that more than three million women and one million men in Canada have
migraine. Approximately 60 per cent of migraine sufferers have one or more
headache attacks per month, and 25 per cent of sufferers have attacks at least
once a week.(5),(6)
    Forum participants suggested that because headaches are so common, people
have their own perceptions and misconceptions of migraine. Some patients even
try to ignore the impact migraine is having on their lives through denial.
    "It's incredibly frustrating that migraines are often dismissed or
trivialized by people without migraines," said a patient at the forum. "My
migraine has affected me professionally, economically, socially and personally
but the extent of this disability is not fully appreciated. I had to stop
working and constantly live in fear that I might miss special life moments,
such as a wedding or Christmas, because of an attack."

    
    Barriers to Quality Care

    Other data and discussion presented at the forum highlighted a number of
key challenges, including:

    - Patients with migraine often do not seek help, although it is
      available. A recent Canadian survey found 48 per cent of women with
      migraine had never consulted a physician for their headaches;(7)

    - Migraine is often under diagnosed. While migraine diagnoses made by
      primary care physicians are largely accurate, it has been shown that
      one in four patients with migraine receives another diagnosis
      instead;(8)

    - Busy primary care practices do not always offer the time for a careful
      history and physical of a patient with a headache and this can delay
      accurate diagnoses and negatively impact treatment;

    - While many symptomatic medications are available, migraine-specific
      medications are underutilized. At the same time, taking painkillers or
      other medications for migraine attacks too often (medication overuse)
      can cause increased migraine frequency. Patients with medication
      overuse make up a significant proportion of migraine sufferers who
      attend specialty headache clinics.

    Participants identified the complexity of effective migraine management
and discussed that even patients with disabling migraines are not always
receiving the best treatments or taking them in an optimal manner. The concept
of stratified care is now supported by most headache specialists but is not
always followed. It involves tailoring medication to the patient's headache
severity and disability rather than sequentially trying a variety of simpler
symptomatic treatments that are unlikely to be effective for patients with
severe attacks.

    Finding Solutions through Leadership and Education

    Better education for physicians, patients and the public, was viewed as a
cornerstone to minimizing the impact of migraine on the individual, the family
and society at large. The Forum concluded by identifying six broad essential
initiatives that, if followed by those in the field of migraine, could help
reduce migraine-related disability in Canada. These include: employing a
chronic disease management model with regular long-term follow up and
multidisciplinary treatment teams; involving Canadians with migraine as
supporting partners in migraine self-management programs and support group
leadership; and increasing public awareness to address misunderstanding of
migraine and under-use of migraine-specific and prophylactic medications.
    "Education is key and this is particularly true for Canadians experiencing
migraines so that they can advocate for better care," continued Dr. Becker.
"We're urging patients to track the impact that migraines are having on their
lives and learn about the importance of prevention and early treatment of the
migraine attack. Armed with this information, patients can work with their
physicians to ensure appropriate treatment and self-management strategies that
will minimize personal disability associated with migraines."

    Migraine Burden of Illness

    Most migraine attacks are relatively severe with symptoms leading to
significant disability. Because of the intense pain, nausea, and other
migraine symptoms, it may be difficult or impossible for many migraine
sufferers to function normally during an attack. The World Health Organization
ranks migraine as 19th overall among medical disorders in terms of causing
years lived with disability (2001) and among women it ranks 12th(9). According
to 1992 estimates, seven million working days are lost annually in Canada due
to migraine.(10)

    About the Canadian Migraine Forum

    The Canadian Migraine Forum was organized by the Canadian Headache Society
(CHS) and Headache Network Canada (HNC) and funded through an unrestricted
grant from Merck Frosst Canada Ltd. The content was determined by a planning
committee made up of members of the CHS and HNC.
    The Canadian Headache Society is a non-profit physician organization
dedicated to promoting research, education and patient care in the field of
headache. Headache Network Canada is a not-for-profit Canadian organization
and a registered Charity which is dedicated to providing headache sufferers
and their families with evidence-based medical and scientific information on
the recognition and treatment of headache disorders through education.
Canadians can consult HNC's innovative website at www.headachenetwork.ca.

    FORUM PARTICIPANTS FROM THE FOLLOWING CITIES ARE AVAILABLE FOR INTERVIEWS:

    Vancouver
    Calgary
    Winnipeg
    Toronto / Hamilton
    Montreal


    REFERENCES
    ------------------

    (1)  Pryse-Phillips W, Findlay H, Tugwell P, Edmeads J, Murray TJ, Nelson
         RF. A Canadian population survey on the clinical, epidemiologic and
         societal impact of migraine and tension-type headache. Can J Neurol
         Sci. 1992 Aug;19(3):333-9.

    (2)  Cooke L, Becker WJ. Migraine prevalence, disability, and treatment:
         Canadian women and migraine survey. Abstracts; Can J Neurol Sci.
         2006;33Supp 1:S27-8.

    (3)  Pryse-Phillips W, Findlay H, Tugwell P, Edmeads J, Murray TJ, Nelson
         RF. A Canadian population survey on the clinical, epidemiologic and
         societal impact of migraine and tension-type headache. Can J Neurol
         Sci. 1992 Aug;19(3):333-9.

    (4)  O'Brien B, Goeree R, Streiner D. Prevalence of migraine headache in
         Canada: a population-based survey. Int J Epidemiol. 1994
         Oct;23 (5):1020-6.

    (5)  Lipton RB, Stewart WF, Simon D. Medical consultation for migraine:
         results from the American Migraine Study. Headache. 1998;38:87-96.

    (6)  Cooke L, Becker WJ. Migraine prevalence, disability, and treatment:
         Canadian women and migraine survey. Abstracts; Can J Neurol Sci.
         2006;33Supp 1:S27-8.

    (7)  Cooke L, Becker WJ. Migraine prevalence, disability, and treatment:
         Canadian women and migraine survey. Abstracts; Can J Neurol Sci.
         2006;33Supp 1:S27-8.

    (8)  Tepper SJ, Dahlof CGH, Dowson A, Newman L, Mansbach H, Jones M, et
         al. Prevalence and diagnosis of migraine in patients consulting
         their physician with a complaint of headache: data from the Landmark
         Study.
         Headache. 2004;44:856-64.

    (9)  Leonardi M, Steiner T, Scher A, Lipton RB. The global burden of
         migraine: measuring disability in headache disorders with WHO's
         classification of functioning, disability and health (ICF). J
         Headache Pain. 2005;6:429-440.

    (10) Pryse-Phillips W, Findlay H, Tugwell P, Edmeads J, Murray TJ, Nelson
         RF. A Canadian population survey on the clinical, epidemiologic and
         societal impact of migraine and tension-type headache. Can J Neurol
         Sci. 1992 Aug;19(3):333-9.
    




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For further information: Laura Espinoza, Edelman, (416) 979-1120, ext.
245, laura.espinoza@edelman.com; Julie Seidel, Edelman, (514) 844-6665, ext.
244, julie.seidel@edelman.com

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CANADIAN HEADACHE SOCIETY

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HEADACHE NETWORK CANADA

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