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migraine treatment and prevention options get a much-needed update with new canadian guidelines
6 minute read
in canada, migraine is the third-highest condition related to missed days at work, with 56 per cent of canadian employees living with migraines taking sick days due to the disorder, 23 per cent having to be on short-term disability, and 18 per cent having to be on long-term disability.
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it’s estimated that roughly 12 per cent of canadians experience migraines. the neurological disorder doesn’t discriminate, and anyone of any age can develop a migraine. that said, it typically affects people most in their 30s and 40s.
while there is a common misconception surrounding migraines as being “just a really bad headache,” new research over the past decades has found that it is an entirely different ailment, driven by various mechanisms, and can lead to a severely reduced quality of life.
the canadian headache society released an updated version of 2012’s migraine prevention guidelines based on advancements in the field of migraines, highlighting newer available treatments and prevention therapies. the guidelines aim to provide healthcare professionals with valuable information that can shape how people living with migraines receive care.
dr. alex melinyshyn, a neurologist and headache specialist based in london, ontario, sees patients who live with migraines and looks forward to a future where newer interventions are implemented.
“i think our new guidelines are a really good update that pays homage to the older medicines and makes sure that there’s still some old favourites that we like to try in certain situations,” he said. “but it’s really a much-needed update to tell people, ‘hey, there are new drugs that are available to you.”
the impact of migraines
it’s commonly thought that migraines are not as severe as people make them out to be, but this could not be further from the truth. research shows that the burden of migraines is significant.
in canada, migraine is the third-highest condition related to missed days at work, with 56 per cent of canadian employees living with migraines taking sick days due to the disorder, 23 per cent having to be on short-term disability, and 18 per cent having to be on long-term disability.
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“this is a really insidious thing, and i think you have to go back through history,” said dr. melinyshyn, later continuing, “in some extreme circumstances, there are people who are missing multiple days from work. they’re unable to hold a job. it ruins their family life. they’re not going to social events.”
dr. melinyshyn also notes that people living with migraines tend to minimize their symptoms due to the stigma surrounding the disorder, making it harder for those people to seek the care they need.
the “much-needed” new guidelines
migraine canada took the guidelines the canadian headache society developed and created a position paper to review the findings and recommendations. the update, which is based on evidence surrounding prevention and management, aims to integrate the latest and greatest research into modern care for migraines.
the guidelines include a host of new medications that show much higher promise in providing relief than the current therapies considered the standard of migraine care.
they also provide information as to what should be considered when prescribing these medications to people, such as how effective it is, what the side effects are, and any comorbidities a patient has alongside their migraine disorder.
“these updated guidelines are a crucial step to help improve care for canadians living with migraine. our position paper reinforces the need for accessible, evidence-based treatment options and serves as a tool to influence policy changes that will improve patient outcomes and lessen the burden on the healthcare system,” said wendy gerhart, executive director of migraine canada, in a press release.
to ensure the guidelines are getting in front of the right people, including policymakers and healthcare providers, migraine canada’s position paper will act as a conversation starter so that organizations can continue to push for better access to migraine medications and treatments.
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the guideline’s evidence-backed therapies and newly developed treatments provide an update that’s more relevant to the times when it comes to migraine medical advancement.
“we’ve had a huge change in the drugs that are available to us. so, we have a lot of new tools in our kit, and this is because migraine and headache medicine, in general, is more of a nascent branch of neurology,” said dr. melinyshyn. “while we always kind of treated it, we didn’t necessarily have good explanations or models of how to approach it from a scientific perspective. that has changed.”
before the advancements, the understanding of migraines on a physiological level wasn’t there, and many drugs used were treating results serendipitously, according to dr. melinyshyn. essentially, they would treat someone for one condition, such as epilepsy or mood disorders and find that the medications also fixed their migraines.
the newer drugs available, which are part of the updated guidelines, target specific pathways that drive migraines so that people can take a drug dedicated to their particular condition, reducing multi-mechanism-driven side effects when taking a medication off-label.
having this new information also helps physicians who have patients with migraines but aren’t necessarily enthralled in migraine medicine make better clinical choices when prescribing therapies and treatments.
“the guidelines provide a really nice, comfortable path for physicians who may not be familiar with a particular area of medicine but are looking to treat it. so, for instance, in primary care, where they need to know hundreds of conditions, the guidelines provide an invaluable resource based on expert opinion and an analysis that’s very in-depth of the current available evidence,” dr. melinyshyn said.
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the small first step in the right direction for migraine treatment
even with the new guidelines, medical providers will still have to play “catch-up” to the newer drugs and recommendations.
“there is a lag between basic science research and the clinical world,” said dr. melinyshyn. “then, there’s a lag between proving something clinically and then ensuring whether it’s public or private paying for it.”
this means that while these new drugs are being developed, accessing them may not be as easy as going to your family doctor and asking for them. the clinical world needs to follow these guidelines and update its approach to migraines, and that doesn’t happen overnight.
typically, insurance companies will favour established medications over new ones and call for people to take “old-class medicines” first to see if they work. once a person goes through those motions and doesn’t find relief, they will be able to access the newer drugs.
however, dr. melinyshyn would love to see this process streamlined so that the most effective medicine is given priority.
“imagine through some twist of fate, whether it’s a fault or not of your own, you have syphilis, okay? it’s happens. now, imagine i made you do all the ancient treatments for syphilis before we get to penicillin, which we know works very, very well,” he said.
he continued, “so, you have to go to the barber and cut out your wounds. you have to put topical mercury, which has horrible side effects and fatality. why on earth, if we have a very good medicine that we know is tolerable and effective and people are very happy, why would we force you to recapitulate all the ancient medicines before you’re able to go to something that’s effective?”
many people waiting for these newer therapies will continue to suffer through the old medications and their side effects, and in many cases, put off their lives due to the lack of access to innovative therapies.
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but dr. melinyshyn is hopeful that other doctors and neurologists will get on board sooner rather than later.
“these guidelines provide extra reassurance, and as we go around talking to people about them, i’m hopeful that other clinicians from different streams will realize these are very well tolerated and do not have a lot of side effects. they work extremely well, and you have an opportunity to really intervene in your patients’ lives and make a huge impact.”
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