There’s an effort within Migraine advocacy to promote the message that Migraine is treatable. Technically, this is true. In reality, the answer is much more complicated. Migraine is treatable just like heart disease, cancer, or diabetes are treatable. Most patients receiving first-line treatments respond well. They take the prescribed medications and adjust their lifestyle to accommodate their disease with minimal interruption to their daily lives. Yay for modern medicine!
Then there are smaller groups of patients that don’t fare so well. They simply don’t respond to the recommended treatments. It is tempting to blame the patient for not following through on the treatment plan. That may be true for some, but not all. Modern medicine isn’t perfect.
So yes, migraine is treatable
Those treatments work best under the following circumstances:
- Early intervention
- Accurate diagnosis
- Abortive treatment
- Rescue treatment
- Preventive treatment
- Lifestyle management
Researchers found that getting access to this kind of treatment is so difficult than only a fraction of those with Migraine can even get an accurate diagnosis.
Sure, there is a problem with public education
Less than half the people with Migraine ever talk to their doctor – not even once. These aren’t the patients who have “tried everything” and given up. These are people who self-medicate with OTC medicines and never ever mention the problem to a doctor.
But why should they? Their odds of getting a correct diagnosis is only about 25%. Most primary care physicians lack the skills to accurately diagnose any headache disorder. On the off chance the doctor gets it right, only 44% will walk out with an appropriate treatment plan. It’s simply not enough to write a script for Imitrex. That’s not good migraine management.1
It’s not the doctors’ fault either
How well do you think you would do with only 4 hours of training on headache disorders? Primary care physicians see a lot of patients with a lot of health problems. It’s not realistic to expect them to be experts on every single problem.
Enter, the specialist
In theory, that’s a great idea. Not knowing the difference between a headache specialist and a general neurologist, a doctor will likely refer patients to the closest neurologist. The time between identifying the problem and finally getting to a neurologist may take years. By that time, the patient could have developed Medication Overuse Headache, Chronic Migraine, or both.
The window of opportunity for early intervention is long gone. The patient had better hope that neurologist is a headache specialist. Otherwise, it could many more years of failed medication trials and a gradual worsening of the problem.
So yes, migraine IS treatable
- If the patient knows to seek help when the attacks are mild and infrequent.
- If the doctor knows how to diagnose it properly
- If the patient is offered a multi-faceted treatment plan.
Even then, there are no guarantees for success
- Medical schools that actually prepare doctors to treat this widespread disease
- Lawmakers who are willing to make research funding for migraine a priority
- Health care systems that routinely screen for migraine and direct patients to appropriate care
- Insurance providers that will actually pay for the needed treatments
- Labor laws that specifically include migraine as a protected disability
- Public service campaigns to educate the general public