Only one in four people with migraines receives prescription medication. For Lisa, it took 20 years
"I'm quite shocked at how low the number is," says a neurologist.
Published
When Lisa Bangaru Melheim was around thirteen years old, she experienced what she considers her first migraine attack.
“It's the first time I remember having such a severe headache that I threw up,” she says.
But it would take 20 years to receive the correct diagnosis and nearly six more years to find medications that truly helped.
A new Norwegian study now shows that she is not alone.
Three per cent of Norwegians receive medication
Many suffer from the condition without receiving proper treatment.
“There's generally quite low use of migraine medications despite it being a very common condition,” says Anker Stubberud from NorHead, the Norwegian Centre for Headache Research. He is one of the researchers behind the new study.
By searching through the Norwegian Prescription Database (NorPD), Stubberud and his colleagues determined how many Norwegians are prescribed migraine medications.
Only three per cent of the population received them in 2020, according to the study published in the scientific journal Cephalagia.
Many more could have received better help
Exactly how many should have been prescribed the medications is difficult to answer.
Some may manage with over-the-counter Paracetamol or Ibuprofen, and they are not included in this study.
However, it is clear that many more could have received better help, given that 11 to 12 per cent of the population suffer from migraines, Stubberud points out.
A rough estimate is that only one in four people with migraines uses prescription medications.
Requires patience from both doctor and patient
As a headache specialist, Mara Argren encounters many individuals with chronic migraines. It is not uncommon for them to have lived for years without effective medications.
Still, the results of the study surprised her.
“I’m actually quite shocked at how low the number is,” says the neurologist at Oslo University Hospital.
Argren believes that part of the problem may be that the path to the right medications is too long.
“The main issue with headache treatment is that we’re operating by trial and error. So finding the right medications requires a bit of patience, and a lot of structure from both the provider and the patient,” she says.
Lisa became a mother of two before receiving medication
Lisa can attest to this.
After her doctor determined that she did not have tension headaches after all, but migraines, she was prescribed medication.
By then, she had become a mother of two.
The pills, called triptans, are taken when a migraine attack begins.
The problem is that many people only try out one of these medications, according to the new study.
This means they might miss out on the help they could have received.
Patients should try three different pain relievers
If you have migraines, you should be given the opportunity to try three different triptans.
A study from 2023 shows that most people then find a medication that relieves their pain after trying three options.
Therefore, doctors should closely follow migraine patients and switch medications more frequently, Stubberud and colleagues point out in their research article.
Lisa found a drug that worked on her second try. But it was not enough.
Her migraines still struck like lightning up to four times a week, leading to frequent sick leave from her job as a teacher.
Never followed package insert instructions
Lisa started taking her migraine medication daily.
“I’ve never followed what was written on the package insert about dosage. So I’ve taken the risk of taking too many pills just to get through daily life,” she says.
This is the case for many others as well.
The new study shows that a small group of patients takes far too many of these pain-relieving medications.
“We know that if you have a lot of headaches and take too much acute medication like Ibuprofen, Paracetamol, or triptans, it can lead to headaches caused medication overuse,” Stubberud explains.
People have to go through excruciating pain
That is why those with chronic migraines should receive preventive medication.
These can help prevent the attacks from occurring.
But finding the right medication can be a difficult process.
“Many migraine medications are nonspecific. They include blood pressure medications, antidepressants, and epilepsy medications,” says Argren.
The Norwegian health authorities require patients to try three such medications before being allowed to try those specifically developed for migraines: CGRP inhibitors.
“This means that for nine months, people have to go through excruciating pain before we can offer them medications that we know are effective even at an earlier stage of the condition,” says Argren.
Headache Norway advocates for more access to CGRP inhibitors
These relatively new medications block the CGRP protein in the brain, which likely functions as a pain signal.
CGRP inhibitors do not work for everyone, but they have given many people their lives back.
For this reason, Argen finds the Norwegian health authorities' requirements problematic.
She receives support from Headache Norway, an association for people with migraines and other headache disorders.
“If you compare this to other treatments people get through subsidised prescriptions,it's not expensive. What makes it expensive is that so many people have migraines,” says Secretary-General Laila Bratterud Mathisen from Headache Norway.
Migraine-related absenteeism costs 141 million USD
The financial toll of untreated migraines highlights a potential area for cost-saving by improving access to care.
A 2022 report by Oslo Economics, commissioned by Headache Norway, estimates the cost of migraines in Norway.
The expenses for sick pay, work assessment allowance (AAP), and disability benefits alone drained 141 million USD from the state budget that year, according to the report.
“The health authorities need to start looking at the health budget as a whole,” says Argren.
More people use medications now than before
Since 2010, there has been progress, with more individuals gaining access to medications.
Back then, only two per cent of the Norwegian population received acute or preventive medications on prescription.
The fact that the study examined the entire population is a strength, says Argren. However, she also notes an inherent limitation in studies relying on health registries:
When you don't talk to people, you can miss out on important information – such as whether some people use medications outside the ones being analysed.
Lisa can start planning her life again
For Lisa, the second CGRP inhibitor she tried became a game-changer.
Her migraine attacks nearly vanished, enabling her to work with minimal sick leave.
“I’ve become social again, and I can plan things,” she says.
This summer, Lisa travelled to Africa with her husband. It was a trip she would never have been able to manage before.
The different climate, unfamiliar food, and the lack of routine could easily have triggered migraine attacks in the past.
“It was an absolutely fantastic trip,” says Lisa.
References:
Ruscheweyh et al. Triptan non-response in specialized headache care: cross-sectional data from the DMKG Headache Registry, The Journal of Headache and Pain, 2023. DOI: 10.1186/s10194-023-01676-0
Stubberud et al. Patterns of migraine medication use in Norway: A nationwide registry-based observational study, Cephalagia, 2024. DOI: 10.1177/03331024241268212
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Translated by Ingrid P. Nuse
Read the Norwegian version of this article on forskning.no
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