How to recognize a severe migraine, this invisible but very disabling illness ?

Migraine sévère : une maladie invisible mais très invalidante  

Very common, migraine manifests itself by recurrent attacks of characteristic headaches, with a normal clinical examination. It is a disabling pathology, particularly for people who suffer from severe migraine.

This neurological disease is common and affects on average 15% of the world population, including 5% of children.

There is no migraine gene but rather a genetic susceptibility. “A migraine sufferer has a hyperexcitable brain that is sensitive to the pluses and minuses: more sleep, too little sleep, more stress, less stress, a fatty meal, hypoglycemia, hormonal variations in women”,explains Dr. Christian Lucas, a neurologist in Lille, interviewed by the association La Voix des migraineux, which is launching the Combattre la migraine campaign with the pharmaceutical group Lundbeck.

How to recognize a migraine ?

Migraine is characterized by a repetition of attacks (at least 5) moderate to severe, which last between 4 and 72 hours, without treatment or with ineffective treatment, explains Inserm. The clinical examination is normal, as is medical imaging. “During these attacks, the headache is often unilateral, throbbing in tone, moderate to severe in intensity, and worsens with or leads to avoidance of routine physical activities”,details the French Federation of Neurology. This pain can be accompanied by sensory hyperesthesia – discomfort with noise (phonophobia), light (photophobia), smells (osmophobia) – and digestive problems such as nausea and/vomiting.

An invisible neurological disease

Migraine is a neurological disease that affects the trigeminal nerve. "This nerve is made up of three branches. A branch which innervates the forehead and also the meninges. This so-called trigeminovascular system is activated during migraine attacks. (…) The hypothalamus also seems to play a major role in triggering migraines, explains Dr. Demarquay, neurologist in Lyon, who responded to the Voice of Migraineurs .

Migraine is invisible. It is not caused by a brain lesion which would be visible on medical imaging but by an electrical and inflammatory disturbance that standard imaging does not "see" not. "Apart from certain specific examinations, a CT scan or MRI is normal. Some patients tell me that they would like us to find something because they would like us to believe them. (…) This invisible side is very often a suffering for patients.

What is severe migraine ?

Among the 10 million French people with migraine, many patients suffer from severe migraine. This is diagnosed in patients suffering from 8 or more days of migraine over a month and in any patient having clearly disabling attacks or obtaining a score of 60 or more on the HIT-6. This test, in six questions, measures the impact of migraine on patients' quality of life. From a score of 60, the impact is considered severe.

In 1 to 2% of the general population, migraine is chronic. "We speak of chronic migraine from 15 days per month but we know that between eight and twelve days per month, there can already be an extremely significant handicap in life daily", details Dr Geneviève Demarquay.

With significant consequences on quality of life. "Patients report a strong impact on professional life with 51% of them having missed one or more days of work at least once in the last 3 months due to of a crisis, notes the association in a press release. 13% of them even give up working because of migraine.

Other figures put forward by the association, this time concerning the private and family sphere: 83% of migraine sufferers report suffering from sleep disorders when only 7% of them claim to have been able to take care of their children without difficulty. "More than 48% of patients suffer from anxiety and more than 73% from depression".

What follow-up for patients ?

Feeling of illegitimacy among these severe migraine sufferers, poor knowledge on the part of caregivers, many patients are not regularly monitored for their migraine. According to a survey by the Voice of Migraineurs, it takes on average 7 years to be diagnosed. Then you have to find a doctor who knows the disease and then a treatment that suits the patient. Severe migraine sufferers need to be followed by a specialist, pain doctor or neurologist. But the first caregiver involved in the care process is the attending physician.

Several medications, including triptans, are indicated to calm migraine attacks. A basic treatment is also prescribed, in order to reduce the frequency of attacks and their intensity.