Every eighth adult Swede suffers from migraine. Using a newmethod, researchers at Göteborg have managed for the first time ever toprovide a detailed picture of an untreated attack. This will be ofgreat significance for the development of new forms of treatment. Thefindings are reported in a dissertation at the Sahgrenska Academy.
Inthe first nation-wide study of migraine in Sweden, it is shown that onemillion individuals, more than 13 percent of the adult population,suffer from migraine. In total they experience some ten million attackseach year. The condition is characterized by an intensive pulsingheadache, hypersensitivity to light and sound, and severe nausea andvomiting. Migraine is roughly twice as common among Swedish women asSwedish men. About 200,000 Swedes have migraine without being awarethat their symptoms are classified as such. A majority of thoseaffected report negative impact on the highest ranking factors in life,such as family life and the ability to perform their work and enjoymeaningful leisure time.
Only every fourth individual withmigraine is seeing a doctor, which is a lower figure than for the restof the western world. The study shows moreover that every thirdindividual who has seen a doctor regards the information about varioustreatment options as poor or extremely poor.
"Many people hadgone to their doctor previously but stopped. This is remarkableconsidering the fact that most people want to try another migrainetreatment than their current one," says Mattias Linde, a medicalspecialist in neurology and author of the dissertation.
In hisdissertation Mattias Linde has managed to use a new method to capturedetailed pictures of migraine attacks. A number of patients who couldstand to refrain from any treatment for 72 hours were asked to assessthe intensity of the various migraine symptoms on a hundred-degreescale. In this way he was able for the first time to produce a highlyexact picture of how a migraine attack develops hour by hour.
"Thisis a breakthrough that provides research with a new and unique pictureof the great complexity and wealth of variation that characterizes thisenigmatic condition. The pain tends to follow a slowly undulatingrhythm between medium and insufferable intensity," says Mattias Linde.
Thefindings show that acute drugs often provide good but short-livedrelief, whereupon the complaints return to their original pattern aftera couple of hours. The conclusion is that the various symptoms aredriven by a common factor in the brain, and that modern treatments forattacks fail to block off this unknown area.
The overwhelminglydominant thinking among migraine researchers internationally, and notleast in the U.S., is that a condition for effective treatment is thatit must be ingested early in the course of an attack before the painmounts. This has now been refuted by Mattias Linde, who has comparedearly and late injection treatment in the same patients. Nostatistically significant difference was shown, and a majority of thepatients felt that the treatment was equally effective whenadministered late, during high levels of pain.
"It's reassuringnow to be able to encourage patients to take their treatment, either asa nasal spray or as a suppository, even if they didn't do so at anearly stage," says Mattias Linde.
Many patients experience sideeffects of modern treatments for attacks in the form of unpleasant andsometime painful sensations. For example, it can be painful to comeinto contact with water, which often leads to a concern that patientswill avoid taking their medicine. The dissertation shows that this is abenign and short-lived phenomenon resulting from a lowering of the painthreshold in the nervous system.
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