Migraine Treatment Create New Challenges for Health Care Providers

Migraine is a chronic illness, but many people, including both patients and health care providers­, don’t think of it that way, said Richard G. Wenzel, PharmD, CPPS, speaking at the Academy of Managed Care Pharmacy’s Managed Care and Specialty Pharmacy Annual Meeting held April 23-26, in Boston, Massachusetts. Wenzel presented about “Migraine—More Than Just a Headache: Exploring the Burden, Management, and Costs” at the Science and Innovation Product Theater, sponsored by Amgen.

“You don’t get migraines, you have migraines,” Wenzel said he tells his patients. Wenzel, a clinical pharmacist at the Diamond Headache Clinic Inpatient Unit in Chicago, Illinois, equates it to a chronic illness like diabetes.

“It’s not just an attack, it’s an event,” he said. “People forget about it until they get their next attack.”

He described migraines as a “hyperexcitability of the brain” to lights and sounds, things that normally are not painful.

Only a minority of people experience an aura after the feeling begins that a migraine is starting. After the attack begins and ends, the patient may report feeling wiped out.

A migraine involves the trigeminal nucleus caudalis and trigenemial nerves, causing swelling in the trigeminovascular system. The pain comes from the terminal end of neurons. During an attack, there is a release of vasoactive peptides, including calcitonin gene-related peptides (CGRPs). The FDA is expected to approve a new class of migraine drugs called CGRP blockers for the treatment of migraines this year.

Thirty two million Americans are affected by migraines, and women are affected 3 times more than men. Of those 32 million, roughly 10 million experience 4 or more headache days per month.

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