Though that was decades ago, today there still several reasons migraine is poorly controlled for so many people. One is a lack of appreciation by both doctors and the public for what it entails, which can discourage patients from seeking treatment. Another is a tendency for migraine sufferers to assume they can or should be able to deal with the problem on their own, either with over-the-counter or prescription drugs.
Resulting from that assumption, Dr. Silberstein said, is yet another stumbling block — an abuse of medication, which can actually make the condition worse. “Half the patients with chronic migraine overuse the treatment based on surveys we’ve done,” he said.
On the other hand, he added, when an attack is imminent, many people wait too long to initiate treatment “because they’re in denial and hope the headache will go away on its own. But the longer you wait, the harder it is to get relief.”
But perhaps the main problem is a paucity of medical experts — 580 specialists, or one doctor for every 80,000 people with migraine, who are conversant with the condition and available therapies, Dr. Dodick said. Even if patients can find an expert, a lot of insurance plans don’t cover certified headache specialists.
Thus, too often, patients with an excruciating migraine end up in a hospital’s emergency room, which Dr. Silberstein called “the worst place to go when you have a migraine, with all the lights, noise, activity and the wait.”
As Dr. Dodick explained, “The brain amplifies the signals coming in, intensifying the pain and symptoms throughout the body.”
There are four oral drugs in two different classes that have been approved by the Food and Drug Administration for the prevention of migraine: two anti-seizure drugs and two beta-blockers. In addition, patients with chronic migraine who have symptoms every day or every other day can get injections of Botox.