by José Luis Cárdenas Tomažič

Adapted from the Spanish column originally published in El Economista on January 25th, 2024 (Migraña: ¿Por qué ha estado invisibilizada?)

Migraine is a chronic neurological disorder characterized by recurrent episodes of headache that can last from a few hours to several days. It is an intense throbbing pain or pulsating sensation, usually on one side of the head. In addition to the headache, symptoms may include nausea, vomiting, sensitivity to light and sound, and blurred vision. Migraine has been classified into two main types: with aura and without aura. Migraine with aura is characterized by transient neurological symptoms, such as blurred vision, numbness, tingling, or difficulty speaking, which precede the headache. Migraine without aura lacks these prior neurological symptoms.

Regarding its frequency, migraine is classified as episodic when it occurs on fewer than 15 days per month, whereas chronic migraine refers to cases exceeding this threshold for more than three months.

It is estimated that the global prevalence of migraine is 14–15%, accounting for 4.9% of years lived with disability worldwide. In 2019, migraine cases were estimated to have increased by 16% compared to 1990, further exacerbating the problem. Additionally, migraine is two to three times more common in women than in men, with women reporting longer-lasting attacks, a higher risk of recurrence, greater disability, and longer recovery periods. This is particularly evident among women aged 15 to 39.

Patients who suffer recurrent migraine often present a range of comorbidities. They more frequently experience depression and anxiety, and migraine is also associated with bipolar disorder, obsessive traits, post-traumatic stress disorder, attention disorders, among others.

Migraine causes moderate to severe disability and disrupts family life, interpersonal relationships, and professional life, and it is the second leading cause of disability worldwide. Many individuals with prolonged headaches and frequent migraine attacks progress to chronic migraine, experiencing the highest burden in terms of years lived with disability.

From an economic perspective, studies have shown that most productivity loss related to migraine (89%) is due to presenteeism (working during a migraine episode), in addition to absenteeism. People affected by migraine in the workplace are less than half as effective due to pain, symptoms, the unpredictability of attacks, the aforementioned comorbidities, emotional impact, and other factors. Migraine-related productivity loss can negatively affect career choices, employment status and job security, financial situation, workplace relationships, mood, and self-confidence.

Economic loss due to absenteeism from migraine has been estimated at USD 238.3 per person per year, while that attributed to presenteeism ranges from USD 375.4 to USD 2,217 per person per year, depending on the methodology used.

In terms of overall economic impact, it has been estimated in the United States that patients with migraine incur total annual costs—both direct and indirect—USD 8,924 higher than those without the condition.

Historically, migraine has been invisible and stigmatized, with sufferers often dismissed as privileged or self-absorbed individuals using migraine as an excuse to avoid social duties and responsibilities. Today, the situation is not much better; despite being a common condition, it is often underestimated and regarded as a simple headache. Social stigma remains an additional barrier to diagnosis and treatment, contributing to migraine being underdiagnosed and undertreated.

In terms of treatment and management, migraine care can include both pharmacological and non-pharmacological strategies. Pharmacological approaches focus on symptom management and prevention, including analgesics, nonsteroidal anti-inflammatory drugs, triptans, ergotamines, anti-CGRP therapies, among others. Non-pharmacological strategies involve lifestyle changes such as stress reduction, improved sleep, and dietary adjustments.

Globally, we are still far from having healthcare systems that recognize migraine as a priority public health issue, or from achieving a societal perspective that empathizes with those who suffer from it. This is despite its tremendous impact on patients’ quality of life and the enormous economic burden it generates worldwide. Therefore, now is the time to give migraine the attention it has historically been denied, and for public policies to seek appropriate solutions in favor of patients.