Chronic migraine affects 65,000 people across Malaga province: the leading cause of inability to work in the under-50s

Today, 12 September, is International Migraine Action Day.

Migraine is a neurological condition that results in throbbing headaches, what is called a 'primary headache', meaning a headache that is not caused by other disorders such as trauma, tumours or strokes. It has a complex physiopathology and a strong genetic component, explained Dr José Antonio Reyes, neurologist at Vithas Xanit International Hospital, to SUR. There are several types, although there are two main ones: episodic is when migraines occur for less than 15 days of pain per month, or chronic, when there are 15 or more.

In Malaga province, experts and medical societies estimate that more than 200,000 people (five million total across Spain) are affected and around 65,000 (one million in the whole country) suffer from the chronic type of migraine, 80% of them women. According to the Spanish Society of Neurology (SEN), it is the leading cause of disability in adults under the age of 50 and is a severe and disabling form of headache.

The underlying mechanism, Dr Reyes explained, "is a disorder of the trigeminovascular or cervical trigeminal system where the pain-processing pathways of pain-sensitive structures in the head and neck area are located. A number of vasoactive substances or peptides are involved, including one related to the calcitonin gene, called CGRP (a hormone that helps control calcium in the blood)." Therefore, it has a genetic basis influenced by external factors (climate, lifestyle habits, diet) and internal factors (hormonal cycles, menstruation, medical or psychiatric disorders).

The defining characteristic is a headache of moderate to severe intensity, lasting "between four hours and three days, affecting one side of the head (unilateral), incapacitating and associated with nausea and/or hypersensitivity to light and sound (photophobia and phonophobia)", said Dr Reyes. He notes that "No two patients are the same." He summed up the patient's perspective as: "I have a very severe headache that wipes me out, with the urge to vomit, to go to bed in the dark, in silence and no one bothering me."

Migraines typically occur in people between 15 and 30 years of age, especially women (twice or three times as many) and the disease accompanies those affected "for most of their lives". "The dramatic thing is that it affects people in the most productive ages of life, so the socio-economic impact is extremely high," said Dr Reyes. He concluded: "There is no cure, although, with the right treatment, it can be controlled in most cases." When the SEN refers to disability, it speaks of percentages that reflect, based on medical criteria, the loss of autonomy or the ability to perform basic activities of daily life.

Another, very much present aspect in this area is the economic impact of migraines associated with loss of work productivity due to absenteeism or presenteeism: per person, according to the SEN, this can exceed 6,000 euros. Furthermore, migraines impact the patient's career: 25% of them report having lost their jobs because of their illness. In Malaga, in 11 months of 2024, a total of 19,312 people lost their jobs due to temporary incapacity associated with mental, behavioural and neurodevelopmental disorders, a category that would include migraines, being the seventh most common cause. There is an increasing number of temporary or permanent incapacity occurring due to this cause.

To this must be added the issue of under-diagnosis. Dr Jaime Rodríguez Vico, coordinator of the headache unit at the Fundación Jiménez Díaz University Hospital in Madrid and member of AEMICE (the Spanish migraine and headache association), said: "Among the most important factors are the underestimation of symptoms, misdiagnoses or under-diagnoses, a lack of specific training in primary care and neurology, the stigmatisation of the disease, the absence of clear referral protocols and the sheer complexity of the clinical picture." Chronic migraine patients require an average of 14.6 days of sick leave per year. The SEN estimates the rate of misdiagnosis at 40%.

This, in turn, leads to a lack of access to preventive treatments for those affected, as well as unequal access to them across different regions.

Dr José Antonio Reyes said that, at the pharmacological level, there are several strategies and compounds "that must be adapted to each patient and their previous illnesses, the most important aspect of treatment, and it is crucial for it to be as effective as possible, is that it has to be individualised. Today we have a very powerful therapeutic arsenal that has been expanded in recent years. In total, we have seven specific treatments for migraine available in Spain, although the most important thing is to maintain good lifestyle habits, good mental health and prevent precipitating factors."

The diagnosis "is purely clinical", as there is no test to identify it. Instead, it is diagnosed directly, stressed Dr Reyes, while other similar pathologies are ruled out by means of a neurological examination, a brain MRI and a study cerebrospinal fluid if recommended.

"The pain can be very intense and experienced as the worst pain you have ever suffered in your life. It is a very subjective sensation. The important thing is that it limits you and makes you unable to go about your normal life. In fact, it's the main cause of disability worldwide in people aged under 50, especially when it's chronic," he stressed. However, the doctor adds that it is possible to lead a normal life with proper treatment and taking some precautions, in addition to controlling the factors that trigger the pain.