The disease affects 12% of Spain’s population, and only 56% of those affected have been diagnosed. Although society may think it is merely a headache, the reality is that it is accompanied by “nausea, sensitivity to light, discomfort caused by noise and brain fog.” All these factors, the specialist says, make migraine “disabling”: “If a patient has one migraine attack a week, that means four a month and almost a month and a half of pain a year.”
Migraine is more common in women than in men because it has a “hormonal” component. Sonia Santos explains that it is common for the first “attacks” to begin in girls with their first periods, with the pain recurring every month alongside “the menstrual cycle.” In this regard, there is a “false myth” that migraine disappears with menopause: “Usually that is the case, but the problem is that before a woman reaches menopause, she goes through three to five years of hormonal changes, and it is this change that causes more pain. The final years of menstruation are terrible for patients,” the specialist says. In addition to the hormonal component, there is also a genetic component, as seven in 10 people with migraine have a family history of the condition.
EACH PATIENT HAS THEIR OWN PARTICULARITIES
Ana, one of the patients, began experiencing migraines in her early youth when she started menstruating. Although they disappeared over the years, the migraines returned with menopause. “It affected my life. I had to leave class and go into my darkened room without speaking to anyone. It was the only way to ease the pain,” she explains. In her case, the pain tends to appear during periods of stress at work or with changes in the weather, and it is also accompanied by dizziness and nausea.
Every patient is different. The specialist also points out that a person with migraine has a “hypersensitive” brain. This means that the brain reacts “poorly” to stimuli: “A person without migraine may be bothered by a light or an intense sound, but they quickly adapt. By contrast, a person with migraine has more difficulty adapting, and it can even trigger an attack.”
Although the cause of the disease has not yet been discovered, some of its triggers are known. “The main ones are stress, changes in meal times, disrupted sleep and hormonal changes,” Santos says, adding that each patient must “identify their own.” She also states that there is no “evidence” that certain foods trigger migraine in all patients, so “there is no need to follow specific diets.”
UNDERDIAGNOSIS AND STIGMA
In Spain, only 56% of people with migraine have a confirmed diagnosis, meaning that practically one in two has not been diagnosed. The causes of underdiagnosis include self-medication, a lack of information and the perception that the symptoms “are not serious enough” to seek medical advice. For this reason, she recommends first visiting a primary care doctor and, if the usual treatments do not lead to improvement, referring the patient to Neurology.
In addition, “one in three patients” has experienced stigma related to the disease at some point, especially those who suffer from pain on more days. Sonia Santos explains that this stigma is not limited to the workplace, but also appears “in social and family settings.”
THREE TREATMENT APPROACHES
According to Santos, migraine treatment is based on “three pillars”: patient education, pain treatment and prevention. Education enables people to better understand their condition, identify the factors that may trigger attacks and know how to act when symptoms appear. Pain treatment aims to relieve migraine episodes, while prevention seeks to reduce their frequency and intensity and improve quality of life.
“As of today, there is no treatment that cures migraine,” she says. However, there are different therapeutic options adapted to each patient’s characteristics and needs. These include nonspecific drugs, used to relieve pain and other symptoms during attacks, and more targeted treatments such as botulinum toxin, or Botox, monoclonal antibodies and gepants. The choice depends on factors such as the frequency of attacks, their intensity, the response to previous treatments and the impact the disease has on daily life.
