It has been described as a game changer by leading neurologist Tissa Wijeratne.
The breakthrough is significant because it comes in an area traditionally neglected by medical research. The current preventive treatments for migraines involve combinations of drugs and other therapies not designed for headache disorders, including antidepressants, anti-epileptic drugs and botox.
“Patients using [botox] were telling their doctors their headaches were getting better,” Professor Wijeratne said. ”Initially the doctors were laughing at them, then trials were done and sure enough it was found to be beneficial.
“But these medications … were not targeted for migraines. Out of utter desperation we trialled a few things and found them to be effective for a certain group of patients”
Professor Wijeratne said many of these medications had unpleasant side effects preventing them from being taken long term, while there were some patients who did not respond to them at all.
Some chronic sufferers experience migraines for more than 15 days a month. As well as head pains, symptoms can include blurred or double vision, seeing auras, speech problems, light sensitivity, nausea and vomiting.
Neurologists say they have migraine patients who are unable drive, or who have to take unpaid sick leave on more than half their work days. There are also those whose marriages have broken down.
Their suffering is often compounded by a perception from doctors and the wider community that migraines are just “bad headaches”.
“Even in 2018, migraine remains the least-respected, most-neglected and worst-managed medical disorder worldwide,” said Professor Wijeratne.
The new treatment is among an emerging class of drugs that work by blocking a molecule involved in migraine attacks called calcitonin gene-related peptide. The first drug to be approved in the United States, called Aimovig, is injected every month by the patient.
Clinical trials have found it reduces migraines by between one and 2½ days a month. Side effects include irritation at the injection site and constipation.
It is set to cost more than $7000 a year, based on the US price, but could be heavily subsidised in Australia if sponsor Novartis is successful in its bid to have it listed on the Pharmaceutical Benefits Scheme, for patients who meet certain conditions.
It is understood that hundreds of letters were sent in support of the listing by headache and migraine sufferers. Novartis is also seeking Therapeutic Goods Administration approval for the drug.
Melbourne neurologist David Williams said he was anxiously awaiting the drug for his patients who had not responded to other treatments.
“People with chronic migraine can be in a state where they are working less than 50 per cent of their brain capacity all the time,” he said.
Maria Ricco was 17 when she had her first migraine. She couldn’t go back to work for days afterwards, but was told to take a few painkillers and hope for the best. At its worst, she was experiencing up to seven migraines a week.
In recent years, botox injections have reduced her episodes by about half, but she still suffers from migraines that come at night and affect her for days. She’s keenly awaiting the approval of Aimovig.
“If I had a toothache for 48 years, something would have been done,” she said.
Aisha Dow reports on health for The Age and is a former city reporter.
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