Migraines may be one of the most common conditions affecting Americans, but that doesn't mean they're receiving equal attention. A lack of funding and research push means meager treatment options for those who suffer.
It's not that there aren't treatments. There are, but many are drugs developed for other medical conditions that also work double duty as a migraine treatment, such as seizure medications designed for epileptics.
About 36 million Americans suffer from migraines, according to the Migraine Research Center, with as many as 113 million missed days of work reported as a result.
Yet the neurological condition isn't receiving the kind of attention it deserves, said Dr. Audrey Halpern, clinical assistant professor of neurology at New York University Langone Medical Center and staff neurologist at the Joan H. Tisch Center for Women’s Health.
"There's just not enough money for migraine research. This is astonishing with over $30 billion in costs because of migraines," Dr. Halpern said. "This is a really big problem that hasn't got a lot of money. Maybe that will change."
Shy of funding
Scientists and doctors know that the debilitating headaches are caused by the dilation of blood vessels outside the brain where pain sensors are located, and are now capable of preventing them in some chronic patients.
There are many theories about what causes them. Dr. Halpern suggests migraines could be an evolutionary benefit.
"Maybe in the stone ages a storm would be coming and someone would get a headache. It may be an evolutionary advantage," she said. "In that sense it's an integral part of brain function that is more active in certain people."
Evolutionary advantage or not, it may not be known in part because of a shortage of funding to study migraines and develop new treatments.
"Things have changed in the last 20 to 30 years -- quite dramatically -- but not dramatically enough. We have a lot better understanding of migraines now. But there's just not enough money for migraine research," Dr. Halpern said.
"There's Parkinson's, MS (Multiple Sclerosis), epilepsy, ALS (Amyotrophic lateral sclerosis), and all sorts of neurological conditions that affect many, many fewer people and affect our economy and business much less," she said noting that many of those conditions have consistently received considerably more funding and public interest.
Currently the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health, is primarily funding research related to Parkinson's Disease, traumatic brain injury, epilepsy, stroke and dementia. The Michael Stern Parkinson's Research Foundation estimates that no more than 1 million American suffer from Parkinson's each year, which represents less than 3 percent of the number of migraine sufferers.
Nine stroke studies and four regarding Parkinson's Disease are currently being funded through the organization. When it comes to migraines, only one is ongoing. That research is designed to determine whether adding a second medication can aid chronic migraine sufferers.
For 2012, the National Institutes of Health has budgeted about $15 million in migraine research funding, according to a report it published. By comparison $461 million has been earmarked for alcoholism, $246 million is set aside for asthma, $1.1 billion for diabetes, $458 million for Alzheimer's disease research, and $192 million is reserved for Tuberculosis. Rare condition Huntington's Disease will receive $66 million next year.
"But with migraines we could see some return," she said. "It affects so many people. It really affects our society, but is tremendously underrepresented in funding. Migraines are more common than diabetes, asthma and many other common conditions."
Why it matters
Not only do migraines affect millions, including many who have not been diagnosed, they have a tendency to affect those in the prime of their life.
Dr. Halpern noted that migraines tend to affect women during their most highly functional childbearing years. About 18 percent of migraine sufferers are women as compared to 6 percent of men, according to the Migraine Research Foundation.
"A good 50 percent of migraines are undiagnosed, they don't know or there's no diagnosis," said Dr. Halpern. "Sinus headaches are the most common wrong diagnosis because they meet over 90 percent of the migraine criteria. They are tremendously underdiagnosed."
She noted that an additional 2 percent of the population suffers from chronic migraines, with many suffering from headaches daily.
Those numbers equate to a substantial impact on the economy, both in terms of health costs from medications and hospitalizations, as well as missed or shortened days at work. In the U.S. alone, migraines cost between $5.6 billion and $17.2 billion in lost work productivity.
In addition, migraines can take an emotional toll, causing sufferers to cancel activities or engagements out of fear of developing a migraine. Depression or anxiety as a result of migraines and their impact on work and personal relationships also can complicate the ability of migraine sufferers to function.
Drugs are available to assist those who suffer from migraines. Not all patients, however, are onboard with trying medications associated with other medical conditions, particularly those usually used to treat mental illness.
"We have a number of new treatments available; it's a very active area of research, but patients are resistant to trying medicines for seizures, or antidepressants," Dr. Halpern said. "Though there are more migraine preventatives designed as migraine preventatives, most medications came from other areas."
Heart drugs and antihistamines also may be prescribed to treat migraines. The dilemma is that many of the drugs used to treatment migraines were initially developed to treat other conditions and later found to also work for migraines.
Much of the reasoning is simply that drugs for other conditions have been better funded. For example, Dr. Halpern notes that a common epilepsy drug used to treat migraines was funded by the National Institutes of Health.
Botox, better known for its use in plastic surgery, also can aid migraine patients because it is a known neurotoxin that prevents the release of acetylcholine, stopping the nerves responsible for muscle contraction from signaling for them to contract.
Experimental neuromodulation surgeries have become available to treat migraines, but most patients would rather suffer through migraines than opt for a risky operation for a non-fatal condition. Dr. Halpern noted that it's also possible that surgery could inactivate that area of the brain, though not enough is known about how or whether that might occur.
"Most people wouldn't want the risk associated with that unless they were really serious migraines," she said.
For many patients caffeine and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are enough to do the trick, or even taking a brief nap. That may be simply because researchers haven't had the funding to develop many targeted drugs designed to treat migraines.
"But we haven't had that kind of a push in migraine research," Dr. Halpern said. "It really fascinates me that no one is talking about it."