Study: Poles with migraines correctly diagnosed, but still poorly treated

In Poland, as many as 5 million people may suffer from migraines , which poses a huge socioeconomic burden, according to research led by Dr. Marta Waliszewska-Prosół. Although a relatively high percentage of patients are diagnosed quickly and correctly, their treatment leaves much to be desired.

The team of Dr. Marta Waliszewska-Prosół, a neurologist from the Medical University of Wrocław, conducted the largest national study on migraine to date, "Migraine in Poland." It resulted in two large analyses. The first, published in "The Journal of Headache and Pain" (https://doi.org/10.1186/s10194-023-01575-4), examined migraine symptoms, comorbidities, quality of life, and disease burden. The second, published in "Therapeutic Advances in Neurological Disorders" (https://doi.org/10.1177/17562864251338675), presented diagnostic and treatment patterns among Polish patients and identified their greatest challenges.

The study was conducted as a survey. Over 3,200 people aged 13 to 80 participated, 87% of whom were women.

The results showed that over four million people in Poland suffer from migraines, although according to Dr. Waliszewska-Prosół, this number may be underestimated. "This is a huge number of people, which demonstrates the scale of the disease. We also demonstrated that the burden of migraines in Polish patients is the highest of all European countries. Their quality of life is truly poor," the study's author told PAP.

The first migraine attacks most often appeared in the second decade of life, at an average age of 19. However, the study found that those affected typically delay seeing a doctor, with the first consultation occurring approximately two years after the first attack, and a formal diagnosis occurring on average four years later. Patients experience an average of 4.7 headache days per month, although nearly half experience more.

Interestingly, compared to many other countries in Europe and around the world, Poles with migraines are much more likely to seek medical help: 93.6% of them have consulted a professional, most often a neurologist, about their symptoms. Over 90% have received a formal migraine diagnosis, and 92.5% use some form of treatment.

However, according to Dr. Waliszewska-Prosół, this only appears to be the case. The most commonly used medications are nonsteroidal anti-inflammatory drugs, paracetamol, and codeine-containing medications, which are unsatisfactory for migraines and are not recommended for this condition. Nearly 60% of patients use codeine-containing medications, which carries a significant risk – they can lead to overuse headaches or the development of chronic migraines. Such complications were observed in as many as 23% of respondents. Triptans, the basic, modern medications that block migraine attacks, are used by 57% of patients in Poland. However, the study authors emphasized that this is still too low a percentage, considering their high effectiveness.

Preventive treatment, which could help reduce the number of pain attacks, is particularly poor in Poland. Although nearly half of the study participants met the criteria for its implementation, only 11.5% used it. Furthermore, the most frequently chosen medication was iprazochrome – a drug popular in the 1970s that is not included in any modern recommendations and lacks solid evidence of its effectiveness. Furthermore, 17 of the 18 people prescribed it discontinued its use.

The analysis also showed that many patients abandon preventive treatment due to lack of results, side effects, high costs, or simply because they feel better – and often do so without consulting a doctor. According to the PAP interviewee, this is a worrying phenomenon, as treatment administered too briefly may not produce lasting results, and abandoning it without supervision is associated with the risk of disease relapse.

The study showed that Poles with migraines often consult multiple specialists – not only neurologists, but also ophthalmologists, otolaryngologists, psychiatrists, and gynecologists. According to the PAP interviewee, this may be due to diagnostic difficulties, as migraine symptoms can be confusing and resemble those of other conditions.

"Patients go from doctor to doctor. Often, their symptoms are ignored, and they're only advised to rest and take a widely advertised painkiller. In my opinion, there's often a lack of humility among doctors regarding migraines, as well as a lack of consensus and cooperation between specialists. Many are afraid of this condition and afraid to treat it," said the neurologist.

She noted that in Poland, migraine sufferers consult pharmacists exceptionally often – 35% of respondents sought their advice. By comparison, in Japan, only 3.6% of patients reported such contact. This suggests that it's worth educating pharmacy staff about treating this condition, especially in the context of the risky use of over-the-counter medications.

The study also revealed that nearly three-quarters of people with migraines are bedridden during an attack, and only 0.4% are able to function normally. The average duration of such disability is 18.6 hours per attack.

Because of this, migraine sufferers have significant difficulty functioning at work. In the two weeks preceding the study, 330 people took time off work due to their condition, and more than half went to work despite feeling unwell. However, 86% of those with migraines performed their duties less efficiently than usual.

According to Dr. Waliszewska-Prosół, low work efficiency among migraine sufferers is a significant problem in Poland. Seventy-eight percent of sufferers admit that during an attack they are unable to perform their work tasks half the time, nearly 80% work more slowly, and a quarter have to correct their own mistakes due to pain.

"This clearly shows that presenteeism, or staying at work despite illness, is the norm among people with migraines, and at the same time, a huge burden on employers and the economy. Contrary to appearances, such behavior is only a false economy for the system. Because even if someone goes to work, their productivity is minimal," the researcher noted.

She reminded the public that migraines aren't just physical. The mental health assessment tool used in the study yielded alarming results: as many as 65.7% of migraine sufferers exhibited depressive symptoms, and over 20% exhibited anxiety symptoms.

Moreover, a migraine attack often doesn't end with the pain subsiding. For most people, it takes an average of 16 hours to return to normal functioning, and symptoms preceding an attack occur in as many as 83% of those surveyed. This means that migraines impact sufferers' mental lives not only during the attack itself but also before and after it.

Although migraine treatment in Poland may be partially reimbursed, for many patients it involves significant, ongoing expenses. According to the study, the average monthly cost of treatment was nearly 300 PLN, which for some respondents represented over 13% of their monthly income.

"We need to make people aware that migraines are a serious illness, and not repeat the message that it's hysterical and 'just your nature.' Of course, it's easier to research and treat diseases whose effects are immediately visible: cancer, diabetes, etc. Migraine's main symptom is pain, invisible to those around it. But the social problem is enormous," concluded Dr. Waliszewska-Prosół.

Katarzyna Czechowicz (PAP)

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