A Second Chance for People with Headache Disorders

By Christopher Gottschalk, MD, FAHS

Headaches are just an excuse to avoid everyday responsibilities, society sometimes tells us, certainly not a “real” medical problem. My years of treating patients prove this stereotype utterly inaccurate.

People with headache disorders are among the most resilient patients I have treated; they deserve to have clinicians as dedicated and treatments as effective as they are.

Headache disorders are just as serious as other nervous system disruptions, such as seizures or Alzheimer’s disease. The difference is that headache disorders inflict symptoms that are often invisible, symptoms like debilitating pain, vision disturbances or nausea. When you tally them up, headache attacks rob more people of more time in their lives than all other neurological disorders put together.

The 36 million Americans living with headache disorders deserve relief from these attacks; they deserve to suffer less impairment than we have become accustomed to accepting. That requires continued investment in medical innovation.

Advanced medicine has already made real strides for those living with headache disorders. I think back to the 1990s, when headache patients began using triptans, medications that target overactive nerves in the head that convey pain. Triptans provided patients with much-needed relief. But they also were thought to pose serious risks, including heart attack, stroke and even death. These risks discouraged providers from treating headache disorders and discouraged people with headache disorders from pursuing treatment.

I’m thankful science marched on.

Today we know that triptans are far safer than originally believed and we have a host of new treatments, such as CGRP inhibitors, that are effective, convenient, and incur minimal side effects. Whereas in the past we had tools that required slow titration to build-up the dose and often caused intolerable side effects, the monthly CGRP injections we now offer will decrease headache attacks in a matter of days or weeks. The tablets in this class also provide rapid relief of acute attacks with minimal side effects.

Migraine is a disease, meaning a common disorder of brain function that leads to predictable features, but it’s also a symptom for other conditions. Persistent attacks are sometimes a hint that something else is acutely wrong. For the small percentage of patients who don’t achieve meaningful relief, treatment failure can serve as a diagnostic of sorts. When Botulinum toxin and CGRPs don’t do anything for a patient, clinicians like me know it’s time to look for a hidden source of what looks like migraine.

Whether headache attacks are the primary symptom or an indicator of another condition, the millions of people experiencing them need treatment options. Imagine if we’d stopped exploring new treatment options after triptans were discovered, if we’d waved off finding a more effective treatment simply because one treatment already existed? No one would consider doing that for diabetes, or hypertension, or MS; we should be no less dedicated to expanding treatment options for migraine and related disorders like cluster headache, post-traumatic headaches, or spinal CSF leaks.

I’ve seen patients’ tears of joy when a new treatment allows them to get out of bed, play with their children or excel at work – often for the first time in years. It’s powerful to see these patients get a second chance. They remind me of how fulfilling it is as a clinician to be able to offer my patients effective medicine. 

I’ve also seen tears of frustration when a treatment doesn’t work. These are the patients who remind me why research and innovation must continue.

Headache disorders are no more one-size-fits-all than any other disease. So, we must continue studying, continue researching – continue trying – until every headache patient has a treatment that works.

With continued innovation, the future can be bright for all my patients.

Christopher Gottschalk, MD, FAHS, is a practicing neurologist and headache specialist in New Haven, Connecticut. He is also a member of the Alliance for Patient Access’ Headache and Migraine Disease Working Group.

Breakthrough, an IfPA blog series, offers health care providers a voice in the ever-growing conversation about innovation and value.

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