By Andrea Hargraves 
It does not choose ages or genders and can happen at any time in life without warning. They can appear after a bad night’s sleep or, conversely, after many hours of sleep, appear after eating some kind of food or drink, or after several hours without eating. Triggers that trigger migraines vary from person to person, but one common outcome: a severe, incapacitating headache, that can last for hours or even days, and that causes nausea, vomiting, and sensitivity to light, noise, and movement. . “These characteristics are characteristic of this headache, and when nothing else can be explained, this is what leads to a diagnosis of migraine,” explains Felipe Palavra.
Watch the debate video:
For the neurologist of the Centro Hospitalar e Universitário de Coimbra (CHUC), the recurrence of these symptoms should always prompt a visit to the doctor because the earlier the diagnosis is made, the faster and more appropriate the treatment of this chronic neurological disease. . “This first step to recognizing that pain has characteristics that affect daily life is important to identify the cause, because this is what prompts people to seek medical help.”
It is estimated that about one and a half million people in Portugal suffer from chronic migraines. There is a number, Felipe Palafra explains, based on a reference epidemiological study done in the 1990s, which calculated that approximately 16% of the population would be diagnosed with migraine. “I would say that it may happen that we have a higher prevalence, because the time of diagnosis depends on the initial step. If we are sufficiently sensitive to complaints that may correspond to a diagnosis of migraine, then it is likely that they will even have more diagnoses,” the neurologist confirms. Who participated in Talk Viver com migraine, an initiative of Diário de Notícias, supported by Pfizer, which took place on Monday, but which you can still watch on the newspaper’s website. Also in the studio was Ines Carvalhao, a migraine sufferer, and a member of the governing bodies of MiGRA Portugal, the Association of Migraine and Headache Patients.
The female sex is the most affected
Although there is no specific profile for migraine sufferers, Philip Palavra explains that in adulthood, the disease is more prevalent in females than in males. Overall, he asserts, “we assume that one in five women may have the diagnosis.” However, in males, the condition is estimated to affect one in sixteen men, and in the pediatric population, the prevalence would be about one in eleven children. In this case, the neurologist advances, “In the children’s category, we see that before puberty the diagnosis is mainly made in boys, but after puberty the diagnosis is more in girls.” This is caused, mainly, by hormonal factors related to adolescence which are critical to altering this epidemiological profile of the disease.
For many patients, the most complicated matter is the employer’s undervaluation of migraines. Saying “It’s just a headache” is one of the most frequently heard responses.
Another factor to consider when diagnosing migraines is genetics. “When there are already cases in the family, it is important that this hypothesis is always considered as soon as there are complaints,” warns Filipe Palavra. Symptoms can begin in childhood, even in the first year of life, and then, in adolescence, headaches can appear with characteristics already suggestive of a migraine diagnosis. In other words, the neurologist emphasizes, “the moment when we come into contact with this person can be decisive for us to be able to make a diagnosis or not, although, if it is early, it can be more difficult.”
The case of Ines Karvalhau reflects precisely this difficulty. She suffered from excruciating headaches all her life, but it was only diagnosed at the age of 45. “My father also had migraines, but I always thought it was a part of life and I had to put up with it,” he reveals. An idea that, in Philippe Palavra’s opinion, remains a cultural issue. “But it does not have to be this way, and therefore, it is necessary to realize that behind the complaints of headache there may be a diagnosis of an incurable, but treatable disease,” he warns.
However, despite the fact that many diagnoses take years, headache is the leading reason for consultations in neurology, “if we look at the data generated by the same care activity, how many of them are actually migraines?” , this refers to outside the doctor.
Society still does not recognize the effect
With a late diagnosis, Ines Carvalhau has spent more than half her life suffering from the effects of migraines. Today, between treatment and learning through experience, he has avoided some crises and regained part of his quality of life. However, he is aware that the disease has a significant impact on professional, social and family life. “There are so many programs that we end up not being able to fulfill, and we always put off situations because, in a crisis, we can’t be fully in those situations,” he posits.
However, for many patients, what is more complicated is the employer’s undervaluation of migraines. Saying that “it’s just a headache” is one of the most frequently heard answers, and as Inês Carvalhão points out, the need to stay at home sometimes tends to cause discomfort in companies. “But it’s really crippling,” he adds. In fact, according to the World Health Organization (WHO), migraine is the largest cause of disability in people under the age of 50, which means that the disease has a significant impact on society as it contributes to high absenteeism, with consequent social and economic consequences. normal. “There is often the perception that it is just another headache, but it is not,” Felipe Palafra assures.
According to the World Health Organization, migraine is the largest cause of disability in people under the age of 50, which means that the disease has a significant impact on society.
Ines Carvalhau also warns of the need to legalize this disease. “It is necessary to explain and try to change public opinion and realize that migraine is, in fact, a chronic neurological disease.” The MiGRA representative also stresses the importance of educating policymakers and labor organizations, so they know they can help make the lives of patients with migraine not so difficult.
On the other hand, Felipe Palavra advocates that educating the medical community should also be a priority. According to the neurologist, the Sociedade Portuguesa de Cefaleias has made an effort to include doctors specializing in general and family medicine in its training courses. And this, in his opinion, is necessary because the first diagnosis of migraine can and should be made by a family doctor. “Raising awareness is important so that people can think about the diagnosis. Because nobody makes a diagnosis if they don’t think about them and if they don’t know what their criteria are,” he adds, highlighting the critical role of the general and family physician and health care provider to play, At least, with a preliminary approach and diagnosis.
Lack of awareness in the medical community means that patients often seek help in the private sector, as it is faster. According to a study by MiGRA, 40% of migraine sufferers do not undergo any medical follow-up, and among those who do, 54% go private. It was the same with Ines Karvalhau who, despite everything, is aware that the public sector is currently better prepared to deal with this disease, and that there are some specialized headache centers in some hospitals. However, the increase in the number of patients in these units leads to longer waiting times for appointments.
Sharing experiences helps
Information and awareness about it is equally important for the general public, so that more and more people can be diagnosed and monitored for this disease. And at this level, Inês Carvalhão believes that the role of patient associations such as MiGRA is essential. “I believe that the role of the association is to ensure that reliable information reaches the patients who are part of it and who turn to it.
The MiGRA representative also highlights workshops, webinars, meetings between patients and a support line – Migra Responde – where people can leave their questions online and always get an answer. There are also face-to-face regional meetings in Lisbon, Porto and the Algarve, where people meet and share experiences about the disease. “It is good for people to meet, to be able to talk to each other, also so that they do not feel lonely in the midst of this situation,” Ines Carvalhau, also stresses the role of associations in order to change public opinion regarding this matter. The type of pathology, as well as policy makers and employers.
By way of recommendation, Filipe Palavra leaves a final message: “Do not suffer unnecessarily. If you have any of the symptoms indicated, seek medical help.” The doctor confirms that this is a serious and chronic disease, but it is imperative that the diagnosis be confirmed by a doctor. “Could it be a migraine? Yes. Could it be something else? It could be. But the task of diagnosis is left to the doctor and more than self-medication or resorting to treatments to treat something that can even be treated with other types of interventions, it is important to diagnose. Diagnosis Always medical, period.”