By Mark Greener

Eighty per cent of UK migraineurs are dissatisfied with current medications, according to a new survey, which also underscores the considerable morbidity associated with migraine.

The survey, funded by an educational grant from Janssen-Cilag, included 2,061 migraine sufferers from the UK and nine other European countries - 32% of whom reported suffering migraines on more than 30 days a year. Migraineurs lost an average of 4.1 days of work or study because of their attacks during the six months before the interview, 54% of migraines lasted more than 12 hours, while 48% of sufferers were unable to function during an attack. Sixty-eight per cent said that they found concentrating at work or when studying difficult during an attack and 56% feel guilty about taking sick leave because of their migraines.

This morbidity persists despite a growing armamentarium. The launch of triptans, which alleviate acute attacks, in the early 1990s helped drive a marked growth in the migraine market. Indeed, analysts expect triptan sales to increase from $2.25 billion in 2001 to $4.2 billion in 2010 [Nat Rev Drug Discovery 2003;2:175-6].

Furthermore, doctors prescribe several drugs as prophylaxis, although few are specific. Most address co-morbid conditions, such as depression and anxiety. “When you see a long list it’s usually because none are particularly effective,” Anne MacGregor, from the City of London Migraine Clinic, commented during a press conference to launch the results, held to coincide with the European Neurological Society meeting in Vienna. Indeed, just 20% of UK patients said that they were completely satisfied with current medication.

Despite this, until recently, prophylactic management didn’t attract as much interest from drug companies as developing agents to abort acute attacks. However, several preventative agents are in development – including Janssen-Cilag’s topiramate, currently in regulatory review. “Prophylactic treatments can break short-term cycles of attacks and provide extended relief,” MacGregor said. “It’s not something people need to take daily for 20 years.”

New prophylactic treatments should find a ready market. The survey revealed that 69% of sufferers are interested in taking a daily prophylactic drug. Formal criteria suggest that around a quarter of migraineurs are suitable for preventative medications. However, safe and effective prophylactic drugs, MacGregor suggested, might allow more people to benefit. “Essentially, prophylaxis should be available to all patients,” she said. Instead of applying formal criteria, she suggested that doctors should ask: “are your headaches so badly controlled by symptomatic treatment that you might consider taking a daily treatment that is effective and safe.”

“Migraine can be seriously debilitating, with a huge impact on daily activities that most people simply take for granted,” MacGregor concluded. “For some migraineurs with frequent and disabling migraines, preventative medication can help them regain some control over their condition.”