In June, about migraine and myasthenia
June 21 is International Migraine Solidarity Day. Although migraine is a serious brain disease that significantly impairs the daily activities of people with the disease, it is unfortunately often ignored by those around it. It is also often misdiagnosed and incorrectly treated. That is why it is so important to constantly raise knowledge and public awareness about this disease.
June is also Myasthenia Awareness Month – a rare autoimmune neuromuscular disease that affects around 9,000 people in Poland. These patients, just as often as migraine sufferers, encounter a lack of understanding from their environment: family, friends, co-workers, and even medical personnel. Symptoms of myasthenia are treated as laziness or being under the influence of psychoactive substances. Meanwhile, myasthenia is a serious disease that, in extreme cases, can even be life-threatening. It is worth learning more about it.
Since both migraine sufferers and myasthenia sufferers are most often people of working age, professionally active, the entire society is burdened with the indirect costs resulting from these diseases. That is why we must do everything to diagnose and treat them effectively, so that patients do not drop out of professional and social life – emphasize experts from the Polish Neurological Society.
Migraine is a fairly common disease, affecting 10-12% of the world’s general population, which means that around 4 million people in Poland suffer from it. Women are more likely to suffer from it. Migraine is characterised by severe, paroxysmal headaches and accompanying symptoms from the central nervous system, such as: nausea, vomiting, hypersensitivity to light and noise. These are the so-called autonomic symptoms. In some cases (15-30%), there is also the so-called aura, i.e. focal neurological symptoms (most often various visual disturbances), which last from 5 to 60 minutes and precede the onset of headache and autonomic symptoms. The most common is the visual aura, other forms occur less frequently, such as: sensory aura (related to sensory disorders, e.g. wandering tingling), motor aura (consisting of, e.g. temporary paralysis of various parts of the body) or aura with speech disorders (the patient speaks incoherently and has difficulty finding the right words).
Correct diagnosis of migraine is key
In addition to the division into migraine with and without aura, clinicians also use the division into episodic migraine
and chronic. The latter is considered the most severe form of the disease. Chronic migraine is one of the three diseases that most impair daily functioning in people aged 18-60! It practically excludes patients from normal social, family, professional and social activities. Chronic migraine is diagnosed when the patient experiences a headache every day or every other day (at least 15 days a month) for at least three consecutive months. At least eight of these headaches must meet the criteria for migraine headaches according to the International Classification of Headache Disorders. Episodic migraine, on the other hand, is diagnosed when the typical symptoms appear less often than 15 days a month.
– Patients diagnosed with chronic migraine can be treated prophylactically in a drug program that has been in force in Poland since July 2022. Under it, patients receive reimbursed treatment with botulinum toxin or monoclonal antibodies, in accordance with global and European standards. This treatment aims to prevent migraine attacks, reduce the number of headache days per month, reduce the use of painkillers and improve the quality of life of migraine sufferers.. In order to treat migraine well, it is crucial to make a correct diagnosis – preferably by a neurologist. The visit during which the doctor makes the diagnosis should last 40-60 minutes. During it, the doctor examines the patient, conducts a very thorough interview, excludes other diseases and discusses further treatment with the patient, which should be individually tailored to both the diagnosis and the patient’s profile.. When choosing pharmacological treatment, it is necessary to take into account the patient’s preferences and intolerance and contraindications to taking various drugs. Some drugs are contraindicated in women of childbearing age, and it is important to remember that women constitute the majority of patients with migraine.
It is also necessary to determine the possibilities of non-pharmacological treatment and individual factors triggering attacks, so that the patient can avoid them. It is important for the patient to know exactly what form of migraine they have and whether, for example, they can take over-the-counter medications, and if so, which ones. Of course, in the treatment of migraine, in addition to preventive treatment, acute treatment is also used, although overusing acute medications can lead to the development of drug-induced headache. Acute treatment involves the patient taking medications to alleviate the symptoms of the migraine attack they are experiencing. In this case, patients are recommended to take simple painkillers, non-steroidal anti-inflammatory drugs (NSAIDs) and preparations from the triptan or gepant group. – says prof. dr hab. n. med. Izabela Domitrz from the Department of Neurology, WLS, Medical University of Warsaw, president of the Headache Section of the Polish Neurological Society.
Drug program for patients with myasthenia gravis
Myasthenia is a disease that is caused by improper functioning of the immune system, which produces antibodies against proteins located in the so-called neuromuscular junction, i.e. the place where the information necessary to initiate muscle contraction is transmitted from the motor nerve to the muscle. Most often, in about 85% of myasthenia cases, these are antibodies against acetylcholine receptors. As a result, various muscle groups become weak and excessively fatigued, which results in symptoms such as drooping eyelids, double vision, problems with speaking, biting, swallowing, weakness of limb muscles, and even shortness of breath. These symptoms directly translate into a significant limitation in performing everyday activities. In more than half of patients with myasthenia, the disease is diagnosed a year or later after the first symptoms appear. This is because the symptoms are non-specific and myasthenia can initially be confused with other diseases.
The most dangerous complication of myasthenia is myasthenic crisis. This is a condition in which, due to weakening of the respiratory muscles, acute respiratory failure occurs, requiring treatment in intensive care. Increasing shortness of breath, severe swallowing disorders, choking are indications for immediate hospitalization. Myasthenic crisis may occur in a person with myasthenia as a complication of infection, abrupt discontinuation of immunosuppressive treatment, sometimes surgical procedures. The prognosis for myasthenic crisis has improved, but it is still a condition of immediate life. Experiencing a myasthenic crisis is always an indication for intensification of pharmacological treatment.
– Treatment of patients with myasthenia should be individually tailored to the clinical condition, severity of symptoms, comorbidities, age and other factors. In pharmacological treatment, symptomatic drugs that inhibit the breakdown of acetylcholine in the neuromuscular junction (anticholinesterase drugs) are used first. In about half of patients, these drugs are sufficient. In some patients, it is necessary to include steroid or non-steroid immunosuppressive drugs, which reduce disease activity. Unfortunately, chronic immunosuppression or steroid therapy carry a significant risk of adverse effects. The solution for some patients who do not respond sufficiently to standard treatment is modern biological drugs, which in a more targeted way reduce the number of pathological autoantibodies against acetylcholine receptors and as a result limit the disease process in myasthenia. We are very pleased that since April 1 this year, a new drug program has been in force, long awaited by patients and clinicians, dedicated to the treatment of the most seriously ill patients with seropositive myasthenia, treated with corticosteroids and at least two immunosuppressive drugs, and despite this being seriously and actively ill (drug program B.157).
As part of the new drug program, patients with myasthenia who meet certain criteria can receive one of two biological drugs with an innovative mechanism of action. For people with severe generalized myasthenia, this is a chance to return to normal life: social, family and professional. – says Prof. Dr. Hab. n. med. Anna Kostera-Pruszczykmember of the Council of the Medical University of Warsaw Centre of Excellence for Rare and Undiagnosed Diseases, head of the Neurology Clinic of the Medical University of Warsaw, which is the Reference Centre for Rare Neuromuscular Diseases ERNEURO-NMD.
Neurology awaits organizational changes
Experts from the Polish Neurological Society emphasize that in order to fully utilize modern drugs that appear in neurology, it is necessary to comprehensively improve the organization of care for patients with diseases of the nervous system, as well as to increase financial outlays on diagnostics and improve the valuation of drug program management, including the valuation of the work of medical personnel.
In order to diagnose diseases such as migraine or myasthenia more quickly and efficiently, it is necessary to increase the number of neurologists, of whom there are currently far too few in Poland in relation to the rapidly growing number of patients. For years, the Polish Neurological Society has been drawing attention to the increasingly pressing problem of insufficient staff in neurology and has appealed to decision-makers to urgently take appropriate action – first and foremost to establish neurology as the third strategic field in the state’s health policy, alongside cardiology and oncology.
