What is the issue?
Chronic migraine is a serious condition which has a significant impact on the health and wellbeing of many Australians, as well as a considerable impact on the Australian economy. Yet this surprisingly widespread condition has been largely overlooked in national health priorities and strategies to date.
The time has come to take action. Earlier diagnosis, treatment and migraine prevention is not only possible, but critical to improve the lives and productivity of the half a million Australians who experience chronic migraine.
The burden of chronic migraine
Migraine attacks are recognised by the World Health Organization as among the most disabling illnesses, comparable to dementia, quadriplegia and active psychosis. Patients can experience severe head pain, nausea, vomiting, blurry vision or blind spots, difficulty concentrating or communicating, sinus congestion, muscle weakness and more.
Nearly 500,000 Australians experience migraine on at least eight days each month.2 Over 30% are using opioids to treat their migraine attacks.15 One in three people suffering from chronic migraine also experience depression and anxiety (making them at least four times more likely than others to experience depression and anxiety). Patients are also far more likely to have other medical conditions that are comorbid with migraine such as allodynia (central pain sensitisation), obesity, sleep disorders, fibromyalgia, arthritis, hypertension and heart disease.
Women are disproportionately affected with more severe and longer lasting migraine attacks. Approximately one in four women of working age experience migraine. Chronic migraine can drive a wedge between the sufferer and their family, friends and colleagues. It also peaks in middle age when an individual is likely to be more actively engaged in work, social and family duties.
People with chronic migraine experience considerable pain and suffering which impacts on their physical and mental health, and their workforce participation. The impact spreads even further than the half
a million sufferers, to also affect their families, communities and workplaces. An estimated one in four households are affected by migraine.5 Children living with one or more parents with migraine are significantly affected across several domains of wellbeing. Parental migraine puts children at developmental risk with potential long-term transgenerational impacts.6
Where are the gaps?
Many Australians living with chronic migraine are currently unable to access best practice assessment and management of their condition due to a low awareness of treatment options and lack of access to health professionals with relevant knowledge and skills.
The Pharmaceutical Benefits Scheme (PBS) covers a significant amount of the $1.86 billion spent each year on migraine and migraine-related prescriptions.9 Most prescription medications used for migraine have other primary indications which dramatically underreports the true PBS expenditure on medications for migraine.7
There is evidence of considerable misuse and overuse of medications used for migraine. 34% of patients with migraine use an opioid to treat the attack.15
GPs are inadequately trained and skilled in the management of chronic migraine. Just 1 in 20 patients with chronic migraine who see a doctor, receive an accurate diagnosis and appropriate treatment.8 This equates to a shocking 19 out of 20 patients with chronic migraine who are not seeing a doctor
for their condition, or are not receiving an accurate diagnosis or appropriate treatment.
The consequences of these gaps are immense. Chronic migraine represents a significant disability which is not recognised by Australian disability services. Patients themselves are forced to simply survive with severe and debilitating pain. This strains relationships with family and friends and places more pressure on work performance. In addition, those with chronic migraine have significantly higher cost and utilization of healthcare services, with healthcare expenditure for a person with migraine averaging $7,476 per annum.9
The cost of migraine extends beyond the individual and their families. In Australia, chronic migraine costs $4.1 billion each year in lost economic output.
What can be done?
This Pre-Budget Submission from Migraine & Headache Australia proposes initiatives which will make a significant difference. These include a national web-based consumer support network to reduce misuse of prescription medicines; a workplace productivity program to educate employers and return more people with migraine back to the workplace and increase productivity; initial work towards a Migraine Centre
of Excellence to train GPs and provide better treatment for the highest need chronic migraine patients; an epidemiological study into migraine in Australia; and a request to increase PBS funding for the first proven effective medicinal treatment designed to prevent migraine specifically.
Better care aligns with several existing federal health priorities such as reducing harm from medications (including opioids); promoting rural health participation; managing mental health with chronic pain conditions such as chronic migraine; supporting the national pain strategy; suicide prevention and better childhood outcomes.
Addressing chronic migraine is an urgent and until now, largely overlooked national policy priority. There is a compelling case to act now. Real and immediate action will not only improve the lives of people with chronic migraine, but will benefit all Australians through economic returns, a reduction in federal health expenditure and reduced pressure on our health care system.
Click here to download a copy of Strategic Action on Chronic Migraine >>
Trevor Thompson
CEO, Migraine & Headache Australia
