They concern young and old, and handicap millions of French people.
New drugs raise hope.
A storm under the skull.
Spikes of fire in the brain.
"
The headache that crushes the head drives you crazy, misleads your ideas
",
wrote Guy de Maupassant about his attacks.
Migraines and other headaches are a nuisance, sometimes an ordeal for millions of French people who experience them on a daily basis.
And yet, curiously, the subject is not considered a public health emergency.
This is all the more surprising since headaches are one of the most common pathologies: in France, one in two people have been victims of them during the year, one in six suffers from them every day with social and economic repercussions. important.
Worldwide, these ailments are the third leading cause of disability for people of all ages.
” READ ALSO –
“As if my brain went to the blender”: in the hell of migraines
A real handicap
We will say a little quickly that a headache is not that serious.
It depends for whom… Certain extremely painful headaches ruin the lives of migraine sufferers or those suffering from vascular algia of the face.
For them, the impact is such that family, social, school or professional activities prove impossible: they have to interrupt everything and isolate themselves for long hours without light and far from noise.
A real handicap against which we must fight.
This is the case of Pauline.
This very young woman “in survival mode” dreads the onset of a crisis at every moment.
“
I'm told to stop thinking about it because that's how it happens… Fine.
But if people had the slightest idea what a migraine with aura is… If they knew the physical and psychological pain felt, they would surely better understand why I spend my life controlling everything to avoid getting to this point”
,
she says on the website of the association La Voix des migraineurs.
Its pathology constitutes one of the many subtypes of migraine, which is itself one of the 200 kinds of headaches, affections with varied origins whose clinical descriptions cover nearly 500 pages in the last edition of the international classification. .
Headaches can be the consequence of an illness, intoxication (those the aftermath of alcoholic parties are famous), a cranial traumatism… They are said to be “secondary”.
Primary headaches are a primary source of pain.
It is in this category that the most common of all headaches falls, the one that we will all experience one day in our lives: tension headache, a pathology whose origins are still poorly understood, both muscular, psychological, and related to dysfunction of pain control systems.
“
As a rule, this headache does not pose a real problem
: a tablet of paracetamol, a breath of fresh air, rest, and you're forgotten!
commented
Jérôme Mawet, neurologist at the Lariboisière-Fernand-Widal University Hospital in Paris.
But for a small percent of the French population, physical inactivity, overwork, stress, or the abuse of painkillers are likely to make it a chronic disease that strikes at least every other day.
Morale is obviously affected.
Even if the pain, much less than that induced by a migraine, does not prevent the person from continuing his activities.
” READ ALSO –
Doctor Michel Lantéri-Minet: “Facilitating the professional life of migraine sufferers”
“
We rarely see these patients in our departments
,”
points out Michel Lantéri-Minet, neurologist at the Nice University Hospital Center.
The practitioner regrets that these repeated headaches are too often perceived under the unique prism of psychology and depression.
“
When I was younger, it was even referred to as a psychogenic headache!
Can you imagine the effect on a person who does not feel depressed at all?
continues
the doctor.
“
I try to explain to them that we are quite helpless in the face of their disease, and that we have few medicines to offer them.
“
Some antidepressants have, according to him, a small effectiveness in spacing out the number of days with headaches.
But he directs his patients instead towards non-pharmacological approaches, such as transcranial magnetic stimulation.
Stress and anxiety management
The principle: waves in the brain to soothe the pain.
This treatment, performed in certain hospital pain management departments, is based on twenty-minute sessions.
Magnets are attached to the head of the patient who will be subjected to a magnetic field to stimulate his neurons.
The practice has already proven itself for pain due to nerve damage and it seems promising for the problematic pain of chronic tension headache.
“How can we stay zen when fifteen to twenty days a month, or even more, we are no longer operational at all?
asks
Dr. Mawet.
Adobe Stock
Other solutions, stress and anxiety management techniques, such as behavioral and cognitive therapies, have their place in the management of too frequent headaches.
In particular, during a chronic migraine.
With this pathology, which rots the lives of 2 to 3 million French people, the pain is exacerbated until it sometimes becomes unbearable.
“
How can we stay zen when fifteen to twenty days a month, or even more, we are no longer operational at all?
asks
Dr. Mawet.
” READ ALSO –
Pfizer obtains positive results for an anti-migraine treatment
This is the experience of some migraineurs, and especially migraineurs: two to three times more women than men are affected after puberty.
The same violent suffering for these few thousand people suffering from cluster headaches, or vascular algia of the face, in a chronic form.
This condition, rare and rather masculine, is characterized by pain around the eye and in the head so devastating that it can lead to suicide.
Does it have anything in common with migraine?
“
There are genetic predisposition factors for both,
”
replies Christian Lucas, neurologist at the Lille University Hospital, and current president of the French Society for the Study of Migraine and Headaches.
The genetic nature of migraine, suspected for a long time, was revealed by studying one of its particular forms, present in several members of the same family.
This genetic hemiplegic migraine results in what is called a motor aura: half of the body is paralyzed, transiently and more or less markedly, before the headache.
To date, four versions – or mutations – of genes have been implicated.
In practice, the genetic examination makes it possible to confirm a diagnosis, without there necessarily being any symptoms.
Mutations only increase the risk of becoming ill.
But unfortunately they are very numerous.
Last February, a large study published in the journal
Nature
identified more than 120 places in our chromosomes where mutations predispose to their occurrence.
Knowing them should make it possible to learn more about the mechanisms involved, in order to better remedy them.
Genetics, again, other data shed new light on a hitherto mysterious phenomenon.
“
We knew that women could pass from migraine to cluster headache after menopause, and it even happened, more rarely, that the two diseases coexist,
says Dr. Lucas.
Seven genes of susceptibility to these pains have just been discovered… including one which also predisposes to migraine.
»
Migraine scenario
For now, the origin of cluster headache remains poorly understood.
We know, however, that this disease corresponds, like migraine, to a dysfunction of a small structure located at the base of the brain: the hypothalamus, which plays a fundamental role in the regulation of hunger, thirst, sleep, emotions , etc.
” READ ALSO –
Does the computer screen really damage our eyes?
Both diseases are also known to involve activation of the largest of the cranial nerves, the trigeminal nerve.
"
But we don't know why or how cluster headache can change from an episodic form, with a short painful period followed by a long period of remission, to another chronic one where the situation is reversed"
,
comments Professor Anne Ducros, neurologist at the Montpellier University Hospital Center.
The scenario is better identified for migraine.
Whether or not there is discomfort with light, whether or not vomiting is present, whether or not the headache is preceded by an aura, migraine begins in all cases with an aberrant activation of the hypothalamus and always leads to that of the trigeminal nerve.
This ultimately results in dilation and painful inflammation of the arteries supplying the meninges and brain.
And it is from this observation that the very first drugs were offered to patients.
In the 1970s and 1980s, by studying the dilation of blood vessels, Dutch and Australian scientists realized that a neurotransmitter, serotonin, could have a beneficial effect.
About a decade later, this research led to drugs capable of mimicking its effects and thus countering migraine pain: triptans.
“
When they appeared, I was still only a medical intern and I didn't know much about migraine
,”
says Dr. Lantéri-Minet.
“
But I remember perfectly the faces of the patients coming to test these products at the hospital and leaving transformed
: finally, drugs managed to relieve them!
»
” READ ALSO –
Lightning meningitis: these signs that should alert you
In tablets, in nasal spray or in injectable form, triptans today occupy a leading position in the management of severe attacks, including for cluster headache.
If they are taken in time, they are of unparalleled effectiveness in relieving pain.
Genetics has confirmed the validity of their use: among the genes implicated in migraine, some code for the serotonin receptor
.
But it has also heightened interest in another category of drugs aimed at an oh so important objective: to reduce the intensity, duration and number of attacks.
The hope of antibodies
To avoid triggering them, a migraine sufferer must constantly develop strategies, especially at work.
"
My colleagues don't necessarily realize how much I can put in place discreetly,"
explains Morgane.
My screens, for example, are at the lowest brightness level, I have specific glasses, I avoid staying too close to a window…
”
New molecules are giving hope: antibodies directed against a pain mediator, and called anti-CGRP.
Adobe Stock
To minimize the risk of a migraine, everyone quickly learns to avoid the stimuli they know are capable of causing them.
The disease, in fact, makes the brain so excitable that the deleterious process engages as soon as even slight changes are perceived.
This is why some flee the sudden arrival of light, noise, smells, etc.
However, not everything is controllable: it is impossible, for example, to prevent a woman's hormone levels from varying every month.
Hence the importance of drugs to make the brain less sensitive.
” READ ALSO –
Migraine: what is it?
Manon, a young student, has been on beta-blockers since her final year: this allows her to space out her migraine attacks with visual aura by three to four months.
But this is not ideal: the drugs for these basic treatments do not act quickly, and expose the patients to frequent undesirable effects: drowsiness, concentration problems, weight gain, hair loss... Result,
"
after one year, 80
% of patients stop taking them ,
”
laments Professor Ducros.
From this relative acknowledgment of failure was born the crazy hope aroused by new molecules: antibodies directed against a pain mediator, and called anti-CGRP (for peptide linked to the calcitonin gene).
“
I had the right to the obstacle course.
I took basic treatments one after the other hoping that they would work,
”
recalls Barbara who, in her fifties, ended up in the emergency room twice in the same year as the pain was unbearable.
She had stopped working and was in despair.
Until his neurologist prescribed him anti-CGRP.
“
I was skeptical, and then…the improvement was rapid, excellent, and my life changed completely!
»
Today, her migraine is nothing more than a bad memory: she can go to a restaurant without fearing a crisis, go out with friends… in short, allow herself everything she had forbidden herself for a long time.
For millions of migraine sufferers, will debilitating headaches be forgotten tomorrow?
Barbara lives in Switzerland, where the anti-CGRP treatment is reimbursed up to its selling price.
This is not the case in France.
In addition, these drugs have a very restrictive marketing authorization (AMM), excluding, for example, cluster headache.
If they have the immense advantage of being very effective and devoid of adverse effects, they do not work for a small fraction of migraine sufferers.
Patients and doctors nevertheless try to remain confident.
Especially since other molecules are in the pipeline, some of which are already marketed in the United States.
