Headache, a disorder that adults and children share
I don't come to the office today, I have a headache. Sounds like an excuse, but it's not. According to WHO, headache is among the top 10 causes of disability in the world. Globally, with episodes occurring at least once a year, one in two people suffer from it, more often women than men and 40% of children.
On the occasion of the fifteenth edition of the National Headache Day on May 27, which this year has the slogan "Turn off migraine, light up life", the Sin (Italian Society of Neurology) and the Sisc (Italian Society for the Study of headaches) take stock of the diagnostic and therapeutic aspects of headache and also on the implementing decrees of law 81/2020 which recognized chronic migraine as a social disease.
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On the Sin and Sisc Facebook, Instagram and Twitter channels, popular videos on headaches made with specialists are published: some of these videos, in particular, take their cue from users' questions sent to scientific societies via social media or email.
Headaches aren't just one type
There are two broad categories of headaches: primary headaches, the most frequent, are disorders not related to or due to other diseases, and secondary headaches: these, on the other hand, depend on other diseases. For example from head trauma, from cerebral vascular disorders (stroke) or from internal non-vascular diseases of the skull, such as brain tumors or changes in CSF pressure.
Primary headaches are migraine, tension headache and cluster headache, which differ in the type, intensity and location of pain, in the duration and frequency of attacks, and in the presence, or absence, of symptoms accompanying the ache.
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What are the characteristics of migraine
Migraine manifests itself as a throbbing pain of moderate to severe intensity and often affects half of the head (hence the name: hemi, in Greek means half). Sufferers are unable to carry out daily activities because every action aggravates the pain.
In migraine with aura the attacks are preceded by neurological disturbances, especially visual ones (the aura, in fact). The migraine crisis often occurs together with other symptoms such as nausea, vomiting and intolerance to light, noise and strong smells. It can last from a few hours to 2-3 days. Two times out of 3 migraine patients are women.
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That circle on the head
The tension-type headache is the classic circle in the head, it can last from a few minutes to a few days but is generally not associated with nausea or vomiting. It is the most frequent form of headache with a prevalence in the population of about 80%. This headache also prefers women.
Finally, there is cluster headache, which causes attacks of intense and excruciating pain in the periocular area that last about 1-3 hours and which occur several times a day for an average of 2 weeks (the cluster, in fact) and alternate with pain-free periods. Cluster headaches predominantly affect men.
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Migraine, social disease for the law
"In Italy 12% of the adult population suffers from migraine - he explains Alfredo Berardelli President of the Sin –: it is a reality that affects 6 million people, who find themselves living with such a debilitating pathology that it has been indicated by the WHO as a cause of greater disability in the age group between 20 and 50, i.e. at the time of the life in which you are most productive".
Chronic migraine has been recognized as a social disease by law 18/2020. "The implementing decrees issued by the Ministry of Health - he comments Franco Granellapresident of the Sisc - provide for funding of 10 million euros for 2023 and 2024 with the aim of carrying out regional projects for the experimentation of innovative methods of taking charge of patients".
By the end of the year, the various health facilities will have to present their project proposals to their respective regions in order to obtain funding and Sisc is trying to help them by developing procedures and formats that can help operators in the implementation of their proposals".
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But headaches aren't just "grown-up stuff" or a matter of productivity at work. Far from it. Knows the headache 40% of children and 10% suffer from migraine.
When headache affects children and adolescents
Data from the Italian Migraine Registry, coordinated by the Irccs San Raffaele, show that migraine occurs on average between 10 and 17 years of age. Only in 8% of cases do patients go to a general practitioner and in 80% of cases they have undergone completely useless diagnostic tests.
Piero Barbantidirector of the Unit for the treatment and research on headaches and pain of the San Raffaele in Rome, issues a warning: "Beware of headaches in school-age children. In the world, migraine is the leading cause of disability in women under the age of 50. In Italy the latency between the onset of the problem and the consultation of a specialized center is about 20 years. In the meantime, migraine can become chronic. Headaches must be intercepted as early as primary school, raising awareness teachers and school leaders".
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Traveling headache center and school leave
For selected cases, it would be appropriate to guarantee young patients, who are 10% of school-age children and adolescents, the possibility of using school leave for headaches. "It is a measure similar to that of the menstrual leave that has just been introduced in some Italian schools", continues the neurologist. "Like San Raffaele - he adds - we are also evaluating an experimental school medicine project, so as to make our Headache Center itinerant and bring it to schools, first in Rome, to favor the early diagnosis of the pathology".
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Early treatment and diagnosis
Thanks to the discovery of the molecular mechanism underlying pain, therapies based on monoclonal antibodies have entered clinical practice, which reduce the number of attacks in the episodic form and are also effective in chronic and drug-resistant migraine.
These new approaches, in addition to improving the quality of life of patients, prevent the disease from evolving into a chronic form and "reduce the risk of drug abuse and also allow recovery from chronicity in difficult patients. In July - anticipates Barbanti - is expected also the reimbursement of a fourth antibody, very powerful, the only one to be administered intravenously. If we were able to diagnose all cases in time, it would be a turning point".