Read our submission on chronic migraine and medical card eligibility

17th July 2014

Migraine Association of Ireland Submission on the Development of a Policy Framework for Medical Card Eligibility to Take Account of Medical Conditions

The Migraine Association of Ireland

The Migraine Association of Ireland (MAI) exists to provide information, support and reassurance to migraine sufferers and those affected by primary headache disorders. The Association aims to empower people and optimise quality of life by creating awareness and promoting education of these conditions, encouraging further research, and seeking improved services for those affected.

The MAI is a member of the Neurological Alliance of Ireland, the Disability Federation of Ireland, the World Headache Alliance and the European Headache Alliance.

 

Overview of Submission

The MAI would like to submit Chronic Migraine as a condition which should merit medical card eligibility. Migraine is the 7th ranking cause of all disease associated disability worldwide.[1] Awareness needs to be raised amongst legislators, employers and society generally about the debilitating nature of chronic migraine and the social and economic burden of headache.

According to the World Health Organisation, lack of knowledge among health-care providers is the principal clinical barrier to effective care.[2] This poor awareness extends to the general public. Headache disorders are not perceived as serious because they may be episodic, they do not tend to cause death, and they are not contagious. This must be addressed.[3]

The MAI would also suggest that medical card eligibility should not be determined solely by medical condition but through an examination of medical need. We are concerned that a prioritised set of medical conditions would be restrictive and potentially inegalitarian, excluding people who may have equivalent levels of need but whose condition is not listed.

Chronic Migraine

(This section was prepared in consultation with our medical advisors Dr Edward O’ Sullivan, Director of the specialist Migraine/Headache Clinic at Cork University Hospital, and Esther Tomkins, Clinical Nurse Specialist at the Migraine/Headache Clinic in Beaumont Hospital).

It is important not to underestimate the level of disability associated with Chronic Migraine which affects 1 – 2% of the adult population. Chronic Migraine is defined as a chronic migraine headache on at least fifteen days per month for at least four hours per day, for more than three months.  Many migraine patients remain in a chronic headache state for years and therefore daily or near daily migraine remains a challenge for clinicians.

The World Health Organisation classifies severe attacks as among the most disabling illnesses, comparable to dementia, quadriplegia and active psychosis.[4]

 

Medical Management

Chronic Migraine represents one third of the workload at specialist headache clinics. It necessitates many visits to the GP, at least one per month.  It is important to note that because of the nature of the symptoms and the associated disability, patients often end up in the emergency departments, taking up a lot of hospital time. Greater access to primary care would reduce hospital admissions and potentially unnecessary investigations.

Chronic Migraine is managed medically through a combination of acute and prophylactic (daily) treatments.

Acute medications include analgesics, anti-emetics and Triptans, of which there are six:

  • Almogran (Almotriptan)
  • Frovex (Frovatriptan)
  • Imigran (Sumatriptan)
  • Zomig (Zolmitriptan)
  • Naraverg (Naratriptan)
  • Relpax (Eletriptan)

 

Prophylactics include Beta Blockers, Anti-Convulsants, Tricyclic Anti-Depressants, Calcium Channel Blockers and 5 – HT Antagonists. These include, but are not limited to:

  • Half Inderal LA
  • Topiramate
  • Amitriptyline
  • Flunarizine
  • Sanomigran (Pizotifen)

Often a patient is prescribed more than one daily preventative and these are very expensive.

Specialist assessment of chronic migraine may result in other pharmacological treatments such as occipital nerve injection or injections of Botulinum Toxin Type A.

Prevention should not be limited to pharmacological treatment. In addition to therapeutic management patients often require non-drug approaches including physiotherapy, occupational therapy and cognitive behavioural therapy (CBT).

 

In-patient Treatment

In-patient admission for infusions of Dihydroergotamine (DHE) or IV Lidocaine to help to break the chronic cycle of migraine may also be treatment options for patients. These patients tend to fail to respond to multiple treatment options.

 

Societal Impact of Headache

The MAI would like to emphasise that there is a lack of acknowledgement with regard to the disability associated with headache.

Migraine attacks trigger weakness and a loss of ability to function. The resulting societal and financial burden is enormous. It is estimated that migraine costs Irish businesses €252 million every year as a result of lost productivity. However migraine is the least publicly funded of all neurological illnesses relative to its economic impact.[5]

The WHO states that many governments, in seeking to constrain health-care costs, do not acknowledge the substantial burden of headache on society. The fact remains that the direct costs of treatment are small when compared to the huge indirect-cost savings that may be made (for example by reducing lost working days) if resources were allocated to treat headache disorders appropriately.[6]

Conclusion

The focus of the expert panel established by the HSE is on ‘chronic, life-long and life-limiting conditions.’ The MAI believes that Chronic Migraine more than satisfies these criteria and would ask that the panel reflect upon the levels of disability associated with this condition. Our position is that Chronic Migraine should merit at least consideration of medical card eligibility and furthermore, that an assessment of medical need or impact/disability would be more advantageous in determining medical card eligibility than a prioritised set of medical conditions.

Please do not hesitate to contact the MAI for further comment or clarification.

ENDS

For Reference:

Jenny Costello, Communications Officer with the MAI

Email: info@migraine.ie Telephone: 01-8941280


[1] Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990—2010: a systematic       analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15; 380(9859):2197-223.

[2] World Health Organisation. Headache Disorders: Fact Sheet No. 277, October 2012.

[4] Shapiro, R. and Goadsby, P. (2007), The long drought: the dearth of public funding for headache research. Cephalalgia, 27: 991–994.

[5] Shapiro, R. and Goadsby, P. (2007), The long drought: the dearth of public funding for headache research. Cephalalgia, 27: 991–994.

[6] World Health Organisation. Headache Disorders: Fact Sheet No. 277, October 2012.

Read our submission on chronic migraine and medical card eligibility

17th July 2014

Migraine Association of Ireland Submission on the Development of a Policy Framework for Medical Card Eligibility to Take Account of Medical Conditions

The Migraine Association of Ireland

The Migraine Association of Ireland (MAI) exists to provide information, support and reassurance to migraine sufferers and those affected by primary headache disorders. The Association aims to empower people and optimise quality of life by creating awareness and promoting education of these conditions, encouraging further research, and seeking improved services for those affected.

The MAI is a member of the Neurological Alliance of Ireland, the Disability Federation of Ireland, the World Headache Alliance and the European Headache Alliance.

 

Overview of Submission

The MAI would like to submit Chronic Migraine as a condition which should merit medical card eligibility. Migraine is the 7th ranking cause of all disease associated disability worldwide.[1] Awareness needs to be raised amongst legislators, employers and society generally about the debilitating nature of chronic migraine and the social and economic burden of headache.

According to the World Health Organisation, lack of knowledge among health-care providers is the principal clinical barrier to effective care.[2] This poor awareness extends to the general public. Headache disorders are not perceived as serious because they may be episodic, they do not tend to cause death, and they are not contagious. This must be addressed.[3]

The MAI would also suggest that medical card eligibility should not be determined solely by medical condition but through an examination of medical need. We are concerned that a prioritised set of medical conditions would be restrictive and potentially inegalitarian, excluding people who may have equivalent levels of need but whose condition is not listed.

Chronic Migraine

(This section was prepared in consultation with our medical advisors Dr Edward O’ Sullivan, Director of the specialist Migraine/Headache Clinic at Cork University Hospital, and Esther Tomkins, Clinical Nurse Specialist at the Migraine/Headache Clinic in Beaumont Hospital).

It is important not to underestimate the level of disability associated with Chronic Migraine which affects 1 – 2% of the adult population. Chronic Migraine is defined as a chronic migraine headache on at least fifteen days per month for at least four hours per day, for more than three months.  Many migraine patients remain in a chronic headache state for years and therefore daily or near daily migraine remains a challenge for clinicians.

The World Health Organisation classifies severe attacks as among the most disabling illnesses, comparable to dementia, quadriplegia and active psychosis.[4]

 

Medical Management

Chronic Migraine represents one third of the workload at specialist headache clinics. It necessitates many visits to the GP, at least one per month.  It is important to note that because of the nature of the symptoms and the associated disability, patients often end up in the emergency departments, taking up a lot of hospital time. Greater access to primary care would reduce hospital admissions and potentially unnecessary investigations.

Chronic Migraine is managed medically through a combination of acute and prophylactic (daily) treatments.

Acute medications include analgesics, anti-emetics and Triptans, of which there are six:

  • Almogran (Almotriptan)
  • Frovex (Frovatriptan)
  • Imigran (Sumatriptan)
  • Zomig (Zolmitriptan)
  • Naraverg (Naratriptan)
  • Relpax (Eletriptan)

 

Prophylactics include Beta Blockers, Anti-Convulsants, Tricyclic Anti-Depressants, Calcium Channel Blockers and 5 – HT Antagonists. These include, but are not limited to:

  • Half Inderal LA
  • Topiramate
  • Amitriptyline
  • Flunarizine
  • Sanomigran (Pizotifen)

Often a patient is prescribed more than one daily preventative and these are very expensive.

Specialist assessment of chronic migraine may result in other pharmacological treatments such as occipital nerve injection or injections of Botulinum Toxin Type A.

Prevention should not be limited to pharmacological treatment. In addition to therapeutic management patients often require non-drug approaches including physiotherapy, occupational therapy and cognitive behavioural therapy (CBT).

 

In-patient Treatment

In-patient admission for infusions of Dihydroergotamine (DHE) or IV Lidocaine to help to break the chronic cycle of migraine may also be treatment options for patients. These patients tend to fail to respond to multiple treatment options.

 

Societal Impact of Headache

The MAI would like to emphasise that there is a lack of acknowledgement with regard to the disability associated with headache.

Migraine attacks trigger weakness and a loss of ability to function. The resulting societal and financial burden is enormous. It is estimated that migraine costs Irish businesses €252 million every year as a result of lost productivity. However migraine is the least publicly funded of all neurological illnesses relative to its economic impact.[5]

The WHO states that many governments, in seeking to constrain health-care costs, do not acknowledge the substantial burden of headache on society. The fact remains that the direct costs of treatment are small when compared to the huge indirect-cost savings that may be made (for example by reducing lost working days) if resources were allocated to treat headache disorders appropriately.[6]

Conclusion

The focus of the expert panel established by the HSE is on ‘chronic, life-long and life-limiting conditions.’ The MAI believes that Chronic Migraine more than satisfies these criteria and would ask that the panel reflect upon the levels of disability associated with this condition. Our position is that Chronic Migraine should merit at least consideration of medical card eligibility and furthermore, that an assessment of medical need or impact/disability would be more advantageous in determining medical card eligibility than a prioritised set of medical conditions.

Please do not hesitate to contact the MAI for further comment or clarification.

ENDS

For Reference:

Jenny Costello, Communications Officer with the MAI

Email: info@migraine.ie Telephone: 01-8941280


[1] Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990—2010: a systematic       analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15; 380(9859):2197-223.

[2] World Health Organisation. Headache Disorders: Fact Sheet No. 277, October 2012.

[4] Shapiro, R. and Goadsby, P. (2007), The long drought: the dearth of public funding for headache research. Cephalalgia, 27: 991–994.

[5] Shapiro, R. and Goadsby, P. (2007), The long drought: the dearth of public funding for headache research. Cephalalgia, 27: 991–994.

[6] World Health Organisation. Headache Disorders: Fact Sheet No. 277, October 2012.