According to the World Health Organization, migraine represents the third most frequent and second most disabling disease of mankind, so much so that 14% of the planet's population suffers from it. It clearly favors the female sex, so much so that it affects one woman for every three men, taking the form of a condition that faithfully follows the trend of fluctuations in female sexual hormones. Despite the evident female characterization, there are still many critical issues that emerge in the management and care of patients with this disease, in particular the lack of a multi- and interdisciplinary approach, of medical references at a local level, as well as of diagnostic pathways. homogeneous therapeutic-assistance. These are the first results that emerged from a working group made up of the Onda Foundation and Anircef – the Italian neurological association for headache research, aimed at developing a new model for the management of migraine patients, which takes into account the peculiarities of the different female and male life cycles of some specific aspects relating to the female gender.
The objective – explains a note – is to guarantee more timely, appropriate and effective multidisciplinary management through the synergistic collaboration of all the specialists involved in the treatment process. The preliminary results of the work were presented today in Rome at the Chamber of Deputies, during the event 'Women's migraine path: organization of integrated care', with the non-conditioning contribution of Teva and the patronage of Al.Ce. Group Italia – Cirna Foundation onlus and Aic onlus, Italian Association for the fight against headaches.
“The project represents another important step in our commitment to protecting health, in particular of women, who are by far the most affected by this disease and have the strongest symptoms – declares Francesca Merzagora, president of the Onda Foundation – The results undoubtedly represent the beginning of a great work to carry forward. We hope that the experience of this working group can lead to the development of a biopsycho-social model for the management of women with migraine, taking into account all the specificities of the life stages female, starting from pre-adolescence and then arriving at menopause”.
In women, migraine generally appears after the first menstruation – the note recalls – reaching its maximum prevalence in the fourth and fifth decade of life. Symptoms tend to improve during the second and third trimesters of pregnancy, and then resurface after childbirth and breastfeeding. The disappearance of migraines with menopause is far from the rule, since in a third of women it persists unchanged, while another third even complains of a worsening of symptoms. Migraine is also more severe in the female gender: women experience more frequent episodes, of greater intensity and duration, and have a greater overall number of comorbidities with consequent greater negative implications on the quality of life, which affect the family and work environments. and relational.
The objective of the Fondazione Onda and Anircef project is to start a new path arising from the awareness that a new organization of assistance for women with migraines is necessary, leading to a new management model. The critical issues relating to management emerge from childhood: although there are national and international guidelines for the diagnosis and treatment of headaches in pediatric age, in fact, the transition between pre-puberty and post-puberty is not adequately paid attention to.
The consultation of a neurologist or a headache specialist is always desirable – it emerged from the meeting – if not even necessary, in many phases of female life, starting from the menstrual period, which in many women can lead to the onset of episodes of migraine characterized by high intensity and prolonged symptoms which may require the evaluation of the prescription of specific drugs and adequate perimenstrual prophylaxis. Consultation with a neurologist or specialist is also essential regarding contraception in women with this pathology: for example, migraine with aura represents an absolute contraindication to the use of estrogen-progestin oral contraceptives due to the increased risk of ischemic events . In these cases, progestin-only contraceptives are indicated.
Pregnancy and menopause also require special attention: in the first case to use a therapy that is safe for the future mother and the fetus, in the second to evaluate the prescription of Hormone Replacement Therapy (HRT). If on the one hand it is true that HRT is associated with a lower ischemic risk than estrogen-based contraceptives, therefore allowing its use in women with sporadic migraine aura – the experts highlight – on the other hand, in the event that symptoms worsen with the administration of replacement therapy, this must be discontinued.
However, a gray area remains represented by medically assisted procreation, due to the lack of sufficient data in the literature. In clinical practice there is a high dropout rate among women after the first attempt. The hormonal stimulation used for egg retrieval, in fact, is identified as the main cause of migraine attacks and the exacerbation of associated symptoms. Furthermore, the presence of migraine must be carefully considered before undergoing assisted reproductive techniques and the gynecologist must consider the administration of lighter protocols. Finally, even in cancer patients, treatment is often associated with a worsening of migraine symptoms, which is particularly evident with hormonal therapies against breast cancer.
Hence the need for coordinated and integrated management of women with migraine and for active collaboration between the neurologist and the reference specialist (gynecologist and/or oncologist). “Anircef is strongly committed to ensuring that all people who suffer from headaches in Italy find an adequate response to their health problem and that scientific research resolves uncertainties and unmet needs – states Cinzia Finocchi, president of Anircef – The fundamental inspiring principle of model dedicated to women with migraines, developed in collaboration with Onda, is the personalized approach to management and treatment, which takes into account individual variability in terms of genetic characteristics, environment, lifestyles and personal experiences”.
“More and more studies demonstrate the diversity between men and women with respect to the sensitivity and incidence of different diseases or pathologies, so much so that the WHO itself increasingly underlines the need for an approach to health through gender medicine, which – underlines the Honorable Ilenia Malavasi, Social Affairs Commission of the Chamber – also takes into account the effects on health of lifestyles (smoking, alcohol, diet, physical activity, body weight, socio-cultural and environmental context), since these factors also have a strong impact on the development and evolution of diseases. Migraine is certainly among the most 'sensitive' pathologies to this issue, because throughout the world it has a prevalence 3 times greater in women, with a strong impact both on the quality of life and on direct and indirect costs incurred by the company”.
“For this reason – he adds – every in-depth analysis and every evaluation of its characteristics and its social impact are very important in providing information on the actions to be undertaken, among which integrated care and multidisciplinary approach represent the priority objectives on which to work: the initiative that we promote today is moving precisely in this direction. I am happy to have hosted this initiative, created together with Fondazione Onda – concludes Malavasi – bringing into the Chamber a reflection on a gender pathology that penalizes women, on a personal, family, work and social”.
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