Neurologist Jan Versijpt on the difference between headaches and migraines

Wikipedia states that migraine is more common in the Netherlands and Belgium than elsewhere. Is that true?
Jan Versijpt: "That's incorrect. They probably compared different measurement methods. In fact, it affects around ten to fifteen per cent of the population in every country. Not just in Western society, but worldwide."

Do you suffer from migraines yourself?
"I did as a child, but as an adult it disappeared. It wasn't a typical migraine, because I didn't have headaches. For me, it was mainly stomach ache and vomiting. This is called cyclic vomiting. I also had the aura that characterises migraines: a flickering in my field of vision. In addition, it returned every month with clockwork regularity. That pattern is also typical. But I've actually lost that almost completely. The likelihood of it going away is much higher for boys than for girls. In childhood, migraine is equally common in both sexes. However, after the first period and the onset of puberty, the number of women with migraine increases dramatically. It is three times more common in women than in men."

What exactly is the difference between migraines and headaches?
"A headache is a symptom, whereas migraine is a condition. Migraine is a complex neurological disorder that often involves headaches, but not always. In addition to being recurrent, migraine is characterised by a series of typical symptoms such as nausea, sensitivity to light and sound, and sometimes an aura with visual disturbances. Ordinary tension headaches are usually less intense and do not have the typical associated characteristics."

Why is it more common in women?
"It is probably hormone-driven, with oestrogen playing the biggest role. That may also be why many women's migraines disappear around the time of menopause. But we are still far from knowing everything about it. In men, it also improves with age, but not as abruptly as in women."

So we actually know very little about hormones?
"We do know that hormones play a major role, but whether oestrogens, progestogens or even testosterone are a crucial factor is still the subject of considerable scientific debate. Perhaps we will learn more about how hormones work from research involving transgender people. Nowadays, there are more sex changes, which means that more hormonal treatments are being used. We sometimes see shifts in migraine in these cases. Hormonal fluctuations are not as significant in men as they are in women. They are also not studied as extensively. However, one in four migraine patients is male. In fact, it has to be said that we do not know exactly how these hormones play a role."

Are there any new developments in the treatment of migraine?
"In recent years, everything has revolved around a protein called CGRP, Calcitonin Gene-Related Peptide. We have known for some time that this protein is released during a migraine attack. Medicines have been developed that inhibit this protein. The latest development is that these pills can be used both during a pain attack and to prevent such attacks by taking them every day or every other day. We are conducting research into the added value of this new drug compared to traditional painkillers."

What does this promise for the future?
"The advantage of these drugs is that patients tolerate them well. What's more, you can better respond to what the patient wants. Are we going to take a more preventive approach, or are we going to use them to build up defences? These drugs have changed the entire migraine landscape. They have been developed specifically for migraine and patients experience far fewer side effects, which means they are also more likely to adhere to the prescribed treatment."

What kind of research do you conduct yourselves?
"Our research focuses on identifying types of headaches, possible treatments and predictive factors. We do not conduct fundamental basic research ourselves. This would be very difficult anyway, because there are very few animal models available, for example. We do collaborate quite extensively with industry. For these sponsored studies, we often test medicines that are in the final phase before being brought to market."

The human brain is difficult to mimic. So how do you test new medicines?
"Placebo-controlled studies are the gold standard for any research into pain. You give a placebo – a fake medicine – to one group and the real medicine to the other group. You then compare the results of the two groups."

Why is it that you hear so little about migraine, even though a large proportion of the population suffers from it?
"Migraine comes in many forms. It is very common and sometimes very mild. As a result, many people mistake it for a trivial headache.

Another cause is the stigma surrounding migraine. We have moved beyond this for some time now, but in the past it was seen as a hysterical condition that mainly affected women. This has slowly changed as we have come to realise that migraine is simply a brain disorder in which certain things go wrong in the brain.

The recent medicines, developed specifically for the condition, have also helped to reduce that prejudice. This has once again confirmed that it is not just an act, but a real physical illness."

What impact does migraine have on a patient's daily life?
"The effect is not insignificant and affects many aspects of your life. Professionally, you are of course absent from work, but even when you do go to work, you are less productive. With a headache, you often cannot give one hundred per cent. But it affects everything. If you ask people with migraine whether it affects their family life, you get strong responses. They say they consider themselves to be less effective parents, or that they have scaled back their desire to have children, or that they have decided not to have children at all because of it. They say they have a smaller circle of friends, or even no friends at all. Migraine often has a huge impact on their lives.

The repercussions are also so great because it mainly affects people between the ages of twenty and fifty. That is precisely the age when want to start a family, buy a house, work full-time and participate in society. It is the most active part of a person's life. For people with chronic migraine, who have more days with headaches than without, it is even catastrophic. Their lives are actually taken away from them by migraine. That is two per cent of the population. In Belgium, we are talking about more than 200,000 people."

What is the economic impact?
"That is also particularly significant. But it is not always felt. The greatest financial consequences of headaches are in terms of lost working hours. These are paid for by the employer, but it is almost impossible to calculate how much that is. For the employer, this falls under normal sick leave. The medical costs for treatment are not that high in comparison. The new medicines are expensive, but that really only applies to a very specific small category of patients."

What attracts you to this disease?
"Headaches are an interesting discipline because there is so much you can do - contrary to what many people think. As a treating physician, you also get a lot in return. Sometimes simply by explaining to patients what headaches are and that migraines are benign. And, of course, by controlling migraines with medication. We have been getting better at this in recent years. What also appeals to me is that it is still a purely clinical discipline. You don't really need sophisticated scanners or blood tests. You just have to talk to the patient. The diagnosis is made after a simple interview. I find that very satisfying. There are hundreds of types of headaches, and by sitting down with the patient for a moment, you can tell them what it is."