Joint pain causes headache for migraine patients

by Michael Fronstin | Apr 27, 2016

I’m going to go out on a limb and assume everyone reading this has had a headache. Some people have them frequently, some not very often. But we all know what they feel like.

Now add nausea and vomiting. And light and sound sensitivity. And vision disturbances. And fatigue. What you’d take for a typical headache doesn’t touch the pain when having these incremental, unwanted symptoms. It’s likely you’re experiencing a migraine, which affects approximately 42 million people in the U.S., based on data from PainMPact.

While some people treat their migraines preventively with beta-blockers, antidepressants or antiseizure medications, other patients take their medication once the migraine starts. These abortive medications can be taken sublingually, via a skin patch, through nasal spray, or via self-injection.

Several compounds are in development to treat migraines, and self-injection is a popular method of administration:

  • ALD-403: Last month Alder Biopharmaceuticals announced ALD-403’s Phase IIb trial met primary and secondary endpoints demonstrating prevention in chronic migraine patients, as well as positive Phase I data supporting quarterly dosing via a single intravenous, subcutaneous or intramuscular injection.
  • Lasmiditan: CoLucid Pharmaceuticals has received a special protocol agreement for its pivotal Phase III trial to evaluate the safety and efficacy of lasmiditan.
  • TEV-48125: Teva Pharmaceuticals initiated Phase III trials in chronic and episodic migraine patients.

Injections are used more frequently because they enter a patient’s system more quickly than tablets, thus alleviating symptoms faster, and they are often used when other treatments are no longer effective. However, a common comorbidity experienced by migraine sufferers may create an unmet need for patients who need to treat with a self-injection: 15% of people with migraines report having arthritis pain in their fingers and/or hands, according to the National Health and Wellness Survey (NHWS).

Migraine patients have worse health-related outcomes than the general population to begin with, but comorbid arthritis in the hands and fingers significantly worsens patients’ health-related outcomes and more specifically results in an increased use of health resources. For example, migraine patients without a diagnosis of arthritis in their hands or fingers have visited a healthcare provider an average of five times in the past six months; patients with comorbid migraine and hand and finger joint pain see their physician twice as often. Patients with migraine and arthritis are significantly more likely to visit the emergency room: 33% compared with 22%, respectively, in the past six months.

In addition, joint pain in the hand and finger significantly decreases migraine patients’ productivity. Migraine alone causes activity impairment of 30%, but the addition of arthritis impairs patients’ activity levels by a staggering 57%. Meanwhile, work productivity loss is 26% among migraine patients but rises to 45% for patients with migraine and arthritis in the hands and fingers.

Whether people are experiencing a migraine without the challenges of arthritis of the hands and fingers or their burden is increased with arthritis of the hands and fingers, there exists a large medical unmet need for these patients. Quality of life is lower than average, use of health resources is higher, work productivity and activity impairment is worse. Until newer treatments are available there’s an opportunity for physicians to seek appropriate treatments and discuss the challenges for those experiencing comorbid arthritis in the hands and fingers, which may continue even with newer, injectable options. The healthcare industry has an opportunity to alleviate the humanistic and economic burden associated with migraine with or without arthritis, and this cannot occur quickly enough for those of us suffering from the pain and symptoms associated with migraines.  

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