UK Migraine Sufferers Face ‘Broken Healthcare System’

By Pat Anson, PNN Editor

The United Kingdom has a “broken healthcare system” that leaves millions of migraine sufferers without treatment or a proper diagnosis, according to a new study.

The report by The Migraine Trust estimates that one in every seven people in the UK – about ten million -- suffer from migraine attacks. Most say they haven’t been officially diagnosed by a doctor and have never seen a headache specialist.

Those who have been diagnosed often have trouble getting a new class of drugs to prevent migraine -- calcitonin gene-related peptide (CGRP) inhibitors – even though the medications have been approved for use by the UK’s National Health Service (NHS).

“My migraine has never been managed properly by the NHS. I’ve suffered for 13 years and they’ve increasingly become worse each year. I’m bed bound at least once a week,” a migraine sufferer told the charity. “I visit my GP regularly and they send me away with a different drug to try for another year before I can be considered for another. I asked for a referral to the migraine clinic and was refused by my doctor.”

The Migraine Trust filed Freedom of Information requests with nearly a hundred NHS healthcare systems in England, Northern Ireland, Scotland and Wales and found that only a few were giving eligible patients access to CGRP treatment.

“There is clearly a postcode lottery of care where only the lucky few can access a treatment which has proven transformational for many migraine patients,” Rob Music, CEO of The Migraine Trust, said in a statement. “This should be such an exciting and positive time for those needing migraine care, but right now this lack of access is leading to continued poor health and deep frustration.” 

CGRP inhibitors have been available in the United States since 2018, including a drug recently approved for both migraine prevention and treatment. The medications – which block a protein released during migraine attacks from binding to nerve receptors in the brain – are not cheap. Eight tablets of Nurtec, for example, cost nearly $1,000. 

Not treating migraines can be costly as well. The Migraine Trust estimates that lack of adequate migraine treatment in the UK results in 16,500 emergency admissions and 43 million lost workdays every year.  

The charity says migraine attacks also have a negative impact on the lives of migraine sufferers. In surveys, nearly a third said migraines negatively affect their mental and physical health. About one in four said migraines disrupt their family and social life. 

The pandemic has also taken a toll on migraine patients, with 68% saying their symptoms have worsened. Some reported it was because of stress, some because their lifestyle was harder to manage, and others because they couldn’t access the treatment they had been receiving. An increase in computer screen time during the pandemic also contributed to worsening migraine attacks.    

The Migraine Trust recommends that everyone seeing a doctor for head pain should be assessed for migraine and receive an individualized care plan. More headache specialists and neurologists should also be recruited to bring the UK in line with other European nations. The Trust called for public awareness campaigns to improve understanding of migraine symptoms and reduce the stigma associated with migraine. 

About a billion people worldwide suffer from migraine headaches, which affect three times as many women as men. In addition to headache pain, migraine can cause nausea, blurriness or visual disturbances, and sensitivity to light and sound.

Medical Cannabis Not Recommended for Chronic Pain in UK

By Pat Anson, PNN Editor

It was a little over a year ago that the UK’s Home Secretary announced that medical cannabis would be legalized in Britain and become available by prescription – a move that was cheered by cannabis activists.

“This is a major victory for our campaign and will mean a lot of people will have a much better quality of life,” said Clark French, a multiple sclerosis patient.

It turns out the celebration was premature. After a lengthy review, the UK’s National Institute for Health and Care Excellence (NICE) recently recommended to the National Health Service (NHS) that medications containing cannabidiol (CBD) only be used to treat epilepsy, multiple sclerosis and chemotherapy-induced nausea.

CBD was not recommended as a treatment for chronic pain, at least not yet.

“There is evidence to suggest that CBD reduces chronic pain,” NICE said. “However, where cannabis-based medicinal products reduced chronic pain, the benefit is small and economic analysis shows that this compares poorly with the high costs of (CBD products).”

Cannabis medications containing THC were also ruled out, even when combined with CBD.  Most cannabis products contain at least trace amounts of THC, the psychoactive ingredient in cannabis.

NICE said further research was needed to see if CBD can be used to treat fibromyalgia, neuropathy and cancer pain. It recommended that patients suffering from those conditions should only use CBD if they are part of a clinical trial.

One cannabis activist called the NICE guideline “a massive missed opportunity.”

“It is particularly devastating that there is no positive recommendation that the NHS should allow prescribing of whole-plant medical cannabis containing both CBD and THC in appropriate cases of intractable childhood epilepsy,” Millie Hinton, from the patient advocacy group End Our Pain, told The Guardian. “This restrictive guidance is condemning many patients to having to pay for life-transforming medicine privately, to go without, or to consider accessing illegal and unregulated sources.”

According to a recent survey, up to 1.4 million adults in the UK are self-medicating with illegal cannabis products.

The one big winner in the NICE report is GW Pharmaceuticals, the UK based company that developed Epidiolex and Sativex, two cannabis-based medicines that are used to treat childhood epilepsy and muscle spasms caused by multiple sclerosis. NICE had previously rejected Epidiolex because of its high cost, but is now recommending it.

“This is a momentous occasion for UK patients and families who have waited for so many years for rigorously tested, evidenced and regulatory approved cannabis-based medicines to be reimbursed by the NHS,” said Chris Tovey, GW’s Chief Operating Officer. “This is proof that cannabis-based medicines can successfully go through extensive randomised placebo-controlled trials and a rigorous NICE evaluation process to reach patients.”

Last year, the FDA approved the use of Epidiolex in the U.S. to treat seizures caused by two rare forms of childhood epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. The initial list price per patient was $32,500 a year.

Medical cannabis has been approved in 33 U.S. states and Washington DC, but the qualifying conditions vary from state to state. Click here for a list of qualifying conditions in each state.