“The headache is not all of me, it’s a part of me.” The blonde girl who smiles, and, looking straight in the room and pronounces this sentence in the documentary A life in halfjust presented at the Venice Film Festival, contains in a nutshell the most intimate and cruel nature of Embranilian: an almost invisible and not understood disease, which is isolating from the world and is capable of invading, literally, the life of those who suffer from it.
Neurological pathology that affects beyond 6 million Italians And it is – according to the WHO – among the main causes of disability under fifty years, is not a “banal headache”, but an enemy who forces to close at home, turn off the light, to give up entire working days, relationships, projects. Even today it is accompanied by prejudices, distrust and misunderstanding, and those who suffer from it is often perceived only as a lazy person, who exaggerates the symptoms looking for an excuse not to work or not to get out of bed.
The revolution in care
Until just a short time ago, the available care were limited, more than anything else, to symptomatic and pain -relieving remedies to be administered at the time of the attack, hoping they worked. Now, however, something is really changing. “We are in a moment of authentic” epochal jump “: today we have therapies that are used both to prevent the attack of migraine and to turn it off, and this is an absolute novelty,” Professor tells Panorama Piero Barbantiprofessor of neurology at the San Raffaele University of Rome and member of the board of the International Headache Society (IHS), an international scientific organization dedicated to the study and care of headaches.
“The new drugs work on patients much better than in clinical studies, which in medicine happens very rarely: to make a simple example, it is as if I buy a car that should make 10 kilometers per liter and then using it I have the beautiful surprise that makes more than 20. For the sick, the moment of the turning point has finally arrived”.
The protagonists of this revolution are of two categories: on the one hand the Monoclonal antibodieswhich are administered by injection, and on the other i gepantitablets to be taken by mouth. Both strikes-obviously in different ways-the same target, namely the CGRP circuit (Calcitonin Gene-Related Peptide), neuro peptide that is “freed” during the attack and causes inflammation and vasodilation. “It is a sort of switch that lights up migraine pain,” continues Barbanti. “Gepanti and antibodies act on different tracks but get the same result: whether you” turn off “the plug or the grip, the circuit does not work anymore and the pain disappears”.
Results and new drugs
The results are impressive. As for monoclonal antibodies, in the Italian registers – which today make international literature – it is observed that after a year the 91.3 percent of patients He replies to therapy: where to respond means at least halving the days of headaches, which in the sick can even reach 15 or 20 per month.
For its part, the new drug rhymepant That only a few days have been rendered refundable, and is produced by Pfizer (Nurtec and Vydura commercial name) has revealed powers – if possible – still superior, because it can be used as a preventive therapy. “It is like a coin with which, whether it comes out head or cross, always win,” continues Barbanti. «If it is used during the attack, it turns it off: if it is used as chronic therapy, and then taking it on alternate days throughout the month, prevents the onset of the crises, arriving to halve them. Which for a patient who perhaps has ten attacks a month is a real change of perspective of life. We can define it the first “double face” drug of recent history ».
The weight on the health system
And of course we do not only speak of the quality of life of the patients, but also of the estate of the National Health Servicebecause the days of migraine have a not indifferent weight also on the emergency departments, on the hospitalizations and the waiting lists of the exams.
“Those who have to face an attack and cannot calm the pain with the remedies it has available, often shows up in the emergency room,” he explains Alessandro Riccardipresident of Simeu (Italian emergency emergency society). “They are patients who have been vomiting for hours because of pain and they are also dehydrated, or who have waited too much, hoping that the pain would pass, and therefore need strong intravenous therapies with hospital drugs: only in the emergency departments can they find a suitable response”.
The problem is that often, precisely on these patients who are also young people many times, one ends up exercising an excessive defensive medicine. Because in front of a very intense micranium, the doctor with little experience, the specializing or the pseudo-runtonist on loan that perhaps has to do only one round, prefers to immediately make a CT scan or maybe even a resonance, and “get safe” from any problems.
«However, this can make damage to the patient: remember that a single brain Tac” weighs “as number of radiation as about 40 chest radiographs. It should be avoided if not in the event of high clinical risk, and certainly should not be carried out for a known and already diagnosed migraine, “says Riccardi. «But not only. This excess of exams will negatively affect the whole system, going to swallow the waiting lists and to extend the times for patients who actually need. It is like a dog who bites his tail ».
Costs and access to care
The fact of finally having an effective therapy that allows you to prevent attacks therefore has a huge positive relapse, which goes beyond the “small world” of the single patient. And here we come, however, to the painful notes: the costs. A single tablet of the new “Double Face” Rimagepant Medicine Costa 33 euros: having to take it one day yes and one day no, to prevent the crises the patient would spend 500 euros per month.
In fact, precisely because of the huge costs, the drug has so far never been used by the sick. But now it has been rendered refundable, without any tickets, both for the acute attack and for preventive therapy: but, according to the rules of the Italian drug agency, it can only be prescribed to those patients who have not received benefits from at least Three classes of first -line drugs (NSAIDs, Triptani, anti -epileptic, antidepressants, betabloccants, etc.) and which, however, often have very high side effects: while these new molecules have very few.
This skimming of the sick, of course, creates very discontent. “The knot of access to new therapies so effective is really crucial,” he says Alessandra Sorrentinopresident of the Cefalalgical Alleanza Association (Al.ce). «The fact of being able to obtain them only after having failed three previous therapies means losing at least one and a half years. It is a paradox: we know that the new drugs are effective and have few side effects, but we sick still have to wait, suffer and get worse. It is true that we are talking about significant expenses, but we should consider it an investment, because preventing chronicity means lightening the health service. Today, however, the system pretends not to see ».
The economic impact
Aside health service, in Italy the overall weight of the disease has been estimated – by the most recent studies – in about 20 billion euros per year.
Most of this economic damage is due to the loss of productivity, not only to absenteeism but also to presentism: those suffering from migraine, in fact, often go to work, to avoid the stigma of colleagues and superior, but obviously it cannot make as it should.
“Migraine is an obstacle that must be skipped, and then continues its race,” says the rowing Olympian Matteo Sartori23 years old, one of the protagonists of the documentary presented in Venice. Today that race can really start again: we have weapons to fight migraine, we only hope that the Italian bureaucracy Don’t ideas.
