Millions of migraine sufferers are missing out on drugs that could control their disabling headaches because the condition is massively under-diagnosed and under-treated in Britain, one of the country's leading specialists said.

Only 8 per cent of the estimated 9 million people with migraine in the UK are prescribed medications that can reduce the severity of acute attacks, and still fewer are given preventive drugs that can reduce their frequency, according to Peter Goadsby, Professor of Neurology at University College, London.

This low treatment rate compares extremely poorly with other countries: about a third of sufferers in Sweden are treated, and about 12 to 14 per cent in the United States, he said. A stoical attitude among British migraine patients and a lack of awareness among GPs contribute to the problem, as does the widespread perception that there are few good drugs.

“We under-treat migraine here,” Professor Goadsby said. “It used to be thought that there's no way forward, but the message coming in the last two to three years is that we're vastly under-managing the problem.”

“There is a misconception that migraine means apoplectic and on the floor. There is a big problem with misdiagnosis. If you're a woman and you see your GP, you have only a 60 per cent chance of a correct diagnosis. If you're a man, it's just 50 per cent, as GPs have a concept that it's a women's disease.”

Approximately 15 per cent of the population suffer from migraine, which is by far the most common neurological condition. It is three times more common among women than men, probably because of hormonal factors: it is most prevalent during the female reproductive years.

The headaches that it causes, often accompanied by extreme nausea, vomiting, or sensitivity to light, sound or smell, can be so disabling that it is impossible to work or even to leave a darkened room. A recent study estimated that it costs the economy between £4 billion and £5 billion a year in England alone.

Attacks can vary widely in frequency and severity, but about a third of sufferers have attacks at least three times a month, and just over half of these are reported as severe.

Acute attacks can often be treated with drugs belonging to a class known as triptans, which can reduce both duration and intensity. Patients who suffer frequently can also take one of three classes of preventive drugs - beta-blockers, serotonin antagonists, and anti-convulsants otherwise prescribed for epilepsy.

Professor Goadsby said, however, that both acute and preventive drugs are under-prescribed, because patients often suffer in silence and GPs fail to diagnose them or prescribe correctly. All also have side effects, particularly the preventive options, which are often very poorly tolerated.

“There is quite a disconnect between what's actually happening and what ought to be happening,” he said. “I think about half as many people who ought to be on something are on something.

“It's a range of problems. I think there's a proportion of patients who aren't aware that something could be done - they think ‘mum had these, I've got them, she suffered and no-one could do anything, why would I bother going to see anyone?'

“Then there's the general practice side of it, and the education hasn't got through - academics like myself probably haven't done a good enough job. So there's still quite a lot of not only misdiagnosis, but of ideas that there's little to be done so take quite a nihilistic approach. Even if you decide you want to do something, the options we have in the armamentarium are rather modest.”

At present, the main group of acute drugs are the triptans, which are effective in about 30 per cent of patients. They have the side-effect of constricting blood vessels, however, which can raise the risk of a heart attack or stroke in some susceptible patients.

A new class of drug, known as CGRP-inhibitors, has recently been developed, which does not have this side effect. One of these, known as MK0974, produced by Merck, has recently had very promising results in phase-two clinical trials. These have suggested that it is much more effective than both triptans and a placebo.

After two hours, 45 per cent of those tested were pain-free, compared with 14 per cent on a placebo and 32 to 33 per cent on a triptan. After 24 hours, 40 per cent were pain-free, compared with 11 per cent on placebo, and between 18 and 32 per cent on triptans.

The results of phase-three clinical trials are expected to be announced in two weeks' time at the American Headache Society's annual conference.

Another approach to prevention is a new class of drugs called gap-junction blockers, one of which, Tonabersat, is currently in phase-two clinical trials.

“If the studies are suitably positive it would be a step change, it would provide increased understanding and better therapy,” Professor Goadsby said.

“Existing preventive drugs are poorly tolerated, but work in about half of patients, reducing attack frequency by about 50 per cent. We are looking for something that's effective, but at a tolerability that's acceptable.”

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