Infraestructura de Medicina de Precisión asociada a la Ciencia y la Tecnología
Chronic migraine (CM) has a prevalence of 1-2% in the general population, even higher in women and those of working age. CM is usually the result of a transformation in an episodic way, but so far the possibility of reversing the process is low, without individual data from the different disciplines having been shown to be good predictors of this chronification-dechronification process.
The main objective of this project is to establish a personalized and targeted therapeutic strategy that reduces the socioeconomic impact of migraine through predictive tools that allow a reduction in its chronification. To this end, two fundamental lines of action are proposed:
With all this, the aim is to achieve a reduction in the impact of the disease on the patient’s quality of life and its costs, both direct (medical visits, complementary studies, hospitalization, futile treatments) and indirect (high rate of presenteeism and absenteeism) estimated at two billion euros per year for migraine in our country.
The main objective of the project is to establish a personalized and targeted therapeutic strategy that reduces the impact of migraine through a reduction in its chronification.
To this end, two specific objectives are proposed:
Predict migraine attacks. Early diagnosis and treatment of migraine attacks in patients with high-frequency episodic migraine. This would be achieved through a wearable device and a mobile application in real time with monitoring of biometric variables and clinical aspects of pain crises (triggers, prodromal symptoms, pain intensity and other characteristics).
To predict response to initial and sustained treatment to anti-CGRP monoclonal antibodies in patients with high-frequency episodic migraine and chronic migraine through machine-learning tools.
Migraine is a disabling neurological disease, with a high impact on health systems as it represents a high economic and social burden. In Spain, it affects more than 5 million people. More than 50% of migraine patients have severe or very severe disability, and in patients with chronic migraine the rates of very severe disability reach almost 70%. The group with the greatest disability is 16-47 years old. Migraine is also a disease with a high functional and emotional impact, in which more than 80% of patients have missed social and/or family events due to the disease, even greater in the subgroup of patients with at least two therapeutic failures. In addition, migraine has a very significant effect on presenteeism and absenteeism from work, with a decrease in work productivity from 4 migraine days per month, so it can occur in a large percentage of patients with CM.
Headache accounts for 1 in 5 consultations to a Neurology service, which has been estimated at about 14,000 new consultations per month in Spain. Specifically, migraine consultations account for more than 50% of the first consultations in a Neurology service and more than 80% of referrals to Headache Units are due to cases of chronic or frequent migraine.
The burden of a disease is estimated in disability-adjusted life years (DALYs), which are measured as the sum of years of life lost to premature death (YLLs) and years lived with disability (YLDs). Thus, in migraine, DALYs are equal to YLDs. In 2016, a migraine burden in Spain was estimated at 405,466 YLDs, which accounted for 5.6% of all YLDs (6.8% in women and 4.8% in men). In women between the ages of 15-49, migraine caused 20.3 million YLDs. In the case of ME, the average total economic cost per year is €5,041 per patient, and in CM this cost rises to €12,922 per patient, of which 93% would correspond to indirect costs (2/3 due to reduced productivity).
The treatment of migraine must be personalized and, in many cases, it can and should evolve over time. More than 40% of patients with migraine are undiagnosed, which has a direct impact on the risk of chronification due to misuse of medication. It has been estimated that 50% of patients self-medicate with over-the-counter painkillers and that only 17% use correct medication for the treatment of migraine attacks.
Acute treatment is necessary in all patients with migraine, and should be adapted to the characteristics of the patient, their seizures and degree of disability. The goals of acute treatment are: rapid and persistent relief of pain and associated symptoms; prevent their reappearance; recover functionality; and to optimize patient self-care and reduce the use of health resources (emergency room visits and hospital admissions). Suboptimal acute treatment can lead to increased migraine-related disability and disease progression. The way to assess the effectiveness of the treatment is usually through the interview in the consultation with a calendar. The use of online calendars has proven to be a very useful tool insofar as they facilitate daily access, are available at the time of consultation and can also offer evolutions, summaries and/or statistics.
For some patients, preventive treatment of migraine can reduce the frequency and severity of attacks. However, preventive treatment for migraine is underused: only 1 in 3 candidate migraine patients receive it. Current oral preventive treatments are associated with poor patient adherence and high rates of treatment change and discontinuation. Among the most common causes of discontinuation are loss of efficacy, adverse effects and lack of tolerability, which represents higher direct costs associated with the use of health resources.
All this reflects that migraine has a direct and indirect effect on the lives of patients who suffer from it, who suffer significant uncertainty about when the pain will occur and about the effectiveness or not of the treatment prescribed to them, which is often poorly tolerated. The main objectives of this project are to be able to predict pain crises and to be able to know the expected effectiveness of a treatment designed specifically for migraine such as anti-CGRP monoclonal antibodies.
With this, the project will have a positive impact on several levels: