Italy one of the first countries to recognize migraine as a disease with a social impact
The Italian senate recently laid a historic milestone when it approved legislation recognizing chronic primary headache,* including migraine, as a disease with a social impact. This decision sets a precedent in Italian healthcare of political action as a significant step towards greater understanding and improvement of care for people with this condition.
Migraine affects at least 11.6% of Italy’s population and is three times more prevalent in women than in men (~15% versus ~5%). It is estimated that ~3% of people with migraine go on to develop chronic migraine, a more severe and disabling form of the disease. Furthermore, waiting lists to visit headache centres in Italy average three months, according to a nationwide migraine patient survey. 1
In this blog post, we spoke to prominent members of the migraine community—Lara Merighi, Director at Cirna Onlus Foundation; Dr. Gianluca Coppola, Senior Researcher at Sapienza University of Rome; and Elena Ruiz de la Torre, Executive Director at European Migraine &
Headache Alliance—to better understand the significance of this ground-breaking Italian law and its potential impact on people with chronic migraine and healthcare systems on a global scale.
"The recognition of chronic migraine as a disease with a social impact has given us visibility."
Lara Merighi
Migraine sufferers have often endured attacks from a very young age, when they start to hide their pain due to the lack of understanding they experience from people. This is particularly the case in those with chronic migraine.
The new Italian law allows people with chronic migraine to be respected in their own right, giving them a type of visibility that hasn’t been available before. This recognition is the beginning of a positive change in the migraine care landscape, providing a significant step towards overcoming the challenges people with the disease endure every day.
So, what’s next? With a law of recognition now in place in Italy, we can begin to look to the future and see how to make an even greater impact. This change starts with education.
Education, at every level, will be the catalyst for change. With greater understanding of the condition, other measures will begin to be prioritised. This includes better access to care and psychological support, longer medical consultations and timely rescheduling to allow for appointment cancellations due to an attack, and a system to properly measure migraine severity. Putting these provisions in place would allow for a much more straightforward and structured patient care pathway in the migraine landscape. Learn more here.
Migraine is no longer overlooked in Italy. With the Italian government now recognising the severity of migraine on a national scale, changes can soon begin to facilitate greater patient care for migraine and push towards a brighter future.
"Healthcare systems that ultimately strive to improve the patient’s quality of life"
Dr. Gianluca Coppola
This law will trigger the identification and testing of new ways for optimal patient care, which implies the inclusion of the treatment for chronic migraine and other chronic primary headaches in the Livelli Essenziali di Assistenza (essential level of care, LEA), meaning that the disease would be part of defined care pathways 2 and patients would be exempt from healthcare co-payments. Of course, to come into practice, this requires changes in the evaluation of headache as a disability, according to the most up-to-date diagnostic criteria from the International Headache Society.
Once these steps have taken place, physicians will be able to provide more individualized diagnostic and treatment pathways. Patients will have free or reduced-cost access to specialized diagnostic procedures, and to innovative and potentially costly drug treatments, which have the potential to improve work-productivity in people with migraine and enable them to continue working. 3 Additionally, they will be able to take advantage of certifications designed to improve their quality of life at work, enabling them to request special work schedules, as well as exemptions from tasks that may trigger or aggravate migraine pain.
Ultimately, the goal is to improve the patient's quality of life.
"Italian law highlights the need for more, including actions at EU level."
Elena Ruiz de la Torre
The Italian law demonstrates that policy makers are beginning to understand the severity of chronic migraine, but also highlights the ongoing need for more—more action, more change, and above all, more respect. Efficient and accurate acute and preventative migraine treatment should now be the existing standard of care, and not simply a dream for the future.
Without prioritization in government policy, people with chronic migraine are left without the ability to live a normal life. Economic burdens and delayed treatment rob them of their chance to participate, creating a devastating public health challenge that needs to be addressed.
Political support and prioritization of migraine remains crucial to fill the gaps that still exist in the migraine care pathway and prevent patients from achieving optimal and timely support from healthcare services.
At EU level specifically, here are some of the actions that can improve migraine care: 4
Make migraine a priority so that it can be incorporated into the European Commission’s work on gender equality, education, demographic change, disability and pharmaceutical strategy
Provide greater funding into research for migraine to better inform policies and public knowledge of migraine care
Strengthen the Migraine Alliance’s presence in European Parliament and integrate migraine into the European health agenda
Include migraine in the delivery of the European Pillar of Social Rights and the European Semester
Combat discrimination in the workplace by ensuring that the Work-Life Balance Directive has a significantly positive impact on people with migraine
This milestone in Italian law sheds light on the challenges facing people with migraine in countries that are yet to give it the recognition it deserves. By following Italy’s lead, countries across the world need to begin advocating for stronger migraine care in government policy to overcome the stigmas that surround it. Recognising chronic migraine as a disease is the first step to creating the framework that supports the migraine care pathway needs.
The time for meaningful change is now.
*Chronic primary headache includes high-frequency and chronic migraine, medication-overuse headache, chronic cluster headache, chronic paroxysmal hemicrania, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), and hemicrania continua.
References
‘Vivere con l’Emicrania’. CENSIS 2019.
‘Inclusion of some highly disabling primary headaches among the essential levels of assistance (LEA): the letter-appeal of the Cephalalgia Alliance-CIRNA Onlus Foundation’. Cefalea (2017). Available at: https://www.cefalea.it/sezione-blog/inserimento-cefalee-primarie-lea.html. Last accessed February 2021
Burton WN et al. Mayo Clin Proc 2009.
Elena Ruiz de la Torre, ‘Migraine in Europe: Time to Act Now!’, European Migraine & Headache Alliance (2020). Available at: https://www.emhalliance.org/wp-content/uploads/2020/09/EMHA-Call-to-Action-Final.pdf. Last accessed February 2021
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