Suppose you suffer from debilitating, chronic headaches. In that case, you’re far from alone. According to the American Migraine Foundation (AMF), at least 39 million people in the United States live with migraine. That’s more than the number of Americans who have diabetes and asthma—combined.
Migraine symptoms aren’t just a hassle; they can have a severe impact on your quality of life. Migraine can cause severe, throbbing pain, usually on one side of the head, and may be accompanied by nausea, vomiting, and extreme sensitivity to sound and light.
Migraine attacks can come on suddenly and last for hours or sometimes days, derailing your ability to perform at work and fulfill other obligations, like taking care of your family.
After all, you suddenly have to cancel plans or disrupt your holidays because you’re stuck in bed. You may be fearful of drinking a glass of wine lest it triggers another attack. And it can be even more disheartening if a doctor doesn’t take your pain seriously or can’t provide you with sufficient relief.
Unfortunately, treatment can also be subpar for many people with migraine, which only adds to their ongoing impact. Currently, there is no cure for migraine; there are only medications that either help lessen the number of attacks you have or take during an attack.
In 2021, Mable conducted a research study in the United Kingdom on the effectiveness of treatment for 700 people with migraine. Researchers found that a whopping 70 percent were on the wrong drug - meaning a drug that was likely to cause side effects for them or not to reduce the pain effectively.
People have been suffering from migraine for thousands of years, according to the AMF. But the condition has been historically minimized, and funding for research has been insufficient.
People who don’t have migraine often trivialize it as unimportant or just a typical headache. Because of this, people with migraine may feel compelled to downplay their symptoms for fear of jeopardizing their employment or other vital roles in their lives. People have been suffering from migraine for thousands of years, according to the AMF. But the condition has been historically minimized, and funding for research has been insufficient.
Also, migraine affects women more than men—and women’s pain is sometimes not taken seriously by doctors due to gender bias. In 2018, women were twice as likely as men to experience a migraine, according to the Centers for Disease Control and Prevention.
A March 2021 study published in the Journal of Pain found that when men and women reported the same level of pain, observers viewed female patients' pain as less intense and more likely to benefit from psychotherapy instead of medication as opposed to men's pain, which could lead to significant disparities in treatment.
In addition, current treatment options aren't satisfactory, partly because migraine research has been limited and under-funded. Migraine requires more research to understand the genetics and biology of migraine so that treatment can be better targeted to individuals and new drugs can be developed, according to the AMF.
They often allocate funding for medical research towards fatal conditions at the expense of other chronic health conditions, like migraine. “Migraine doesn’t kill you” is a dismissive statement many people and researchers with the condition have heard.
Doctors rarely understand migraine despite its impact and prevalence, and treatment is often a hit-or-miss process. “About 80 percent of migraine patients are currently handled in primary care,” says Roman Rothaermel, PhD, co-founder and Chief Executive Officer of Mable. “There's a system failure to educate [primary care] doctors about how to diagnose migraine correctly—and how do you treat something you haven’t diagnosed? ”
Primary care doctors often learn little about migraine when attending medical school. It may not teach them much except to ask about symptoms and prescribe specific treatments that usually won’t work to a person’s satisfaction, according to Dr. Rothaermel.
And although there are headache specialists who have advanced training on how to treat migraine, there aren’t many of them—only 580 migraine specialists in the US, according to Carolyn Bernstein, MD, FAHS, a neurologist who specializes in headache medicine at Osher Center for Integrative Medicine at Harvard Medical School and Brigham and Women's Hospital in Boston. This means you probably have to wait months—or even close to a year—to get in to see a headache specialist.
Suppose you’re like most people and see a PCP to diagnose and treat your migraine. In that case, they may prescribe you a particular medication because it’s familiar or because they’ve prescribed it to other patients before. Then you’ll need to take the drug for several months to see if it will help you or not.
Migraine treatments can come with side effects that don’t make them workable for some people to take, such as fatigue. If a particular treatment doesn’t work, your doctor will essentially be back at square one to prescribe you something else.
But even if you can see a headache specialist, they can be limited in how tailored they can make your treatment. Although headache specialists will look at factors like migraine frequency, how severe they are, and how much they affect your life, specialists don't have a quantifiable way to measure the effects of treatment on you. So treatment can still be a guessing game as you wait months to test out a particular drug’s effectiveness for you.
The most significant advance in migraine care over the last few decades came in 2018 when a more targeted drug class called anti-CGRP (calcitonin gene-related peptide) treatment was the first drug approved by the Food and Drug Administration (FDA) specifically to treat migraine.
CGRP is a protein known to cause migraines. These drugs are not only more effective but come with fewer side effects. However, it can take some work to get them prescribed, and they can cost $600 a month, with varying insurance coverage.
Mable was formed because of the expertise of migraine researchers, specialists, and geneticists, who recognized the challenges many people with migraine face and how the current healthcare system fails to provide them with relief.
Telemedicine has become increasingly popular because of the COVID-19 pandemic, and migraine care is no exception. A May 2021 study published in the journal Headache found that telemedicine can improve access to headache medicine specialists and PCPs and results in high patient satisfaction rates.
Mable uses telehealth to provide clients with timely, at-home access to headache specialists who can review their profiles and prescribe treatments that are far more likely to work for them.
Mable asks you to fill out an online questionnaire about your migraines and mails you a DNA test to provide you with the most personalized treatment options possible. After you return the test, the company offers you a medication plan based not just on the latest in clinical advances but also on the DNA test results.
The DNA test can show which medications are most likely to help you while causing the fewest side effects—a burgeoning new field of medicine called pharmacogenetics, which is being used to more effectively tailor treatments for several health conditions, including depression and certain cancers.
In Mable’s study of people with migraine in the United Kingdom, when the clients followed the company's recommendations, they reported 80 percent high treatment effectiveness—showing a 55 percent reduction in pain, versus 35 percent for people who were on the wrong drug.
Also, the Mable care team can send you this medication in your mail and will follow up with you to see how well the treatment is working. This means your care is just better and even more personalized over time.
This model is unique in the migraine treatment space because no other company combines pharmacogenetic reports, virtual care, and an online pharmacy into one convenient, one-stop-shop for people with migraine.
The result is faster, better, more convenient, and more effective migraine treatment. Virtual visits with Mable specialists might be covered by health insurance, just as any other telemedicine appointment usually is.
If you’re ready to get started with better, more accessible care for your migraines, take the Mable quiz
1. American Migraine Foundation, What Is Migraine? https://americanmigrainefoundation.org/resource-library/what-is-migraine/
2. American Migraine Foundation, Migraine – Where We Are and Where We Are Going. https://americanmigrainefoundation.org/resource-library/migraine-where-we-are-and-where-we-are-going/
3. Interview with Dr. Roman Rothaermel, CEO of Mable
4. Centers for Disease Control and Prevention, Quick Stats: Percentage* of Adults Who Had a Severe Headache or Migraine in the Past 3 Months, by Sex and Age Group — National Health Interview Survey, United States, 2018.” https://www.cdc.gov/mmwr/volumes/69/wr/mm6912a8.htm
5. Zhang, L., Losin, E., Ashar, Y., Koban, L. and Wager, T., 2022. Gender Biases in Estimation of Others’ Pain. U.S. Association for the Study of Pain. https://www.jpain.org/article/S1526-5900(21)00035-3/fulltext
6. Interview with Dr. Carolyn Bernstein, headache specialist and advisor at Mable
7. Migraine Trust, Calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies. https://migrainetrust.org/live-with-migraine/healthcare/treatments/calcitonin-gene-related-peptide-monoclonal-antibodies/
8. Chiang CC, Halker Singh R, Lalvani N, et al. Patient experience of telemedicine for headache care during the COVID-19 pandemic: An American Migraine Foundation survey study. Headache. 2021;61(5):734-739. https://pubmed.ncbi.nlm.nih.gov/34021595/
9. New Migraine Treatment: Anti-CGRP Therapy and Hw It Works. https://www.trymable.com/blog/anti-cgrp-treatment-options
10. Photo by Patrick Schneider on Unsplash