Meet The Expert

Dr Joshua M. Cohen, Global Medical Therapeutic Area Lead for Migraine and Headache

“I live with migraine so this is personal for me”

Migraine is not just a headache. This is probably the biggest misconception I come across when speaking with people about this disease. In reality, it’s a complex and often debilitating neurological condition that can have a huge impact on someone’s life. It can cause severe head pain, nausea, vomiting and extreme sensitivity to light, sound, touch and smell.

The statistics on migraine are staggering. Most people I speak with have no idea that migraine is the world’s third most common disease (behind dental caries and tension-type headache) that affects more than one billion people[1]. According to the World Health organisation, it is the second leading cause of years lived with disability worldwide[2], and the leading cause in people age 15-49[3]. Women are three times more likely to experience migraine than men[4]. The disease has an enormous economic impact too, costing the U.S. and European economies nearly $200 billion a year[5]. So it’s worth repeating: migraine is not just a headache.

I live with migraine so this is personal for me. The disease hit me hard when I was doing my medical training in New York, and I was having up to 10 attacks a month. I would try to carry on working but kept vomiting. We only had eight people in my residency class, so if I was unable to work it was a significant burden for everyone else to make up for me. Thankfully, I’ve started on a medication which has dramatically reduced my frequency of attacks.

My fascination with the brain stretches back to childhood and is part of the reason I became a neurologist. Before I joined Teva, I saw first-hand the scale of migraine and the impact it has on patients and their loved ones. There were so few treatments available at the time.

I found clinical practice very frustrating at times because my tools were so limited. I saw so many patients who were suffering but I could not help. This is the reason why I changed career paths. I wanted to move in to an area where I could help find solutions to the problems patients were facing. This ultimately led me to join Teva as a Medical Director in the Migraine and Headache Therapeutic Area.

There is still a stigma attached to migraine. I’ve met thousands of patients who suffer from the disease and a recurring theme is that they feel others see them as being lazy or exaggerating their symptoms, rather than suffering from a horrible disease that can be totally debilitating. People don’t understand that more than 90% of people with migraine are unable to work or function normally during a migraine attack[6].

Educating people about migraine is now a big part of my job. There is no doubt that advances in treatment have been made in recent years. However, migraine is still an underfunded disease and the impact it has on people is often not understood by decision makers and wider society. To combat this, I’m usually out and about talking to physicians, meeting with advocacy groups and speaking at events and conferences. I also help with researching the impact of migraine on society, such as how it affects people’s productivity. 

We still don’t fully understand what causes migraine. Despite recent advances in our understanding of the disease, so much more is needed to better understand it and the impact that it has. In the U.S., the funding for migraine research in 2017 was only half a dollar per person living with migraine[7].

That said, the industry as a whole has made advances in the last few years. It’s gratifying to see how this is helping patients. For example, a former patient I spoke to recently has had migraine attacks almost every day for nearly 40 years. She is now on a new course of treatment which has significantly reduced the frequency of her attacks, allowing her the exciting opportunity to apply for jobs and launch a career. Her daughter’s wedding is coming up and she is looking forward to planning it and going dress shopping. As I had watched her struggle for so long, this change was incredibly moving. However, we’re still far from where we need to be.  My task at Teva is to ensure we continue to explore new ways to bring better days to people living with migraine.

 

[1] Steiner TJ et al. Migraine: the seventh disabler. The Journal of Headache and Pain 2013, 14:1.

[2] Steiner TJ et al. Migraine: the seventh disabler. The Journal of Headache and Pain 2013, 14:1.

[3] Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice?. J Headache Pain. 2018;19(1):17.

[4] World Health Organization. Atlas of headache disorders and resources in the world 2011.

[5] Gooch CL et al. The Burden of Neurological Disease in the United States: A Summary Report and Call to Action, Ann Neurol (81(4): pp479-84, 2017, and Linde M et all, The Cost of Headache Disorders in Europe: The Eurolight Project, Eur J Neurol 19(5): pp 703-11, 2012.

[6] https://migraineresearchfoundation.org/about-migraine/migraine-facts/

[7] https://migraineresearchfoundation.org/about-migraine/migraine-facts/