NEW YORK — If you live with or work with someone who suffers from migraines, there’s something very important you should know: A migraine is not “just a headache,” as many seem to think. Nor is it something most sufferers can simply ignore and get on with their lives.

And if you are a migraine sufferer, there’s something potentially life-changing that you should know: There are now a number of medications available that can either prevent or alleviate many attacks, as well as a newly marketed wearable nerve-stimulating device that can be activated by a smartphone to relieve the pain of a migraine.

Migraine is a neurological disorder characterised by recurrent attacks of severe, often incapacitating headache and dysfunction of the autonomic nervous system, which controls the body’s automatic activities like digestion and breathing. The throbbing or pulsating pain of migraine is often accompanied by nausea and vomiting.

Translation: Migraine is a headache, all right, but with bodywide effects because the brain converses with the rest of the body.

It is often severe enough to exact a devastating toll on someone’s ability to work, interact with others, perform the tasks of daily life or even be in a normal living environment. When in the throes of a migraine attack, sufferers may be unable to tolerate light, noise, smells or even touch.

“There are 47 million people in this country with migraine, and for 6 million, the condition is chronic, which means they have more than 15 headache days a month,” said Dr Stephen Silberstein, a neurologist at Thomas Jefferson University and director of the Jefferson Headache Center in Philadelphia.

Dr David W Dodick, a neurologist at the Mayo Clinic in Scottsdale, Arizona, said: “It’s time to destigmatise migraine and provide sufferers with effective treatment. They’re not fakers, weak individuals who are trying to get out of work.”

In addition to the price paid by individuals with migraines, the cost to employers can be exorbitant.

For example, in a recent survey by the Japanese Headache Society of more than 2,400 workers at Fujitsu, an information technology company based in Tokyo, the productivity of 1 in 5 employees was impaired by migraines, at an estimated cost to the company of nearly 150,000 employees of US$350 million (S$472 million) a year.

For the United States as a whole, the economic burden exacted by migraines is staggering — at least US$11 billion in direct medical and related costs and at least another US$11 billion in indirect costs from the disability it causes, according to Dr Wayne N Burton of Chicago, former global corporate medical director at American Express.

The condition results not only in absenteeism, but also in what specialists call “presenteeism” — people who are at work but unable to function effectively.

A former editor of mine with migraines had to leave the office as soon as he sensed an impending migraine or he would be unable to get home until it resolved.

Though that was decades ago, today there still several reasons migraines are poorly controlled for so many people.

One is a lack of appreciation by both doctors and the public for what it entails, which can discourage patients from seeking treatment. Another is a tendency for migraine sufferers to assume they can or should be able to deal with the problem on their own, either with over-the-counter or prescription drugs.

Resulting from that assumption, Dr Silberstein said, is yet another stumbling block — an abuse of medication, which can actually make the condition worse.

“Half the patients with chronic migraine overuse the treatment based on surveys we’ve done,” he said.

On the other hand, he said, when an attack is imminent, many people wait too long to initiate treatment “because they’re in denial and hope the headache will go away on its own.”

“But the longer you wait,” he added, “the harder it is to get relief.”

But perhaps the main problem is a paucity of medical experts — 580 specialists, or one doctor for every 80,000 people with migraines, who are conversant with the condition and available therapies, Dr Dodick said. Even if patients can find an expert, a lot of insurance plans don’t cover certified headache specialists.

Thus, too often, patients with an excruciating migraine end up in a hospital’s emergency room, which Dr Silberstein called “the worst place to go when you have a migraine, with all the lights, noise, activity and the wait.”

As Dr Dodick said, “The brain amplifies the signals coming in, intensifying the pain and symptoms throughout the body.”

There are four oral drugs in two classes that have been approved by the US Food and Drug Administration for the prevention of migraines: Two anti-seizure drugs and two beta-blockers. In addition, patients with chronic migraines who have symptoms every day or every other day can get injections of Botox.

“Forty percent of people with migraine should be on preventive medication,” Dr Silberstein said, “but only 13 per cent get it. THE NEW YORK TIMES