Migraine is frequently misunderstood not only by the general public, but by those with migraine and even those in the medical community.
For over a century migraine has been blamed on the patient and yet despite the advancement of information and technology, dangerous and suprising migraine myths are still widespread.
Unfortunately many of these myths are still, even today, reported in the media. This perpetuates further misinformation which is often believed by loved ones, friends, co-workers and even the patient themselves.
Dr Joel Saper MD, FAAN, Founder and Director of Michigan Headache & Neurological Institute said:
“There is no condition of such magnitude that is as shrouded in myth, misinformation, and mistreatment as is this condition, and there are few conditions which are as disabling during the acute attack.”[i]
If we are to promote the effective management of migraine then these myths must be dispelled.
To make progress, we need the facts not just to improve our own condition but to reduce the societal stigma and judgment that so many endure as an additional burden to migraine.
MYTH: Migraine is caused by psychological factors like stress or depression
REALITY: Migraine is a neurological disease
Migraine is classified as a neurological disease which is very different to a psychological disorder. [ii]
Psychological disorders refer to conditions like depression or anxiety.
Migraine on the other hand results from a physiological dysfunction and sensitisation to external stimuli stemming from the nervous system. When triggered, a cascade of events lead to the symptoms experienced by those with migraine including moderate to severe head pain, nausea, vomiting and sensitivity to light and sound amongst other things.
Dr Saper confirms that migraine “is not a psychological or psychiatric disease but one which results from biological and physiological alterations.” (i)
Furthermore, the late Dr Fred D Sheftell, Founder of the New England Center for Headache states that:
"Migraine is absolutely a biologically-based disorder with the same validity as other medical disorders including hypertension, angina, asthma, epilepsy, etc. Unfortunately, there have been many myths perpetrated in regard to this disorder. The most destructive of which are 'It is all in your head,' 'You have to learn to live with it,' and 'Stress is the major cause."(i)
Migraine itself can be a terribly difficult, progressive and chronic disease that can devastate families, jobs, careers and the quality of life for those with frequent or severe attacks.
It’s perhaps not surprising to learn that a significant proportion of those with migraine may also experience anxiety and or depression.[iii] After several years of unsuccessful treatments or consultations, it can be difficult not to lose hope with chronic migraine.
The danger comes when migraine is misdiagnosed as a psychological disorder.
A doctor with this diagnosis may prescribe unnecessary and even counterproductive medication. For example if a doctor may prescribes specific drugs to treat clinical depression the underlying migraine condition remains unchanged. With no reduction in migraine attacks the patient may continue with depression and appear ‘unresponsive’ to the dose or treatment. This can lead to an increase in dose or further medication.
Whilst it’s important for patients and their families to be aware of this distinction. It is critical that healthcare professionals get this diagnosis correct.
You might think it’s safe to assume that most doctors are adequately trained to recognise, diagnose and treat migraine. You'd be wrong.
This leads to the second dangerous migraine myth...
MYTH: Any doctor can recognise and properly treat migraine
REALITY: Research has shown that as few as 1 in 20 with chronic migraine receive an appropriate diagnosis and treatment from a physician.
The International Classification of Headache Disorders most recent revision (3-beta) define chronic migraine as headaches on at least 15 days per month for at least 3 months, with the features of migraine on at least 8 days per month.[v]
There are millions of people who suffer chronic migraine. But there are even more that experience episodic migraine who have less frequent attacks. Lets start with their experience...
The number of people with episodic migraine who visit the doctor, receive an accurate diagnosis and an appropriate treatment is just 26%.[iv]
That’s no mistake. Around one in four people are ticking those three boxes.
The same research revealed that if you visit your doctor for migraine, only 58% (just over half) would receive an appropriate diagnosis and minimally effective treatment.
A minimally effective treatment is classified as any guideline recommended treatment for acute migraine.
These stats are relevant only for those with episodic migraine.
What about chronic migraine?
The result? Around 5% of patients with chronic migraine traverse all three criteria for minimally effective chronic migraine treatment & diagnosis according to the research lead and headache specialist Dr Richard B Lipton.
The days when you can confidently walk into your doctors office to get an accurate diagnosis and minimally effective treatment for chronic migraine have not yet arrived.
We are still decades behind other health conditions in the overall quality of care delivered.
MYTH: Migraine is just something you have to live with
REALITY: There are many effective treatments & strategies to reduce the severity and frequency of migraine
It is true that there is not a universal cure to fix your migraine condition. That being said, there are effective treatments, therapies, procedures, behavioral and lifestyle changes, strategies and approaches with can lead to significant reductions in migraine frequency and severity.
Most doctors would consider an effective treatment to reduce the either the severity or frequency of migraine attacks by 50% or more. Studies have found reductions of closer to 80% during clinical trials when combining several effective approaches together.
This is another dangerous migraine myth that underscores the importance of each individual with migraine to be self aware, with a firm grasp of the facts and mechanics of migraine to ensure they receive adequate treatment and effective management strategies.
MYTH: Migraines aren’t life-threatening
REALITY: Migraine has led to deaths
Migraine has induced conditions such as stroke, coma, aneurysms, permanent vision loss and even death.
According to Michael Coleman and Terri Burchfield at MAGNUM:
“Twenty-seven percent of all strokes suffered by persons under the age of 45 are caused by migraine”. (i)
Stroke is the forth leading cause of death in the United States.[vi]
Before you to worry it helps to understand these number in perspective.
For the general population, research found the annual death rate from stroke was 175 per 100,000. Or 0.18%.[vii]
A meta analysis study of stroke and migraine research found that the range of stroke in those with migraine varied from 3.56 to 350 cases per 100,000.[viii] Researchers concluded that the relative risk of stroke for someone with migraine is 2.16. A 'relative risk' of 2.16 means that you’re around twice as likely with migraine to experience stroke than the average person without migraine.
So if the risk is 0.18% for the general population. Then it’s 0.36% for those with migraine.
This might be higher than what you expect but there is still a 99.64% chance you’re in the clear. Most people who are familiar with statistics would agree that this is a comfortable risk.
There are certain groups however with higher risk. For migraine with aura the relative risk increased to 2.27. For migraine without aura, the relative risk decreased to 1.83.
One of the biggest risks comes to those who take oral contraceptives. Case controlled studies showing an relative risk of 8.72. That’s almost a nine fold increase in risk to the general population. If you have migraine, you may want to reconsider oral contraceptives.
Other factors can also have a significant affect on your risk include smoking, previous family history of stroke, hypertension, high blood pressure, unhealthy lifestyle etc.
If you are concerned about these risk factors you should speak to your healthcare professional and minimise your risk where possible i.e. quit smoking and oral contraceptives.
Migraine is also associated with suicide.
One study reported a three fold increase in the suicide rate from those with migraine compared to the general population. [ix]
Migraine can have a devastating impact on normal living for an individual. Not only do they experience extreme pain and disability during attacks, but they also face social ostracism, isolation, job loss, strained personal relationships and discrimination.
Others can be quick to judge those with migraine as people who “can’t handle life” or who are drug addicts which is dangerously wrong.
One of the world's top headache specialists Dr Stephen Silberstein confirms that those with migraine:
“Must not only cope with their pain, but also with society's misunderstanding of the disorder. Migraineurs are frequently dismissed as neurotic complainers who are unable to handle stress. The truth is that they frequently battle against great odds in order to hold down jobs and support families…” (i)
The more people we, our physicians and the general public understand this, the quicker we can progress to finding better treatment and reducing the stigma of this disabling condition.
Have you experienced discrimination or stigma because of migraine? Let me know in the comments.
Author: Carl Cincinnato is the founder of MigrainePal, a website and community for those looking for medically referenced and reliable facts about migraine. Carl has had migraines for 25 years including 7 years of chronic migraine. Today, he is in remission and recently hosted the Migraine World Summit to help others to better understand their migraines & improve their condition.
[i] Migraines: Myth vs Reality. MAGNUM. http://www.migraines.org/myth/mythreal.htm Accessed June 28 2016.
[ii] Steiner, T. J., et al. "The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity." Cephalalgia 23.7 (2003): 519-527.
[iii] Lipton, R. B., et al. "Migraine, quality of life, and depression A population-based case–control study." Neurology 55.5 (2000): 629-635.
[iv] Lipton, Richard B., et al. "Barriers to the diagnosis and treatment of migraine: effects of sex, income, and headache features." Headache: The Journal of Head and Face Pain 53.1 (2013): 81-92.
[v] Headache Classification Committee of the International Headache Society (IHS. "The international classification of headache disorders, (beta version)." Cephalalgia 33.9 (2013): 629-808.
[vi] Towfighi, Amytis, and Jeffrey L. Saver. "Stroke declines from third to fourth leading cause of death in the United States historical perspective and challenges ahead." Stroke 42.8 (2011): 2351-2355.
[vii] MacClellan, Leah R., et al. "Probable migraine with visual aura and risk of ischemic stroke the stroke prevention in young women study." Stroke 38.9 (2007): 2438-2445.
[viii] Etminan, Mahyar, et al. "Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies." Bmj 330.7482 (2005): 63.
[ix] Breslau, Naomi, Glenn C. Davis, and Patricia Andreski. "Migraine, psychiatric disorders, and suicide attempts: an epidemiologic study of young adults." Psychiatry research 37.1 (1991): 11-23.