The International Classification of Headache Disorders (ICHD) offers a diagnostic definition of what constitutes migraine, but there’s no consensus about what migraine actually is.
Some organizations (i.e., the American Headache Society and the International Headache Society) refer to migraine as a disorder. Elsewhere, (including on this website) migraine is referred to as a disease. But one could also argue that migraine is best understood as a condition.
Dr. William Young at the Jefferson Headache Clinic posed this question to a panel of 15 experts, academics, advocates, and patients. (I was a member of this panel.) We were unable of coming to consensus, but the outcome of our discussion will be published in the journal Headache.
I thought it would be fun to summarize our debate. I’d really like to know what you think migraine is.
Most of the panelists were torn between “disease” and “condition” as the best descriptor of migraine, although “disease” was slightly favored. They drew on three principles when deciding between the two words:
Panelists (especially the physicians in the group) wondered whether there was enough biomedical evidence to describe migraine as a disease. Panelists were particularly concerned about whether “disease” was the right word when migraine had such great variability. They worried that “disease” might be the wrong description for a person who had just one or two migraine attacks per year. Panelists who voiced these concerns were more likely to prefer “condition.”
Panelists wanted to choose a term that built the credibility of migraine and which would help attract much needed resources. Panelists who expressed this concern were more likely to prefer the word “disease.” Panelists wondered if calling migraine a “disease,” might help people talk to their employers about sick days or get approved for disability.
Panelists thought that context mattered. They might, for example, refer to migraine as a “disease” in a room full of doctors in order to get their attention. But the doctors in the group worried that they might scare some patients if they described migraine as a “disease” in the clinic.
In the end, the panelists couldn’t decide what to call migraine, but I think that our debate can help all of us use language in a more thoughtful manner.
So what do you think? Is migraine a disease or a condition? If you think of migraine as a disease, is it always a disease? Or only when it is chronic and disabling?
*The Oxford English Dictionary provides the following definitions of disease, condition and disorder:
Disease: A condition of the body, or of some part or organ of the body, in which its functions are disturbed or deranged; a morbid physical condition; ‘a departure from the state of health, especially when caused by structural change’ (Syd. Soc. Lex.). Also applied to a disordered condition in plants.
Condition: A state of health, esp. one which is poor or abnormal; a malady or sickness. in a certain, delicate, interesting, or particular condition
Disorder: A disturbance of the bodily (or mental) functions; an ailment, disease. (Usually a weaker term than DISEASE, and not implying structural change.)