Common misconceptions about migraine
There are lots of misconceptions about migraine. It can be difficult to counter the social stigma surrounding migraine. Trying to explain it can often leave you feeling isolated and misunderstood. The last thing you want to do in the middle of an attack is to educate people about the disease. However, truth needs to be shared. While we all know the truth, it can still be hard to come up with a good explanation to counter the myths. So in an attack-free moment, I put together a few quick explanations to help get you started.
It’s just a bad headache.
Migraine can include a headache that ranges from mild to severe. However, a migraine attack typically starts hours before pain begins with fatigue, irritability, sensitivity to light, sound, and smell, difficulty concentrating or forming words. Some people never feel pain yet suffer from stroke-like one-sided paralysis, blindness, and other sensory dysfunctions. Even when pain is present, it doesn’t stop there. Nausea and vomiting are common, as are vertigo, dizziness, tinnitus, and much more. It can take up to a full day after the pain stops for a person to fully recover from an attack.
Only stressed-out people get migraines.
While stress is a common trigger, it isn’t the cause. Many people with migraine are calm and easy-going. They manage stress quite well and still get hit with attacks many times each month. There is a lot of debate about whether stress itself is the culprit or if there are behaviors patients do when under stress that trigger the attacks. A study from 2014 did confirm that let-down from stress is, indeed, a trigger. While a patient may remain attack-free throughout a stressful even, the attacks begin once the stress is eliminated.
It’s a woman thing.
As with other chronic conditions, women do outnumber men 3 to 1. However, many men do experience migraine attacks. Some are even disabled by them. Even kids can experience migraine. Many patients can trace their first migraine attack back to pre-adolescence or even preschool. Boys and girls experience migraine equally until puberty, when the rate of girls with migraine shoots up to adult levels. So yes, estrogen does play a role as a significant trigger. But no, it is not the cause. Experts don’t yet know what actually causes a person to develop migraine.
There’s medicine for those.
There has never been a medicine developed specifically to prevent migraine. The medicines that are used (over 100) are borrowed from other categories (anti-epileptics, anti-depressants, anti-hypertensives, and most recently, cosmetic procedures). For the first time in recorded history, a migraine-specific preventive drug is currently in Phase II clinical trials. The results are promising, but public access to the medicine is still several years away.
There are a few classes of drugs that are used to abort a migraine attack in progress: triptans, NSAIDS, and ergot-derivatives. When Imitrex came to market in 1993, it was heralded as a “miracle” drug for migraine. Unfortunately, this new class of drugs does not work for everyone and is contraindicated for use by patients with cardiovascular disease. Since migraine increases a person’s risk for cardiovascular disease (plus others) triptan use can be troublesome. Many migraine patients have no effective abortive and must rely on pain medications (narcotics, opioids, etc.) to manage their symptoms.
It’s just an excuse to get out of something.
The word “headache” has become so trivialized by society that few people take it seriously when someone complains of a serious headache. Since migraine attacks are often viewed as “bad headaches”, they are guilty by association. When articles appear like the one last year on WikiHow that offered instructions on “how to fake a migraine”, those negative impressions continue.
The truth is that migraineurs hate missing out on important events. They generally have a strong sense of responsibility and tend to hide or minimize their symptoms in order to participate in life as much as possible. Few people actually see the true extent of a migraine attack. It’s been well-established by research and the observations of headache doctors that migraineurs underestimate the frequency and severity of their migraine symptoms.
If you just stop eating bad food, they go away.
While it is true that some foods are possible triggers for certain people, studies have shown that food is less of a trigger than once thought. It is now understood that migraine is a neurological disorder similar to epilepsy. More common triggers are weather or environmental changes such as thunderstorms, lightning, bright flashing lights, strong chemical smells, and loud noises. Sleep disruptions, dehydration, and changes in routine have also been implicated. A patient’s world can get very small while trying to identify and avoid triggers. When this happens, patients are often encouraged by family and friends to relax and “live a little” or accused of worrying too much about the next attack. It’s a difficult balancing act to avoid triggers and still maintain quality of life. It’s rarely as simple as just improving one’s diet.
If there’s not an aura, it’s not a migraine.
Less than 25% of all migraine attacks are preceded by aura. It is more common to not experience aura. However, the stereotypical aura is rare, even among those diagnosed with Migraine with Aura. More often, an aura is experienced as blurry vision, a haze (like you see on the highway in very hot weather), phantom smells or sounds, or tinnitus. Not everyone who experiences aura will recognize it as an aura without education.
Because this myth persists, people often think that migraine patients can avoid the symptoms just by taking a pill as soon as they see zigzag lines in their visual field. Even patients with aura cannot always stop the symptoms because they cannot act quickly enough or because they have to save their medication for only the worst attacks because insurance companies limit the number of pills. Patients often receive as little as 8 pills per month while facing 15 or more attacks in that same month. Even when it works, medication only aborts the pain and other headache phase symptoms (nausea, photophobia, etc.). It does nothing to help with cognitive impairment, fatigue, and difficulty communicating.
You can’t have a migraine every day.
The word migraine actually refers to the diagnosis of a neurological disease. Most advocates and doctors prefer to use the term “attack” when referring to the individual episodes most commonly referred to as “migraines”. So a patient can be diagnosed with migraine and get few, many, or daily attacks. Experiencing more than 15 attacks in one month is considered a serious complication of migraine called chronic migraine. It is much more difficult to treat. It can develop suddenly, but is more often a result of patients going years without proper treatment. Because society trivializes headache and migraine, few patients realize that early treatment when the attacks are mild and infrequent is the best protection against chronic migraine. While the guidelines are still in flux, the general rule is to abort attacks at the first sign and to start a preventive regimen if the attacks occur 4 or more times per month.
Do you have any more myths that need an explanation?
Submit them as comments below and I will compile a new list for a second round.
Can you tell when a migraine attack is coming?