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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (11)
  • Jill M.
    4 years ago

    Excellent article, Tammy! Thanks for addressing these common misconceptions and providing clear, concise answers we can share to help educate those around us.

  • solove0611
    4 years ago

    Hi Tammy! Thanks for another great story. While I don’t have another misconception, I wanted to add how lonely migraine is. You’ve touched on that in many of your articles, but just wanted to add. 🙂

  • bluebird
    4 years ago

    Emphasis on the diagnosis of a neurologic disease seems to me to be most helpful to overcome current misconceptions. People with Parkinsons etc enter an educated public understanding that something is going on in the brain that is not within an individual’s control.
    while it is encouraging for people to search out triggers and to feel that there is some thing they can do to help themselves with supplements etc, the reality is that for most of us the fundamental lurking mystery of daily shifts in cognition, ability to communicate and coordinate actions at the speed and accuracy required for many tasks that give us satisfaction, respect and compensation are too often limiting and disabling.
    An emphasis on acceptance, adjustment of inner and social expectations is as important to surviving as any medication. Just saying. Compassionate companions are a gift on this journey.

  • Tammy Rome author
    4 years ago

    There is a lot more that can be done than just changing an avatar. Did you see the article, 10 simple ways to raise awareness?

    That should get the ideas started for you. Also, small efforts add up when they are unified. Please consider joining the American Headache & Migraine Association. It is the patient advocacy arm of the American Headache Society. Dues is very low and participation can help us all join in a unified effort to raise awareness and and research funds to better understand Migraine so that one day a cure will be found. You can learn more at http://www.ahma.memberclicks.net.

  • bluebird
    4 years ago

    Thank you for this article on misconceptions.
    I am having a headache( so sorry for rambling) and it is comforting to be reminded of the current need to make the general population more aware of the neurologic basis of this disease. It’s not “just a headache”.
    How can we help with educating the public and the physicians’s who are not up to date? Is there something more than changing our avatar? I was thinking a slide presentation for public speaking might be helpful. Is that available anywhere?

  • David
    4 years ago

    Tammy, you seem to the very educated and experienced and I agree with 90% of your article. But I have to ask why? WHY? Why is there not more emphasis placed on nutrition? I can only speak from my own experience of course, but it’s fairly well known that the population of this country (and perhaps other developed countries as well) is suffering from deficiencies due to loss of nutritious topsoil, etc. A couple that come to mind are selenium, magnesium, and sulfur. Of course, the target here is magnesium. Like vitamin D, and related to it, most of us are not getting enough. It is directly linked to the neurologic system and therefore it makes sense it could be related to migraine.

    Okay, so my experience? After suffering migraines for years, beginning in my 30’s, I started taking magnesium and riboflavin religiously every day. It took nearly two years, but I went from 2-3 migraines per week to maybe 2-3 per year. Yes, per YEAR! Huge reduction. The disclaimer is this: I work four jobs (usually 7 days a week between them) so stress is off the scale, my diet otherwise is mediocre at best and I love dark chocolate, I spend a lot of time at a desk with poor posture, and I don’t sleep well. I did however stop sleeping-in when I could to try to make up for the loss. I seem to be one who only needs about 7 hours at most.

    My suggestion is this: take the supplements, even if you don’t think they work; they can’t hurt. And you don’t need mega doses either. Take both at bedtime when the B vitamin won’t bother you and the magnesium is available while the brain is repairing itself. Adjust your sleep habits. Figure out how many hours you need and stick with it. Go to bed and get up at the same time every day; be consistent. Stick with the regimen. It takes a while, but I have greatly benefited from it.

    I’m not saying in any way this will work the same for everyone, but the supplements are cheap and even if they only work a little, think how much you will save on other meds. I hope this will benefit someone else as it has me.

    David

  • Tammy Rome author
    4 years ago

    David,

    Thanks for your input. I’m so glad you are getting good results from nutritional supplements and lifestyle changes. We talk a lot about good sleep hygiene, using meditation, yoga, mindfulness, etc. for stress management, even supplements. There is an entire section devoted to natural treatments for migraine.

    Plus, I wrote a series of article on the use of CAM to treat migraine earlier this spring:
    Migraineur’s Guide to CAM: Introduction
    Migraineur’s Guide to CAM: state-regulated practices
    Migraineur’s Guide to CAM:traditional healing practices
    Migraineur’s Guide to CAM: exercise and meditation
    Migraineur’s Guide to CAM: plant-based medicine
    Migraineur’s Guide to CAM: energy and touch therapies
    Migraineur’s Guide to CAM: diagnostic tools

    Just do a quick search. I think you’ll quite a bit on using natural and holistic remedies. We’re pretty CAM-friendly around here.

    However, an exclusively-natural solution isn’t always the best way to go. I’m perfect example. I ran a health food store and have special training in herbalism and energy therapies. I treated migraine exclusively with CAM for most of my adult life. I learned a lot, but it failed as a migraine treatment. I needed pharmaceutical help in addition to my holistic regimen. I certainly haven’t given up on nutrition. Half the pills I swallow are supplements. And my doctor thinks it’s good idea.

    You’ll find that most true headache specialists are supportive of using nutrition as one of many ways to treat migraine. It just isn’t always enough.

    We have to be very careful when talking about nutrition. What works for one person will make another person sick. If we fail to acknowledge the wide range of migraine treatment responses, then we run the risk of sounding like we are blaming the patient for not trying hard enough. That’s something we certainly want to avoid.

    Again, thanks for your comments!

  • Luna
    4 years ago

    Where does this bit of wisdom come from?
    “chronic migraine. . It can develop suddenly, but is more often a result of patients going years without proper treatment.”
    So if a person is very episodic and has appropriate treatment for that then gradually changes to chronic that apparently is not what is being referred to? Or is it? Since there is no cure only symptom managing which doesn’t seem to work well for many and migraine can keep changing this phrase ” going years without proper treatment” needs to be explained to me. I can’t quite grasp what it means. Thank you for educating me.

  • Luna
    4 years ago

    My first abortive for episodic migraine worked great (Cafergot PB). Can’t remember when I was first treated 1970s maybe. Early 1990s tried to get a refill but it had been discontinued. So was given Cafergot. Didn’t work as well. Dr. had me try Imitrex when it came out. 9 pills lasted 2-3 months so when it started rebound headaches it wasn’t overuse. It has very slowly been downhill for me since 2000. But the last couple of years has been better where there are very few attacks which are milder and shorter. But still everyday I have some type of symptom going on. Things I can live with but they get annoying. Some days I’m more here and productive than others. Am beginning to wonder if odors aren’t more than just triggers but an actual allergen to my brain.
    The current standard treatment doesn’t work for a lot of people now according to what I read on this site. The dozen or so migrainers that I personally know are episodic and most use OTCs and herbs and have for many years. So I have trouble relating to the phrase “chronic migraine…a result of .. going years without proper treatment.” Am well aware that everyone has differing experiences. Hope this makes some sense as I’m probably rambling. Take care and thanks for listening. Sometimes that is all a person really needs is someone to have a little verbal give and take.

  • Tammy Rome author
    4 years ago

    Thanks for asking. It’s a bit complicated, so I will probably follow this up with an article that reviews the risk factors for developing chronic migraine. I will try to keep my answer brief for now.

    I would argue that few patients who have had symptoms prior to 1993 (when Imitrex came to market) were getting proper treatment because the standard treatment didn’t work for a lot of people. When you live with episodic migraine for 20 or 30 years without an effective abortive, that increases your risk of transformation to chronic migraine. Anyway, that’s my personal theory.

    Now on to the facts.

    Chronic migraine is not currently viewed as a separate disease, but rather a complication of Migraine. Several risk factors increase the likelihood of developing chronic migraine. Some are within our control and others are not.

    The American Headache Society lists these risk factors as: age, gender, race, educational level, socieconomic level, genetics, attack frequency, obesity, medication overuse, caffeine overuse, sleep apnea, stressful life events, and comorbid mental illness.

    What I meant by “proper treatment” is patient and doctor working together to mitigate the risk factors by reducing attack frequency through trigger avoidance and preventive medication, avoiding medication overuse, maintaining a healthy weight, stress management, and screening for and treating comorbid conditions. That kind of treatment hasn’t been available until quite recently. Even now, it is out of the reach of many migraineurs. Add to that the stigma that “it’s just a headache”, and few of us can truly say we have been getting “proper treatment”. No wonder so many of us have chronic migraine.

    Anyway, that’s the best I can do on short notice. I will put together something more comprehensive that will likely post in July. Until then, here’s a link that might help.

    http://www.americanheadachesociety.org/assets/1/7/Marcelo_Bigal_-_Is_Migraine_a_Progressive_Disorder.pdf

  • Lisa Robin Benson moderator
    4 years ago

    Excellent article, Tammy! I will share!
    -Lisa Benson

  • Poll