Future treatment strategies may address the impact of stigma

In the not-so-distant-future, treatments for migraine may include much more than just the symptoms experienced. In order to minimize the impact of stigma, treatments may be tailored to suit each patient’s personality, too.

The results of a study presented at the June 2014 Annual Scientific Meeting for the American Headache Society show a connection between personality traits and the impact of stigma.  126 migraineurs (57 episodic and 59 chronic) took two assessments: the Stigma Scale for Chronic Illness and either the MMPI-2 or the MMPI-2-RF. Researchers then compared the results of both assessments to determine what (if any) relationship existed between the level of stigma experienced and each patient’s MMPI results. They did find surprising connections.

Study Results

The study found that episodic migraineurs generally experienced less of an impact from stigma. However, introverted migraineurs who tend to prefer being alone even when pain-free were negatively impacted by stigma. This may be due to extroverts having a bigger social network or because our society tends to view introverts negatively with or without migraine.

For chronic migraineurs, the picture is more complicated. A number of personality factors influenced the results.  Patients who are prone to mood swings, excitability, or have periods of excess energy were negatively impacted by stigma more than those patients with a tendency to be calm, cool, and collected.

I was surprised by the next result.  I expected depressed migraineurs to experience the worst impact from stigma.  Apparently that is not the case according to this study. The patients who experienced some of the worst impact from stigma tend to feel a lot of anxiety, worry a lot, be self-critical, have difficulty concentrating, and experience excessive guilt. These issues come up a lot for our readers, so maybe there is something to these results.


The study also found a relationship between stigma and migraineurs who tend to have a lot of vague physical complaints. Their stress manifests as physical symptoms instead of emotional or cognitive ones. This isn’t to say that their symptoms are psychological in nature, but that stress tends to trigger physical symptoms first. My guess is that this explains why so many of us identify stress as a primary trigger.

What this means for you

Don’t take all this to mean that your personality traits either doom or protect you from impact of stigma. This is the very first study of its kind. More research is needed before anyone can determine why stigma affects some patients worse than others.

What the study tells us is that personality traits and the impact of stigma are connected.  Patients with certain tendencies or traits may be more negatively impacted by stigma. Maybe their personality traits make them a vulnerable target for stigmatizing behavior from others.  Or perhaps their personality traits make them more likely to internalize stigma even when it is not obvious. More research is needed to learn how the two are connected.

The researchers suggest that doctors assess the effect stigma is having on a migraineur’s daily functioning. They assert that it’s not just the symptoms of the disease that make life so miserable for some patients.  Hopefully the results of this study (and the many more to follow) will support the development of multidisciplinary programs that include mental health services, peer support services, and migraine education for caregivers, loved ones, and the community.

Concerns, questions, issues, problems

No study is perfect. All have their weaknesses. That’s what leads to more research, better results, and over time, a concensus. This is the first study of its kind to assess the relationship between stigma and personality traits. It also had a relatively small sample size. To extrapolate information about all 36 million migraineurs based on only 126 patients of a single headache clinic is not practical or reliable at this time.

As I thought about my own personality and experiences with stigma, some of the results started to make sense. I am an introvert who enjoys spending a lot of time alone. I also tend to be harder on myself and feel guilty that I can’t do everything I used to do. According to this study, I should be affected by stigma more than an extrovert with a laid-back personality. That might have been true many years ago, but certainly not now. Lots of education and online connection with other migraineurs has made me more resilient. Sure, I tend to react to stigma like a mother bear defending her cubs.  Yet it doesn’t have the power to hold me back anymore. I’m no longer the helpless victim of stigma, but a warrior who fights against it.

What do you think? Do the results make sense based on your experiences? Take the study for what it’s worth – a snapshot of the impact of stigma on the migraine patients of one headache clinic. If it applies to you, use the information to improve your life with migraine.  If not, then I have a circular file where you can dump the results.1-5

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.
View References
  1. American Headache Society, (2014), 56th Annual Meeting of the American Headache Society Program Abstracts, Headache: The Journal of Head and Face Pain, Volume 54, Issue Supplement S1, pages 1–74, June 2014, retrieved online 11/3/2014 at http://dx.doi.org/10.1111/head.12405
  2. Framingham, Jane, (2013), Minnesota Multiphasic Personality Inventory (MMPI), PsychCentral, Retrieved online 11/4/2014 at http://psychcentral.com/lib/minnesota-multiphasic-personality-inventory-mmpi/0005959
  3. Gatchel, Robert J. (2010), Personality characteristics of patients with pain, BehavioralHealthCE, Retreived online 11/4/2014 at http://www.behavioralhealthce.com/index.php/component/courses/?task=view&cid=48
  4. Gatchel, Robert J. (2006), The Role of MMPI-2 in assessment of chronic pain, Practical Pain Management, retrieved online 11/4/2014 at http://psychcentral.com/lib/minnesota-multiphasic-personality-inventory-mmpi/0005959
  5. Lindsay E. Ayearst, Martin Sellbom, Krista K. Trobst & R. Michael Bagby (2012): Evaluating the Interpersonal Content of the MMPI–2–RF Interpersonal Scales, Journal of Personality Assessment, DOI:10.1080/00223891.2012.730085. Retrieved online 11/4/2014 at http://www.tandfonline.com/doi/full/10.1080/00223891.2012.730085.

Comments

View Comments (6)
  • grammayumyum
    4 years ago

    I am wondering if the reverse could be true? From your article, it seems that the association between migraine stigma and personality indicators is assumed to be caused by the personality.
    Instead, is it possible that the stigma causes changes in our personality and coping mechanisms? I know that I have become more cynical and less trusting in revealing my symptoms and needs, due to the rejecting and/or judgmental treatment I have received by family of origin, spouse, medical profession, employer, colleagues, etc. When one risks stating a limitation or need, one risks vulnerability. When a trust relationship is broken, any number of the coping mechanisms mentioned in your article may develop. Perhaps they are just that, coping mechanisms (not necessarily healthy ones) that have adapted to external circumstances, but not true core personality type.

  • Sandy
    4 years ago

    good article. yes. i think all the above. i think it depends on which triggers u have, people u r around, as well as ur own personality. i too have had to work through anxiety, introvert to help cope with migraine when the disease moved from episodic to chronic. and yes, i found even stigma even among those with episodic migraines bc unfortunately no two migraines are alike.

  • peeperview
    4 years ago

    Hi Tammy,
    You write “Take the study for what it’s worth.” I would love to, but how? I think it’s a very important study and I’m really glad to see someone’s conducting one. I, myself, have become a chronic migraineur and the impact the stigma has had or is having on my life is pretty hard to swallow. I’m not to the mama bear point yet. The hardest thing so far are the friends that are slowly but surely drifting away. I’m pretty sure they don’t believe I could be having this many migraines. Anyway, that’s not really what I wanted to address. The study is very similar to another study I would like to see someday. I, too, am an introvert at heart, though for short spells can come out and put on my party hat. I’m also a “highly sensitive person”. I have a hunch that a lot of migraineurs are also highly sensitive people. It would be interesting to know. Anyway, thank you for the work you do and I would be a willing participant in your study if I knew how to be.

  • Tammy Rome author
    4 years ago

    Thank you for your kind words. I had nothing to do with the study; I only reviewed the results and put them everyday language so we could all understand them. Hopefully we will see more studies like this that will help us by teaching doctors how to work with our individual differences. I think you’re right about most of us being sensitive. Stigma has been worse for me at times, but not so much now. It was bad in school and also at some jobs because I was viewed an “antisocial” or “snobbish”. I got a triple-whammy with introversion, Asperger’s, and lots of triggers.

    If you’re interested in participating in future studies, you can go to https://clinicaltrials.gov/ to keep an eye out for ones in your area.

  • Lisa Robin Benson moderator
    4 years ago

    Hi Tammy,

    Thanks for reporting on the study results. I think it goes without saying that how we react to our migraines affects how we are viewed by the outside world, affecting stigma. It’s interesting to see the possible specific correlations. I think for me I can sometimes fit the anxiety profile and other times fit the “cool, calm and collected.” It entirely depends on my level of pain and also if I am with people I am comfortable enough to be a bit more open with. I think I could be stigmatized more when I am more outwardly worrying about my symptoms or triggers. Migraines in my opinion are an easy target for stigma because we as sufferers must adapt our lifestyle to feel better. I wonder if the stigma varies depending on a persons triggers as well. For example someone always avoiding light by wearing sunglasses may be viewed with more stigma than someone with less visible trigger avoidance.
    Lisa

  • Tammy Rome author
    4 years ago

    I think you are right about different triggers being more stigmatizing. In my experience, comorbid conditions also play a role. If someone is struggling with severe Depression, PTSD, or Bipolar Disorder they are more likely to be stigmatized. I saw this a lot when I worked at a community mental health center and spent a lot of time advocating for my clients who also had Migraine. They just weren’t being taken seriously about their pain and most hadn’t ever seen a headache specialist until I forced the issue with our medical director. A therapist with Migraine was accepted (sort of) but patients with Migraine weren’t believed. It was a frustrating situation.

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