Stigma: Compounding the Pain of Migraine

Stigma: Compounding the Pain of Migraine

The other day, I read a very interesting article showing that discrimination increases the risk of developing chronic pain. Even though the article looked at a traditional view of discrimination (race, ethnicity, gender, age, religion, appearance, sexual orientation, or “other characteristics”) I think it has consequences for persons with disabling chronic migraine and other severe headache disorders. The authors show that discrimination causes psychological distress, which in turn contributes to the development of chronic pain.

Measuring discrimination

First, how do you measure discrimination? The authors used information from a national survey with 3 time points, 1908, 2004-2206, and again in 2013-2014.1 They measured lifetime discrimination and daily discrimination, both of which correlated with the development of chronic pain. I will list only the questions I find most relevant to patients with migraine:1

Lifetime discrimination

  • Discouraged from seeking higher education
  • Not hired for a job
  • Denied or provided inferior medical care

Daily discrimination

  • Threatened or harassed
  • Called names or insulted
  • People act as if they think you are dishonest
  • Treated with less respect
  • Treated with less courtesy

Measuring pain and psychological distress

The authors used the brief pain inventory to measure pain. It should pick up the pain and disability of chronic migraine and some other headache disorders but it asks about the last 24 hours so it might not be so good a measure for migraine, which is episodic or fluctuates, but if the number of patients was large, which it was, it may come out in the wash. Even if little of the chronic pain picked up in the study was from migraine or other headache diseases, the general message applies. The measure of psychological distress, the K6, seems appropriate.

Before this study, we knew this: migraine –> stigma –> discrimination (enacted stigma) –> internalized stigma –> psychological distress. The study says this: Discrimination (enacted stigma) –> psychological distress –> more people with chronic pain.1 I would add one other reasonable assumption: if psychological distress worsens the risk of chronic pain or migraine, it also worsens the chronic pain of those who already have it. Putting these together leads to:

Understanding the connection between anxiety and pain

At this point, I think it is important to sound a note of caution. Studies like this can show correlation, they cannot prove causality. Because they measured different things at different times and with very fancy statistics, they were able to calculate out the psychologic distress caused by the pain, and show only the causal flow in just one direction. Therefore, while it is possible that they are too statistically fancy to prove what they think they have proven, it does make sense, and I think they are right.

We know that increasing a person’s anxiety state worsens their pain. We know things like biofeedback and cognitive behavioral treatment (CBT) improve migraine. Moreover, we know that adverse childhood experiences (ACEs) like abuse and neglect increase the risk of chronic pain including chronic migraine. We believe these experiences reprogram our brain’s software and eventually reshape the hardware that causes pain. It makes sense that the discrimination against migraine and the constant barrage of negative and ignorant messages against persons with severe migraine would cause emotional distress and so act to damage further their pain systems and migraine generators.

Stigma hurts… and hurts again

This paper also gives us a new hope. Not only may confronting the stigma of migraine reduce emotional pain and improve self-esteem, but it may also improve the chronic pain and other symptoms of migraine. When I twist my patients’ arm to get them to come to a Miles for Migraine event; when I get them to confront and educate a stigmatizer in their lives; when I get them to advocate for their disease before Congress at Headache on the Hill — I can be pretty sure they are not only making a better world for themselves and others with chronic migraine, but they are actually treating their own migraine disease. In due course, these actions will improve their migraine control.

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. https://www.ncbi.nlm.nih.gov/pubmed/29549869

Comments

View Comments (6)
  • StormKat
    2 months ago

    Thank You to Dr. William B. Young for this enlightening and well written article; Stigma: Compounding The Pain of Migraine! I know when I come under scrutiny by my doctors PA’s, or rather when they dismiss the migraine severity, the pain is unrelenting. I am particularly interested in the correlation of abuse as a child and the development of pain receptors. I didn’t suffer horrible but am sure it was enough to change the receptor pathways. The migraines I have last more than 72 hours lingering to 96 hours. The pain I experience is so incredibly brutal at times I think I will lose my mind or worse. I’ve actually felt that I might lose my life.

  • StormKat
    2 months ago

    This is such a well written article on

  • MidrinMan
    2 months ago

    Follow up. I have a trapezius injury and other musculoskeletal issues that I have been complaining about for 15 years. (redirection) My general doc recently asked if any thing new had occurred. I said I went to an orthopedic surgeon and had two MRIs done and we found a bunch of stuff. He responded with how diet and exercise are the standard practice. Dislocated rib…. diet and exercise? Trapezius injury……. diet and exercise? I’ll spare you the rest. You get the idea. “Denied or provided inferior medical care”. Yup, that’s pretty much how it is around here.

  • MidrinMan
    2 months ago

    My family member worked in a private practice as a office supervisor. Been there 11 years. Chronic migraines. They run in my family. She’s been taking more and more time off. She told me she’s been training a young person. I warned her she’s been training her replacement. It happened two weeks ago. New management team complains about things not done, then she points out the exact day she was told not to do them. She also points out the times management laid people off and expected her to pick up the extra work. I told her it sounded like a squeeze play. They offered her a “lesser job”. She wound up taking it. I offered her the phone number for bureau of labor industries but she didn’t want to cause any trouble. Her employer has less than 50 employees. Maybe less than 40. It hurts the business when someone keeps calling in sick. I told her to update her resume and start shopping around. I myself got a pro drone at work today. Couldn’t see. Didn’t stop anybody from coming at me with things they wanted done. There is no sympathy out there. Except for a nice old asian man who walked up and started massaging knots out of my shoulders. That was unexpected. And it helped. I need to return a kind gesture back in his direction.

  • Crash Test Dummy
    2 months ago

    Will there be a 2019 HOH?

  • Joanna Bodner moderator
    2 months ago

    I believe it will be in February 2019! Hope that helps! -Joanna (Migraine.com Team)

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