Why the “Migraine Personality” is Total Bunk

Never heard of the “migraine personality”? Good. But in case you do come across this antiquated psychology, you might want to have some information in your arsenal.

The “migraine personality” was coined in the early 20th century not long after Victorian doctors thought migraine to be a purely psychosomatic phenomenon. Headache researcher Harold G. Wolff believed that people with migraine fell into a certain category of high-strung, perfectionist, anxious worriers and the like.(1) Without much scientific understanding of migraine aside from the dilation of blood vessels, these personality traits became generally understood as the underlying cause of migraine (especially as they were applied to sexually repressed housewives) and the “migraine personality” gained mainstream popularity by mid century.(2) For perspective, keep in mind this was time in the history of neurology when lobotomies were still performed by the thousands in the United States... (i.e. neurologists had a seriously long way to go in understanding how the elusive human brain works).

Fast forward to 2016 and U.S. doctors are receiving less than a day of training on headache disorders in medical school despite migraine being the “sixth highest cause worldwide of years lost due to disability.”(3) Because primary care practitioners and the general public are still so lacking in up-to-date details about migraine, it’s unfortunately not uncommon for people to still fill in the blanks with lingering stereotypes passed down from our parents and grandparents. One of my relatives called them "sick headaches" and declared that her sister was faking the pain. These comments can stay with us, and influence our understanding of migraine unless we have access to more accurate information.

In a 2003 study titled “Personality traits and stress sensitivity in migraine patients” Huber and Henrick found that “The migraine patients […] used coping strategies characterized by the development of physical symptoms, social isolation, and preoccupation with stress. They rated themselves as less calm, less capable of relaxing, and more irritable than did the healthy controls subjects, and they responded more often with internal tension, especially in work and other achievement situations.”(4)

I don’t doubt that the migraine patients reported exactly this. If that same study interviewed a group of people with freshly fractured ankles, I think they would also report more stress and tension than the control group… because pain is stressful! Especially when that pain is frequent or chronic. It can wreak havoc on our lives and cause a whole slew of secondary issues.

The problem with the “migraine personality” does not lie in observations of people with migraine exhibiting higher amounts of stress, tension, anxiety, or depression than the general population. The problem arises when that stress is assumed to be the sole cause of a person’s pain or when the cause of that stress is attributed to an essential part of a patient’s being: namely, their personality. Despite research that shows our personality traits are not fixed and can actually be shift significantly in reaction to our environments and relationships, generally we tend to think of our personalities as a fixed set of characteristics.(5) Many popular "personality tests" reinforce this idea. Believing that our fixed personality has somehow directly caused us pain; that migraine is somehow intrinsically a part of who we are can lead to shame, hopelessness, and self-blame on top of the already difficult mix of emotions involved in living with disabling migraine attacks, and that’s just not helpful.

Stress and anxiety often play a role in migraine as exacerbating factors as well as secondary effects or co-morbidities, and relaxation techniques can be part of a very effective treatment plan. However, reducing migraine to a perceived inherent or unchangeable “personality” or state of “neuroticism” can prevent doctors and patients from looking at the bigger picture, which we now know involves so many factors. It involves stress and tension yes, but it also involves genetics; changes in the brainstem; neurotransmitters going haywire; neuroplasticity; lifestyle factors; diet; socioeconomic status; access to care; co-morbid health issues; a history of abuse or neglect; environmental factors; and the list goes on.

Migraine is a complex disease with a history of sexist assumptions and patient blaming, and we still have long way to go in understanding both the underlying mechanisms and ways to effectively treat the symptoms. These reasons are precisely why it would be so illogical to continue reducing the causes of migraine to anything so simple as a set of personality traits, and why we should simply dismiss the “migraine personality” as a giant stinky load of total bunk.

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