When Minnesota congresswoman and presidential candidate Michele Bachmann was revealed to suffer from migraine disorder, it caused a lot of debate. Bachmann herself, however, was eager to change the subject.
This is understandable. When it comes to migraine headaches, lots of sufferers clam up. In fact, as a doctor, I’ve found that people are more willing to admit to chronic depression or bipolar disorder than they are to having migraine. (You’ll notice I write “migraine” and not “migraines.” That’s because migraine is a disorder and not an incident. For the same reason, we say “epileptic attack” instead of “an epilepsy.”)
It’s not clear why this is. Part of it may be due to insufficient funding for migraine research. Part of it may be due to sexism. (Migraine affects three times as many women as men.) But most of it is probably due simply to misunderstandings about what’s in fact a very common, although painful, disorder.
When I was a neurology resident in the early 1980’s, the Handbook of Clinical Neurology explained that migraine disorder often seemed to strike frigid, uptight, and perfectionistic housewives who might be neurotic. To be fair, this edition was written in 1952, but it reflected a mindset towards migraine that remains surprisingly prevalent. For instance, the notion of a “migraine personality” is still with us, even though it’s of dubious validity.
How bad is the stigma? In 2010, at the American Headache Society Annual Scientific Meeting, researchers presented some numbers on the subject. These were based on the Stigma Scale for Chronic Illness, a tool created at Northwestern University to measure factors such as how often people feel criticized or outcast for having an illness. The scores for those with episodic migraines were only slightly lower than for those with epilepsy, multiple sclerosis, or Alzheimer’s.
So let’s clear up a few basic facts. “A migraine” isn’t just a really bad headache. Migraine is a neurologic condition, often inherited, and it affects more than one in ten Americans. The migraine headache causes a moderate to severe level of throbbing pain, often on one side of the head, and routine physical activity generally makes it worse. Nausea and vomiting are common. The sufferer often requires darkness and quiet. Untreated, a migraine attack can last as long as 72 hours, but treatments can often abort an attack in an hour or less.
The sufferer of migraine disorder does not bring it on himself or herself. Strength of will cannot prevent an attack. Nor do women get migraine attacks because they are “hormonal.” (Estrogen does play a role in the migraine process, affecting certain receptors in the brain, but it is only one of many, many neurotransmitters involved.)
What we know today is that several genes, some identified and some not yet tracked down, appear to be responsible for migraine. It is a brain disorder of intricate complexity. It does not spring from neuroticism or repressed anger. Certainly, some people with migraine might have repressed anger, but there’s no sign that this causes migraine disorder. People can have migraine without repressed anger or repressed anger without having migraine.
The pain of migraine attacks is often severe, but migraine-specific medications often stop migraine attacks, and most people with migraine are able to function fully in life. Various articles written over the past few days refer to Bachmann’s “chronic migraines,” but this seems like journalistic shorthand for “occasional migraine attacks.” In the world of medicine, “chronic” migraine means having fifteen or more migraine headache days per month. It’s doubtful that this is Bachmann’s condition. Even if it were, many people are able to work and function successfully with it.
Should simply having a migraine diagnosis prevent a man or woman from becoming president? We know that Ulysses S. Grant and Thomas Jefferson suffered from migraine disorder, and that was long before the era of modern treatment. And lots of politicians presumably suffer from the disorder. Since 12 percent of Americans suffer from migraine, it’s quite possible that 12 percent of our Senators and Representatives do so, too.
Should Ben Affleck be barred from the movie set? Should Dwight Gooden, Scottie Pippen, Jose Canseco, Terrell Davis, or Shawn Nelson have been excluded from play? How about Monica Seles? Or Kristen Chenoweth–should she be excluded from performance? All these celebrities experience migraines.
You might argue that a Commander-in-Chief is a special case, but in that case what else should we place off-limits to those with migraine? Being a lawyer? A doctor? Various studies have found that the prevalence of migraine in family physicians and neurologists is higher than in the general population, and is even greater, over 60 percent, among headache specialists.
So, yes, accept that migraine is a real disorder. At the same time, don’t stigmatize it. Migraine is really painful, but it’s really manageable. Both things are true at once. As for what career limits migraine disorder should place on someone, that should be between doctor and patient, not the rest of us. That goes even for patients who are running for president.
*Photo courtesy of thatgrumguy.