Migraine is Not “Just a Headache”
Migraine is a neurological disorder whereas headache is a symptom.
Migraine is a complex, debilitating neurological disease. 1 It’s the leading cause of disability in the US for people under 50. 2 And yet people living with this disorder are continuously belittled with the above comments and the stigma of migraine. These misconceptions are so pervasive that people feel the need to hide this disease. 3
Why is there confusion about migraine versus headache?
1- 40% of those who have migraine haven’t been diagnosed. This is largely due to the stigma of migraine, awareness, lack of research, low funding, and under diagnosis.
2- Migraine has a wide range of severity. While one person may have mild symptoms on rare occasions, another person may have severely disabling symptoms on a continuous basis. Those with mild symptoms may be able to ‘power through’ their attacks and may thus unjustly assume everyone else should also be able to easily manage migraine.
3- A painful headache is often mistaken for migraine. The perception that any painful headache is classified as a migraine attack undermines the fact that migraine is a genetic, neurological disease with dozens of unique symptoms. Over 70% of people will experience a tension headache at some point in their life. 4 While many headaches- including tension headache- can be quite painful, not all of these headaches are actually a sign of migraine.
4- Migraine is not well understood. Very few people without relatively severe migraine know that it is a specific disease. Even fewer people know about more rare symptoms such as temporary paralysis or slurred speech. This misunderstanding even exists amongst medical professionals, as undergraduate medical school only provides less than four hours of headache education. 5 If an individual doctor does not seek out additional training, it is unlikely that they will understand the complexities and severity of this condition.
5- You can’t see migraine or headache. Many of the symptoms of both migraine and headache are invisible to others, especially to those who do not know to look for them. When somebody does not have visible signs like a cast or a bruise, it is more likely that other people may discount their pain and assume they are faking or exaggerating. 6
Well, if it’s not a headache, then what is migraine?
Migraine is a neurological disease which can affect the entire body 7 . It is a disease that spans a broad spectrum of severity and frequency. In some cases it can be mild and infrequent and for around 3-5% of people it can be frequent, painful and disabling. There is no cure for migraine, and it affects everyone differently.
An acute migraine attack refers to the attack itself while the disease is referred to as migraine. 8
Common symptoms include:
- Head pain. While this one is obvious, the severity and quality of this pain can vary between individuals, and even between attacks. 9 This pain alone can completely disable a person.
- Nausea and vomiting 10
- Light/ sound/ scent/ taste/ touch sensitivity 11
- Intolerance to movement 12
- Fatigue 13
- Musculoskeletal Pain (Neck, jaw, shoulder, sinuses, etc.), numbness, and/ or tingling 14
- Tinnitus 15
- Dizziness and vertigo 16
- Gastrointestinal issues (diarrhea, constipation, etc.) 17
- Cognitive issues (brain fog; issues with concentration, memory, and word finding)
- Autonomic symptoms (chills/ hot flashes; eye redness/ tearing; sinus pressure) 18
- Less common symptoms include stroke-like symptoms such as paralysis; loss of vision; impaired consciousness 19
Migraine can affect the way the brain interprets stimuli from every one of the senses during an attack.
Lights are brighter (photophobia.) 20 Sounds are louder (phonophobia.) 21 Tastes and smells are sickening (osmophobia.) 22 Light touch may become unbearable (allodynia.) 23
There are multiple phases of a migraine attack
In a typical migraine attack, there are several phases called the prodrome, aura, headache/ attack phase, postdrome or the “migraine hangover”, and the interictal phase between attacks. Not every person experiences every phase, and these phases can overlap.
Timeline of a Migraine Attack.
Prodrome: few hours to days- irritability, depression, yawning, increased need to urinate, sensitivity to light/ sound, problems in concentrating, fatigue and muscle stiffness, difficulty in speaking and reading, nausea, difficulty in sleeping.
Aura: 5-60 minutes- visual disturbances, temporary loss of sight, numbness and tingling on part of the body.
Headache: 4-72 hours- throbbing, drilling, icepick in the head, burning, nausea, vomiting, giddiness, insomnia, nasal congestion, anxiety, depressed mood, sensitivity to light smell and sound, neck pain and stiffness.
Postdrome: 24- 48 hours- inability to concentrate, fatigue, depressed mood, euphoric mood, lack of comprehension
Interictal: Time between attacks, where some people may experience symptoms like light/ sound sensitivity, and others.
Migraine debilitation is a spectrum
Migraine disease also exists on a spectrum, meaning people experience it in different frequencies and levels of debilitation. 24 Episodic migraine attacks occur from 14 days per month to very seldomly. Chronic migraine attacks occur from 15 days per month and upwards, with some people never receiving relief. Symptoms range from mild to disabling, so even people also living with migraine may not be able to comprehend the true disability experienced by others.
90% of people cannot function normally during a migraine attack. 25
Discuss the needs of your members, consider whether any simple accommodations may be helpful, and work with them to remove any barriers to achieving their full potential.