People With Migraine Don’t Have Attacks to Inconvenience You

Migraine is a major source of absenteeism or being present at work but not being able to give your full effort.

Migraine costs American companies billions of dollars annually in lost work productivity. One would think that we, as a society, would have a vested interest in helping people to manage migraine more effectively, to get back to work, and to get back to their lives.

But, we don’t.

Why?

I think, in part, because it is easier to blame people with migraine than to help be part of the solution.

The Stereotype That Migraine Is Controllable

Migraine is a stigmatized disease. A lot of migraine stigma emerges from the false belief that migraine attacks are somehow under the person’s control. I have always wondered if this stigma is so pervasive because most people’s experience with headaches comes from controllable causes of secondary headaches (e.g., headaches caused by something else). For most people, their experience with headaches comes from substance use or withdrawal (most often caffeine and alcohol).

Although people with migraine may have caffeine and alcohol triggers, migraine attacks are not caused by what people with migraine eat and drink. It is a neurological disease, and it makes one’s brain respond more easily to changes in its environment, including things like caffeine and alcohol. Many people with migraine have stopped drinking altogether and have very small amounts of caffeine, but still experience frequent and disabling migraine attacks.

So, just to be clear, people with migraine do not cause their attacks. They have a disease. Their brains respond (with a migraine attack) more easily to fluctuations in the brain’s environment. There are treatments we can use to manage migraine, but, unfortunately, there is no cure.

If you truly believe that a person with migraine causes their attacks, a natural extension is that a person with migraine is choosing to have migraine attacks. This logic underlies the “secondary gain” type of migraine stigma we identified in our recent study, where we surveyed 59,001 people with migraine. Of these, 8,721 (15 percent) reported that they often experienced people in their lives who they thought were using migraine attacks to get out of their responsibilities.

I have spoken with hundreds of people with migraine over my career, and I have never heard someone say, “Oh, I just wish I could have a migraine attack!” People are not choosing to have migraine attacks so they can avoid some other responsibility. Many times, people with migraine are extremely frustrated that they can’t fulfill the expectations of others due to their migraine attacks.

At the same time, being a caregiver for someone with migraine is hard. It is hard to care for your partner, child, or parent with migraine when neither of you knows when the next attack may occur or when they may have another type of symptom exacerbation. It is a challenging situation for everyone, and everyone needs adequate support.

Next Steps…

If you are a person with migraine, the next time you’re feeling blamed for your disease, ask yourself, “Am *I* blaming myself for having a migraine attack right now? Can I let the guilt go and truly believe that this is just a neurologic disease, and I’m doing my best to manage it with the tools I have right now?” Then, communicate to your partner, coworker, or family member that you are all in the same boat together. “Migraine attacks are so unpredictable; they are difficult to deal with! I appreciate your help in keeping all the balls in the air while I manage this chronic disease.” If you are struggling to find people who support your migraine management, talk to your doctor or therapist, or find a patient advocacy group that can help provide you with the compassionate support you need and deserve.

If you are not a person with migraine, the next time the person in your life with migraine tells you they are having a migraine attack, and you notice your first reaction is to blame them, call yourself out. Ask yourself, “Why am I blaming the person I like and admire for their disease? They don’t control migraine attacks, and they are much more bothered by the attacks than I am.” When you’re ready to support the person in your life with migraine, start by affirming the fact that they are living with a chronic neurologic disease: “I’m so sorry you’re dealing with migraine disease.” Then affirm that you are traveling alongside the person with migraine; you are both dealing with this unpredictable disease together: “Migraine attacks are so unpredictable! It makes dealing with the routine stuff in life so challenging for us as a team.” Then ask the person with migraine, “How can I help right now? We are on the same team, and I want to help you manage this disease and accomplish what we need to get done.”

Migraine Is a Societal Problem and Needs Society-Level Solutions

Migraine is a problem for one in four families and almost every workplace in the country. Migraine stigma places the blame at the feet of the people suffering from migraine. That may make society “feel” better, but it does not help us more fully integrate people with migraine into society, benefiting from their perspectives, wisdom, and work ethic. Migraine is a broader, society-level problem and requires solutions at the public health level.