Here’s a story….
Jane has had headaches for as long as she can remember. As a kid, she remembers sitting in the school office quite a few times waiting for her mom to pick her up because her head hurt, and she felt sick to her stomach. Her parents discussed this with their family doctor at the time and she had some tests done - they were all normal and nothing else was said about it.
By the time she was in university, she was having headaches a few times each week and would often have to go to bed because of them. She noticed that they were worse around exam time and she always had neck and shoulder pain. She discussed these with her new doctor and was told they were probably tension headaches and to drink lots of water.
We’ll come back to Jane later, but her story is one that I hear all the time.
Is migraine just a type of headache?
No. It’s not simply a “headache.” Migraine is a disabling neurologic disease. It has a huge impact on the quality of life and function of individuals.
Migraine is ranked as the most disabling disease in women under 50 by the Global Burden of Disease Study (2019). Aside from the pain and associated sensory symptoms (sound, light, smell sensitivity) or nausea – which is enough of a burden for most – there is the anxiety of anticipating an attack, strain on family relationships, decrease in quality of life, financial implications in missing work...and the list goes on. The worst part is that they are completely invisible and almost impossible to describe to someone who has never experienced a migraine attack.
Who is affected by migraine?
A huge number of people! Almost 15% of the global population suffers from migraines – which is roughly 1 in 7 people (WHO, 2014).
Women. Migraine is primarily a women’s health issue. Migraine affect 3 times more genetically born females than males. They have the biggest impact on people aged 35 to 45 years old. Think of the things that are going on in our lives at that age - completing higher education, reaching career peaks, having families, developing relationships. All these things are affected by migraine. Of note, anxiety and depression are also more common in those living with migraine.
If it’s not apparent – I have a strong interest in women’s health and the impact migraine can have on quality of life. I also know what it’s like to juggle a family, a career, and the self care needed to manage my own migraine disease. This isn’t meant to be a tale of despair. In fact, I think there is SO much that can be done.
It starts with education directed at both those with migraine and healthcare providers. I had very little time in my own clinical education that was dedicated to diagnosing and managing headache disorders. As healthcare providers we like to know that we rule out any causes for a headache that could result in death or immediate harm, however, after that we tend to be less worried. But migraine should cause us to worry - for the long term suffering and impact on quality of life. It accounts for a staggering number of days lost to disabling symptoms over a lifespan. Although there is a room for improvement in diagnosing and managing headache disorders, individuals living with migraine or undiagnosed frequent headaches need to be armed with knowledge to understand your own headache patterns and how they can advocate for the best treatment.
More people are self-educating more about their conditions. I have patients who come to appointments with questions about specific treatments and are looking for evidence-based information on lifestyle strategies. Managing migraine is a long-term partnership between the healthcare provider and patient. We need things from each other to reach the best plan and it is an evolving process.
This is an exciting time in the world of migraine because of improved understanding of the biological processes and new breakthroughs in treatments – with more on the way. Circling back to Jane….
Jane wasn’t a patient of mine. This is my own migraine story. Like many people with migraine I have missed important events, days of work, and quality time with loved ones because of my migraine attacks. It wasn’t until I became a nurse that I realized that my lifelong “headaches” were in fact migraine.
The more recent chapter of my migraine story is that I’ve been able to arm myself with a number of strategies that help to both reduce the frequency and severity of my attacks. I’ve learned to identify my own triggers and I have a good treatment strategy. Like many women with migraine, I had a compete reprieve from my headaches during my pregnancies and while breastfeeding. (I’ll talk more about pregnancy and migraine in a future post!). But these migraine attacks are a part of my reality and are interwoven into my life’s narrative.
My 8 year old daughter also has migraine. Although I like to think she has inherited some of my better qualities, I’m likely the genetic culprit of this neurological disease. Unlike my very delayed diagnosis, we speak about what migraine mean. She can describe the severity, she knows some triggers, and she is learning techniques to help ease the pain. Being armed with the tools and knowledge to live with this condition makes it less likely that it will take centre stage in your life.
If you have migraine, frequent headaches, care for individuals with headache disorders, or know someone struggling to find effective treatment - then I hope you will come back to see some of my upcoming posts.
World Health Organization, 2014 https://www.who.int/news-room/q-a-detail/how-common-are-headaches
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211-1259. doi: 10.1016/S0140-6736(17)32154-2.
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