JoanDon't Let Yesterday Take Up Too Much Of Today-86na Klein, a writer for The New York Times” points out that a misconception still exists that migraines are psychological manifestations of women’s inability to manage stress and emotions.

She explains some of the history behind this notion, and the science that invalidates it.

Neurologists are very clear that migraines are a real, debilitating medical condition related to temporary abnormal brain activity. The fact that they may be more common for some women during “that time of the month” has nothing to do with emotions.

For centuries, doctors explained migraines as a woman’s problem caused by emotional disturbances like hysteria, depression or stress.

“Bizarrely, the recommended cure was marriage!” said Dr. Anne MacGregor, the lead author of the British Association for the Study of Headache’s guidelines for diagnosing and managing migraines.

While that prescription may be far behind us, the misconception that migraines are fueled by a woman’s inability to cope persists.

“It was considered psychological, or that I was a nervous overachiever, so I would never tell people that I have them,” said Lorie Novak, an artist in her sixties who has suffered from migraines since she was 8.

After reading Joan Didion’s 1968 essay “In Bed,” about the writer’s struggle with migraines, Ms. Novak decided to tackle the representation of these debilitating headaches. Starting in 2009, Ms. Novak photographed herself every time she got a migraine.

Under the hashtag #notjustaheadache, hundreds of others on Twitter and Instagram have demonstrated their own frustration with a widespread lack of understanding of the reality of migraines.

Among the 36 million people who experience migraines in the U.S., the affliction is three to four times more common in women than in men.

It’s the reasons behind them that have a way of getting twisted.

Dr. MacGregor, who is also a neuroscience professor at Barts and The London School of Medicine and Dentistry, said that hormonal changes related to the menstrual cycle do play a role in migraines for some women and that migraines have been found to be more common in some women during their periods.

“Clearly this is not a relevant trigger for men!” she wrote in an email.

But excess emotions are not that trigger. Rather, it is a shift in hormones starting “chain of events which activate neurons in specific parts of brain and send out signals which other parts of the brain interpret as pain,” she said. M.R.I. data backs this up.

Hormones are just one piece of the puzzle, said Tobias Kurth, an epidemiologist at Harvard who has investigated the potential dangers of overlooked migraines in women.

Lights, smells, alcohol, and certain foods are among the hundreds of environmental factors that can trigger migraines in people with genetic predispositions for them. At last count, variations of more than 40 genes were associated with migraines, according to David W. Dodick, the president of the International Headache Society. Research suggests that there’s a genetic component to at least 50% of migraine cases.

A better way to understand how various elements work together to produce symptoms, Dr. Dodick said, is to “picture yourself in front of the television, and the volume keeps going up and up and up until it becomes deafening – and you’re not even holding the remote.”

Networks in the brain that control the so-called volume of all the sensory information entering it – such as light, odors and pain – become activated either spontaneously or by an environmental trigger. Because the brain is so interconnected, this rogue volume control also affects nausea, spatial equilibrium, thinking and vision, among other areas.

Importantly, it’s not the light, per se, that causes the migraine; it only activates those networks. The same story goes for factors like stress, anxiety, and depression, according to Dr. Dodick.

“If they succumb to the myth that people get migraine because they can’t cope with stress,” adds Dr. MacGregor. “They are one, completely wrong, and two, will not get optimal treatment.

April 6, 2016


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