Is migraine a disease?

Migraine-Disease-1aMany prominent figures in the world of migraine insist that “migraine is a disease”. One book author actually claims to know how to live well with migraine disease.  Even the Director of the Headache Clinic at Stanford—a neurologist and migraine patient himself—speaks of migraine as a genetic disease. This raises the question:

What is it, that makes migraine a disease?

The educated solution to such a question is to get advice from a reputable English dictionary. The usual suspects—Collins, Merriam-Webster, Oxford dictionary—explain that disease is “any departure from health“—just like ailment, illness, sickness or malady. So, why then do these aforementioned migraine advocates not say that “migraine is a malady”? The alliteration makes it sound so much nicer, doesn’t it?

StruggleWe know that migraine patients—on average, in general, as a group, blablabla—struggle with

  • the shame of not being believed
  • the hurt of not being recognized as truly suffering
  • the fear of being seen as a malingerer
  • the guilt of seemingly exaggerating a mere headache.

All these feelings are perfectly understandable in a world that is madly accelerating, increasingly superficial, often impersonal and annoying; a world, in which critical remarks, cool attitudes and dismissive responses are fashionable; a disappointing world for those who are longing for understanding, kindness and compassion, isn’t it?

ResistanceAnd so it appears to be an  act of resistance when migraineurs assert that their condition is a “real disease” and not “made up”. Almost legendary is the statement “migraine is physiological, not psychological” as if these were mutually exclusive categories. Fact is that every thought and every emotion is the result of neurons (nerve cells) in the brain sending messages to one another.

PhysiologicalThere is no psychological process without its physiological counterpart. The same is true the other way round, but we’re not always aware that our subconscious mind influences the physiology of our body.

Obviously—in some minds—physiological stands for true, serious or just. In contrast, psychological apparently expresses something likeCrazy

  • “lonely, unloved souls who pretend to be in pain in order to get at least some attention” or
  • “notorious malingerers aiming for disability benefits”
  • or even “delusional fruitloops who think they were in pain, but in reality they’re not”.

CategorizationBrainIn short, psychological means fake or crazy to them and a discussion of the psychological factors of migraine is off limits.

My educated readers will quickly recognize that those odd, occasionally petulant phrases result from serious errors in categorization and generalization. Unfortunately, severe migraine goes hand in hand with dysfunctions in the prefrontal cortex and so cognitive distortions and fallacies are typical for migraine brains. Sorry.

Why migraine is not a disease?

People usually don’t saymigraine-disease-2

  • Attention Deficit Disease
  • Mood Diseases, Anxiety Diseases
  • Major Depressive Disease
  • Bipolar Disease, Panic Disease
  • Post Traumatic Stress Disease (PTSD)

HeadWithBombInstead, the commonly accepted terminology is

  • Attention Deficit Disorder
  • Mood Disorders, Anxiety Disorders
  • Major Depressive Disorder
  • Bipolar Disorder, Panic Disorder
  • Post Traumatic Stress Disorder (PTSD)

The term disease is typically used for ailments caused by an infection. In contrast disorders are usually health conditions that are not caused by an infection. This is not an official rule and there may be exceptions here and there (cancer, degenerative diseases), but most people would pretty much agree. One more example: Sleeping disease is a parasitic infection transmitted by a Tsetse fly, whereas sleep disorders are not caused by an infection: Sleep Apnea, Insomnia or Restless Leg Syndrome don’t get transmitted from person to person.

Migraine-Disaease-3Migraine too is not an infectious disease but a neurodevelopmental brain disorder, an imbalance between inhibitory control (prefrontal cortex) and neuronal excitability. In this regard migraine is similar to ADD/ADHD or PTSD, both of which are also frequent comorbidities of migraine. Actually, all the listed disorders above are comorbidities of migraine. Isn’t that interesting?

How the treatment of diseases is different from therapies for disorders

The treatment of infectious diseases is the responsibility of physicians, period. Patients have no say, because the doctor’s first priority is to stop the infection from spreading. Unsurprisingly, there is

  • Vaccino Acupuncture for Measles
  • no Chiropractic for Tuberculosis and
  • no Psychotherapy for Malaria.
  • Also, no self-help books offer advice as to how to “live well with Creutzfeld-Jakob Disease“.

In contrast, the therapy of disorders is the responsibility of the affected patients. They can freely choose between a wide variety of therapies. In the case of migraine disorder, physicians make sure that the crippling head pain isn’t caused by some wicked tumor. They also write prescriptions for attack drugs to help with some of the symptoms. Beyond that, it lies in the hands of the migraineur to make the best of it, because medicine can’t “cure” disorders, only diseases.

VitruvianManSimpleDisorders need more than medical treatments (like surgery or medication). Therefore it is more appropriate to talk about therapy and rehabilitation. The word treatment suggests that the patient is the passive object of the procedure. That is appropriate for diseases where the medical treatment is supposed to kill the offending bug.

The fundamental mistake—for which many patients pay too high a price—is to “treat” disorders, as if they were infections, or at least similar to diseases. In migraine land, many patients and doctors behave as if migraine triggers were the offenders, essentially taking the position of bacteria or viruses. So the headache diary and trigger avoidance become the equivalents to hygiene and disinfection in the fight against Cholera.

Whilst there is a medical cure for Cholera, there is none for migraine. As a disorder, migraine needs therapy and rehabilitation. In a catchy phrase: Drugs don’t end the tyranny!

What should be done for migraine disorder?

PyramidDisorders affect body, mind and brain. Many of them are comorbid to one another, which means that having one makes it more likely to get another one. Migraine sufferers frequently have digestive problems (e.g. Irritable Bowel Syndrome) or Mood Disorders (e.g. Anxiety and Depression).

Disorders are typically caused by a multitude of factors (Not every soldier comes home with Post Traumatic Stress Disorder, but amongst those who develop PTSD, many also start having migraine attacks. Isn’t that interesting?). Therefore it might be a smart idea to address all the underlying glitches in body, mind and brain in a spirit of targeted rehabilitation.FlipPanel

In such a truly integrative approach, “Body” represents biochemical requirements, for example deficits in vitamins, minerals and trace elements or imbalances in natural hormones. “Mind” stands for the need to address bad thinking habits, learned helplessness, passive-avoidant coping strategies, maladaptive schemas and emotional traumas. “Brain” obviously expresses the necessity to improve the stability and the function of the central nervous system, which is best accomplished with Neurotherapy.

EU-TeamOfficial European treatment guidelines for migraine (set forth by mainstream neurologists!) at least urge patients and doctors to apply Behavioral Therapies, possibly, but not necessarily, complemented by medication. Inpatient rehabilitation programs are typically multi-disciplinary, which means that a team of doctors, psychologists, exercise physiologists and other professionals collaborate collegially and the patient profits.

In contrast,  American doctorsAm-Docs

  • neglect to motivate migraineurs for Exercise Therapy
  • are rather dismissive of Behavioral Therapies and
  • completely ignore Neurotherapy, clearly the strongest instrument in the toolbox.

MoneyBagAmerican treatment guidelines recommend drugs only. The question is: Who is the one who profits? Certainly not the patient.

GravatarThe hope must be that some of the opinion leaders in migraine land come to their senses, get a grip on their peeved feelings, start to question their own illogical preconceptions and unhelpful beliefs and guide their followers into a new and more reasonable direction. In other words, it’s their responsibility to start a Migraine Revolution.

Why migraine should NOT be called “a disease“?

Saturn-Migraine-DiseaseThe majority of migraineurs already fear that they will have to live the rest of their life with migraine. What they don’t need is a disempowering concept of migraine as

  • a genetically pre-determined, incurable disease,
  • which can only be treated by physicians,
  • preferrably by “headache” doctors
  • who are also migraineurs themselves.

HangmanYet, that is (in condensed form) what patients with Episodic Migraine currently hear from the greatest experts in the field: Patients with a long history of Chronic Migraine and an abundance of comorbid conditions. With all due respect, with a lot of sympathy and under the assumption of best intentions: Chronic migraineurs should recognize that their own attempts to overcome their migraine problems have failed, for whatever reason.

And whilst their vast experience and knowledge, as well as their care for others is highly appreciated, the danger is that chronic migraineurs (unintentionally) “infect” others with “migraine disease” by “transmitting” inaccurate information and unhelpful beliefs. If you still believe that “migraine is a disease, then you should consider going into “quarantine” in order to prevent a “migraine epidemic“—unless, of course, you live well off other people’s “migraine disease”.

LeePerhaps, now is

  • the time to say “Enough with this nonsense!”,
  • the time to start discussing solutions,
  • the time for a change,
  • the time for The Migraine Revolution.

What do you think?

  • Is it time for a more reasonable approach to the rehabilitation of migraine disorder? Or do you think that migraineurs should content themselves with drugs?
  • Do you think migraine bloggers should be aware of their responsibility? Or is it sufficient if they tell others how much they are suffering?
  • Is it your opinion that chronic migraineurs in leading positions should be more responsible? Or is it okay when they (accidentally) guide their followers towards chronification? Leave your well considered comment below!

If you find this article thought-provoking, controversial or simply interesting, then share it with others!

If you liked this article and want to learn more, have a look at our Scientific Patient Guide for migraine patients!

And consider joining The Migraine Revolution!

 

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14 Responses to “Is migraine a disease?”

  1. TeeApril 7, 2013 at 20:12 #

    Interesting, well written article, which provokes some questions………. I agree with the vast majority of it…….. but do think that migraine patient advocates are needed and the fast majority do not pass on the ‘migraine disease’ – as stated at the beginning of the article a migrainer cannot be ‘cured’ by a doctor – therefore is left to their own devices for the most part to find a migraine management plan which helps them and if it was not for the experience of others whom have walked this path for many years; then many would be lost in the wood for trees… sadly there is no cure – yet – be it a disorder, ailment, illness, sickness, malady…. or disease………….. its MIGRAINE and it is real and it hurts….

    • TheMigraineRevolutionApril 7, 2013 at 20:25 #

      Tee, Thanks for your comment and your kind words. At the end you wrote “be it a disorder, ailment, illness, sickness, malady…. or disease” which implies that you think it doesn’t matter what you call it, essentially contradicting the article. That’s disappointing.
      Fact is, whilst there is no convincing, passive “medical cure” for migraine disorder, successful REHABILITATION is possible. It is easier with Episodic Migraine, but even for Chronic Migraine possible, if the patients are able to comply. I can’t quite see who benefits from the gloomy repetition of “sadly, there is no cure”. Okay, perhaps no medical “miracle cure”, but we can end the tyranny! Being pretty much or completely free of migraine symptoms, would that work for you?
      Cheers, Martin

    • Mary Anne DavisAugust 17, 2016 at 21:58 #

      Well said.

  2. Migraine SurvivalApril 8, 2013 at 08:30 #

    I quite agree that migraine should be called a disorder and not a disease. There is enough stigma regarding migraines as it is without embracing a disease mentality. You will note that the Epilepsy Foundation has worked valiantly to define epilepsy as a seizure disorder, and NOT a disease.

    There is at least one migraine basic science researcher who believes that anyone can have a migraine with enough biologic stress; it’s just that those of us who manifest migraine on a regular basis have genetic influences that lower the migraine threshold below that of everyone else.

    Count me in as an enthusiastic supporter of “disorder.”

  3. MigrainesStinkApril 9, 2013 at 03:04 #

    Martin, can you please talk more specifically about the types of therapies you’re advocating for? Behavioral/Exercise/Neurotherapy? Or point us to some resources with some specifics on what exactly has been found to be so helpful.

    • TheMigraineRevolutionApril 9, 2013 at 10:11 #

      Dear MigrainesStink (Julienne?),

      As you can see on this website, I’m already trying my best to give you lots of helpful information (see Articles, Videos …). Yet, there is sooo much more to explain that it took me 462 pages to write it all down: This scientific patient guide gradually builds the deep understanding that is necessary to become immune against the pharma-medical marketing propaganda and to pursue a very thoughtful, factual, goal-oriented rehabilitation.

      Reading the book from front to back is a therapeutic process that empowers the ‘patient’ reader to abandon the role of the victim whos’s begging for the doctor’s mercy and to become proactive in a targeted rehabilitation program. All that, including a Satisfaction Promise not in a 5-day workshop for §999 or in a series of webinars for $499, but in an easy-to-read book for the price of a massage!

      What we’re up against is the following attitude and energy: “Disorder or disease, that’s just splitting hairs; and so is all the crap about treatment/therapy or rehabilitation. Migraine is a genetic disease and there is no cure for migraine, period. Now I’m living with a chronic disease and sell bracelets to raise awareness for the suffering of patients with chronic ilnesses.

      As a therapist, I do understand the origin of all that hurt and drama and also how chronic migraineurs end up in this ‘peeved’, sometimes even hostile position. One detail is very concerning: Chronic pain leads to gradual loss of cognitive function and one can often observe the lack of focus and diminished logical reasoning on migraine forums or Facebook pages. So, many chronic migraineurs can’t counterbalance their emotional experience/pain with straight thoughts in a cool head. They loose themselves in suffering and their identity changes to that of a hopeless-depressed sufferer, forming bonds with like-minded patients. Understandable, but not helpful. We need to stop that drama, not support it with misdirected sympathy. If we find an injured dog, we take it to a vet, even if that hurts and the dog growls and bites.

      I’m hesitant to list the therapies that I’m advocating for, because I don’t want anybody to rush out and randomly and aimlessly “TRY” any of them. Without proper explanation and evaluation there is a high chance to add to the list of “I’ve TRIED everything.” In psycho-lingo that is called “practising failure” as the result of aimless attempts to find the “miracle cure” that solves all problems in one feel swoop. That’s how antibiotics can work for bacterial infections, but that’s the wrong mind-set for migraine disorder and it’s connected ailments (comorbidities).

      One of the problems with the “disease/treatment/cure concept” is the high likelihood of “unexplained failure”. The sentences on migraine forums are “I’ve tried ____, but it didn’t do anything for me. It didn’t stop my migraines.”

      As an example, magnesium (Mg) supplementation is often recommended for “migraines”. What is the report of the ‘difficult’ migraine patient? “I’ve tried Mg, but it didn’t do anything for me” or “I tried Mg and the result was Hell: Horrible diarrhea!”

      The mistake: Magnesium supplements don’t act as antibiotic against the ‘migraine germs’! Mg supplements supposed to help with a magnesium deficiency which sometimes makes migraine worse. So the success criterion is: Did this Mg supplement increase the low Mg levels in my body tissues? If the answer is yes, then how did the higher Mg levels impact on attack frequency and intensity? And what are the other biochemical/hormonal/behavioural/emotional and especially brain glitches that need support in order to get rid of the migraine, but also of the IBS, sleep issues, mood regulation problems … that migraineurs struggle with.

      In short: Body, Mind and Brain get all the support they require! That’s my understanding of a targeted rehabilitation and that needs all the detailed explanations of the current scientific and clinical knowledge with references to the original studies as you will find in the book “The Migraine Revolution”.

      You will agree that Chronic Migraine is a serious issue that needs a sincere approach and NOT just a flimsy article or brochure “3 steps to cure chronic migraines“.

      Did I answer your question? If so, please feel free to share it with others. If not, keep asking!

      Cheers, Martin Brink

      P.S. “Love actually” should be the undisputed #1 on your list!

  4. ShelApril 9, 2013 at 04:06 #

    Loved the article, very informative. I’ve suffers from migraines over 20 years now and I’m not even forty yet. Just once a month but they last 3-4 days when they come. Would those be considered episodic? It’s definitely a disorder/disease something HORRIBLE! 🙁

    • TheMigraineRevolutionApril 9, 2013 at 18:54 #

      Thanks Shelley,
      One of the oddities in migraine land is this: Up to 14 days with migraine/headache per month is considered Episodic Migraine, no matter for how long the drama has been going on. In other pain conditions, the term “chronic” means the opposite to “acute” and expresses that it’s not the original “injury” eliciting a pain experience, but the brain itself not letting go of it.
      Cheers, Martin Brink

  5. DanielleApril 9, 2013 at 08:21 #

    I am disgusted that this article states that Migraines shouldn’t be referred to as a disease, because it isn’t transferable or infectious. Not all diseases are transferable and infectious; for example Diabetes, but it is accepted by the world as a disease. I am insulted and very mad; I genetically had a 90% chance of getting migraines, due to the fact that migraines ran in both my moms and dads families. So I consider it a disease; it is in my DNA, something that is out of my control. I have suffered with this disease for 28 years; I have missed out on most of my sons childhood, robbed him of a healthy mom, denied him participating in sports. I can’t get back those lost years and that alone kills me inside. As I write this; I am getting angrier by the second, how dare you question the label “disease”. Do you know how hard it is to live with people thinking “its all in your mind, or that I am faking the pain to seek attention”. My “Disease” disabled me to the point where I can’t work anymore and that I am now on Social Security disability. I am in my early 40’s and when people ask what I do for a living, I get the most horrific looks. Then comes the list of things that a migraine sufferer doesn’t want to hear; “I get headaches too, can’t you just take a Tylenol, that I should just wish that I didn’t have Migraines, and they would stop or telling me when I have a migraine what I should do or try.”.
    Just because you don’t think of our disease as a “real disease”, it doesn’t make any less real to us. We suffer with a silent disease; we aren’t in wheelchairs or on machines to help up survive, but none the less we suffer from a debilitating disease, that each and everyone of us wish we didn’t have.

    • TheMigraineRevolutionApril 9, 2013 at 18:40 #

      Dear Danielle,

      First of all, thank you for expressing your disgust and anger with the content of my article and for explaining how you understand what I’ve written. It lies in the nature of the written word that an article is not the same as a personal, face-to-face conversation during which one can adjust to people’s understanding and their responses.

      Looking at your entire comment, it should be fairly easy for the two of us to agree that the way migraine is dealt with is unsatisfactory for many migraineurs. Some patients with infrequent migraine attacks think of them as an ‘occasional nuisance’ and are sufficiently happy with popping pills. Others with frequent attacks and additional problems find their lives going down the drain; just like you’ve described so vividly. Are we still in agreement?

      My intention is to inform and educate migraine patients about how to end the migraine tyranny. I also have a financial interest in helping migraineurs and made it the focus of my professional life in that I see migraine patients for therapy and I sell books. Should I ever sell enough copies to come out even, I’ll celebrate that.

      I’ll now reply to your comment as clearly as I can and confront your sentences, because I can see that they are not helpful. You may not like what I’ll say, but as a therapist, my obligation is to help patients, not necessarily to please or comfort them. If you can’t get a benefit from my musings, because you’ve already directed all your anger towards me personally, somebody else might recognise the traps that you’ve fallen into and can avoid following in your footsteps.

      My basic assumption is that people do their very best to live a happy life, based on the skills they’ve developed, based on resources they were given and based on all sorts of circumstances. Some people get born as cripples into a vile environment, neglected, abused, tortured and killed, without ever having the slightest chance of NOT being a helpless victim. Others are born rich, healthy and pretty and they only need to stay on track to remain rich, healthy and pretty. Life is not fair.

      When people are born comparably wealthy, fairly healthy and only slightly abused/neglected and still see themselves as “eternal victims”, then we can safely conclude that something went wrong. Those migraineurs who try their hardest and still can’t do better for themselves than accusing
      1.) their genes for their pain and
      2.) the world of treating them badly and
      3.) the author of an article for elaborating on the differences between diseases and disorders,
      are not on the right track to health and happiness. Something must have derailed them.

      The book and the movement “The Migraine Revolution” are about exposing those derailing factors to give people the chance to reconsider and to enable them to make well-informed decisions in their own best interest. For some that means, they get to understand that migraine is a developmental brain disorder affecting body, mind and brain, which can be rehabilitated with a clever program that
      -takes care of biochemical/hormonal problems (“BODY”)
      -addresses behavioural/emotional issues (“MIND”)
      -improves brain stability and function (“BRAIN”)
      instead of just suppressing symptoms (e.g. headaches with pain killers).

      You wrote that you feel insulted and very mad. Why is that? It seems to me that you think that the label “disorder” is somewhat lesser than “disease”, less officially “recognised”; as if the classification of migraine as a disorder robs you of the chance of being seen as truly suffering. Well, that is not my understanding of the word. Disorder doesn’t mean “disease light“. You are free to call your personal condition “plague” or “God’s punishment” or anything else that gives you hope that other people will suddenly turn into attentive, sensitive, kind and compassionate humans, who take pity on you and make your pain go away.

      Most migraineurs will say “I don’t really care if other people understand how bad it is. I just want to put an end to the migraine tyranny and get on with my life“. They are the ones who I’m trying to address. They understand that we can only take care of our current and future Self, but we can’t make the injustice of the past undone or inconsiderate words unsaid. We can heal trauma, but we can’t make it unhappen.

      In your comment you’re trying to convince me that your migraine is your “genetic destiny”. What for? How would it help you if I said: “Gosh, you poor thing. You were born with migraine genes and now your life is in tatters. My heart goes out to you.” Would that really help you? If so, how long would that last?

      I believe it is more helpful to explain to you that of those people with a 100% chance of having ‘migraine genes, less than 50% ever experience migraine attacks in their lives. Beyond that, you can read the article “Migraine is not genetic” on this website. It might make you angry again at first, but later the insight will percolate that you’re not condemned by your genes.

      Your argument that there are non-infectious diseases doesn’t contradict my classification of migraine as a disorder. As I pointed out in the article, there may well be conditions that belong in the disease basket without being an infection, but migraine is certainly not one of them. Diabetes, however, is actually an interesting example: Type 1 Diabetes would in fact be a disability, because it is the disability of producing insulin. In contrast, Type 2 Diabetes is a metabolic disorder with a 75% overlap with so-called ‘Metabolic Syndrome’.

      Alternatively, one could simply rename all those disorders into diseases, where affected patients feel misunderstood like
      # Major Depressive Disorder (“Look at the bright side!” or “Have you tried Positive Thinking?”)
      # Generalised Anxiety Disorder (“I wouldn’t worry so much” or “Why don’t you practice meditation?”)
      # Post Traumatic Stress Disorder (“You should be over it by now” or “Just forget about it!”)
      # Migraine Disorder (“Identify and avoid all your triggers!” or “You should try drinking more water!”)
      In short: Migraineurs are not alone.

      What I would ask myself in your position is, who has a benefit from me feeling like a helpless migraine victim. Who earns more money when migraine patients believe “It’s in my DNA, therefore I depend on medication“? Whose business flourishes when patients are convinced that migraine can’t be “cured” and that Botox was effective? Who would NOT want to end the tyranny?

      Danielle, you are mistaken to assume that my article is an attack on you. Can you see that now?

      Cheers, Martin Brink

  6. new hampshire avicultural societyApril 10, 2013 at 02:56 #

    nice article.. Thanks for sharing

  7. MisinformedNovember 2, 2014 at 09:55 #

    Though you may not think this is a disease, would you still believe so if I told you that recent studies disagree with you? Recent studies show that having more than 3 headaches per week can cause brain damage. If i’m not mistaken, an infection is similar in the way that it causes damage to the insides of your body. In which case, this means a migraine could be a genetic disease. You may disagree with me or quote me if you’d like. However, you can’t simply label this a disorder. Best regards, Shane.

    • Martin Brink
      Martin BrinkNovember 2, 2014 at 10:13 #

      Shane,
      Have you read the article before you commented on it? Migraine is officially classified as a “Headache DISORDER”, yet so-called “patient advocates”, “migraine warriors” and other chronic patients insist on labelling “migraines” as a “genetic disease” which is highly misleading. Fact is, Migraine is a Functional Brain Disorder with symptoms during and between attacks.
      However, you are free to think of Migraine as a “curse” or your “destiny” or as a “genetic disease”, whatever floats your boat and helps you stop the attack cycle.
      Martin Brink

  8. Martin Brink
    Martin BrinkOctober 6, 2015 at 10:44 #

    Dear Rebecca,

    Thank you for your kind words. I rehabilitate migraineurs for a living (e.g. Chronic Migraine Rehabilitation).

    There is a strong push by the pharma-medical propaganda machine to label most — if not all — health-related problems as “diseases” (e.g. “Degenerative Disc Disease” for back pain) in order to imply the necessity for a pharma-medical “cure”. It’s merely propaganda and not science.

    Whilst one could argue about the “disease”-label for Cancer and Lupus (an Autoimmune Disorder), one cannot seriously dispute that Migraine in its many variations is a Functional Brain Disorder which requires therapy and rehabilitation, not just meds for temporary symptom relief.

    THE MIGRAINE REVOLUTION supports migraineurs with factual scientific information as a counterweight to the relentless pharma-medical propaganda. Some find it “divisive”, others find it enlightening and empowering.

    Kind Regards, Martin Brink

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