Only half of people with migraine are diagnosed as such, and an even smaller number treated appropriately with triptans and still fewer are placed on preventatives.

Why should this be so? Perhaps the reason is that people with migraine believe that they do not have a real disease and may be embarrassed to seek care. They are often “stigmatized” and this leads to psychological distress, low self-esteem, and poorer social and health outcomes.

In a presentation at the 27^th Annual Headache Cooperative of New England symposium, Robert E. Shapiro MD, reported on a survey of 765 people. They were given vignettes of 4 conditions that may not respond well to treatment: migraine, epilepsy, panic attacks and asthma. The respondents attributed less stigma to asthma than to the other three. No differences in the level of stigma were attached to migraine or panic disorder compared to epilepsy. This seemed surprising in that epilepsy at one point was thought to be caused by demonic possession.

Another opinion by those who completed the survey was that people with epilepsy try harder and are less likely to be malingers compared to those with migraine. Further, migraineurs who missed more work were thought to be less likely to try hard, more likely to be a malingering, less trustworthy and less likely to be interviewed for a job. There are many reasons for this stigma. Migraine is often considered to be a “women’s disease,” caused by “hormones” leading to annoyance rather than severe disability.

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