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Frequently Asked Questions




Misconceptions about Migraine are harmful to Migraineurs on several fronts.

First, misconceptions about Migraine can prevent a Migraineur from receiving proper and effective treatment, leaving the Migraines untreated. Untreated Migraines not only greatly reduce the quality of life, but can be dangerous, leading to stroke, life-threatening dental infections, aneurysms, coma and even death. Similarly, misdiagnosis of Migraine as tension headaches or depression can lead to the prescription of unneeded drugs. Taking of drugs by a person without the underlying condition is always dangerous. In addition, the tendency of Migraine sufferers to treat themselves through OTC drugs, herbs, and other methods can not only be ineffective, but dangerous, for example to pregnant women.

Misconceptions about Migraine can also lead to emergency rooms and other medical facilities to refuse to treat Migraine sufferers, as some doctors think such Migraine sufferers are just seeking medication and turn them away. (The scenario of a person faking a Migraine to receive drugs was depicted in an episode of the television show ER.) MAGNUM is working with doctors and emergency rooms to update and standardize the protocol for treating Migraine in emergency rooms. Misconceptions about Migraine oftentimes severely damage the work and family life of Migraine sufferers. Trying to overcome misinformation about you as a Migraine sufferer can be both exhausting and fruitless. Misconceptions about Migraine as being a result solely of stress or other controllable factors makes a person be perceived by themselves and others as weak, hypochondriacs, and unproductive. Both misconceptions about Migraine and untreated Migraines typically lead to unhappy family lives, loss of respect in the workplace, loss of jobs and greatly reduced quality of lives. Children who miss school fall behind and children who have Migraines in school can be ostracized, teased, and often remain isolated.




The top neurologists today admit that Migraine is grossly misunderstood and misdiagnosed. For example, according to noted neurologist Dr. Joel Saper, "Migraine is a serious and underestimated health problem. . . patients with Migraine are shunted along an assembly line of misdiagnosis, undertreatment, or frank mismanagement. They are subjected to unnecessary procedures and preventable consequences."

It has been estimated that 60% of women and 70% of men with Migraine have never been diagnosed with Migraine. It has been reported that over 60% of Migraine sufferers have had bad experiences with doctors, and many never return. However, much the genetic and other research on Migraine has taken place in the last few years, of which many doctors are unaware or only tangentially aware. General practitioners and others receive continuing education, but little or any of the training may involve Migraine. Overall, many physicians simply do not have updated information about Migraine. For example, the average physicians PDR (Physicians Desk Reference) is 7 years old. Headache doctors or neurologists are not necessarily Migraine specialists, and therefore if one suspects they have Migraine, they should seek a Migraine specialist. In addition, diagnosis of Migraine can be difficult, as the symptoms and triggers vary from person to person, as do responses to treatments.

In addition, Migraine pain is usually on one side of the head, but is bilateral one-third of the time. Some Migraines are accompanied by aura and nausea, some are not. Overall, unlike other diseases such as epilepsy and cancer, there is no definitive medical test for Migraine at this time. In addition, Migraine mimics, such as hypoglycemia or meningitis, are rare but real.

Notwithstanding medical criteria, some physicians are ready to assume, and some Migraineurs are ready to believe, that bad head pain is most likely attributable to stress or is simply "in their heads." They may typically tell a head pain sufferer to reduce stress and undergo other non-drug treatment, and, even when this doesn't work, may never recommend a drug regiment for the head pain. This may apply especially to women, who account for up to 80% of Migraine sufferers, or 18 million Americans.




It is often not difficult to ascertain a doctor's competence in treating Migraine and their attitude about Migraine by the evaluation the doctor does, the questions the doctor asks, and the answers to patients' questions a doctor gives.

In order to diagnose a patient with Migraine, a doctor should go through an analysis that is similar to the following, and if he does not, go elsewhere. The doctor should ask your family and medical history of Migraine, as Migraine is hereditary, with a positive family history in two-thirds of the cases. The doctor should ask the age of onset, as Migraine surfaces in women at the onset of puberty, and can be triggered by such hormonal events as menstrual cycle. The doctor should ask the type, duration, and location of pain, as Migraine pain is usually throbbing and on one side of the head, while tension headache is bilateral and constant. The doctor should ask about triggers, as tension headache is triggered by such events as stress, while Migraine is triggered by such events as weather patterns, menstrual cycle, and certain foods. The doctor should ask about other symptoms that accompany the head pain, as Migraine is often accompanied by nausea, aura, or sensitivity to light and sound. The doctor should ask what types of medications and vitamin supplements exacerbate the headpain, as Migraine, unlike tension headache, can be exacerbated by vasodilators such as nitrates and medications such as oral contraceptives. The doctor should then conduct both a physical and neurological examination.

As the doctor performs his examination, the patient can engage in conversation with the doctor about the doctor's previous experience with Migraine and other headache patients, the doctor's thoughts on the differences between tension headaches and Migraine, and the doctor's opinion on what causes both. If the doctor says that there are few differences between types of head pain, that mental condition plays a predominant role in all types of head pain, and the treatment is the same for all types of head pain, go elsewhere. You can even start the visit by stating that you have been diagnosed with Migraine disease, have had no luck with previous treatment regiments of other doctors, and you wonder if he can help improve your situation. If the doctor flinches at the word disease or seems otherwise nonresponsive to your condition, go elsewhere.

Even if the doctor diagnoses you with Migraine and prescribes a medication, the doctor should inform you that there are a number of different medications to treat Migraine and that if the medication he prescribes doesn't work for you, to come back to try another type of mediation as some medications work for some people and not others. In addition, some medications are safe during pregnancy and some are not. If the doctor indicates that all medications are alike and therefore the one he prescribes either works or not, go elsewhere, as he may just be prescribing the medication he is most familiar with, not the medication best for you.




Unfortunately, the main sources of misinformation include not only non-medical publications such as women's magazines, fiction novels, and medically-based TV news shows and dramas, but by medical community itself (including both physicians and drug companies) that disseminates incorrect and outdated material, or that decide to still use old information or ideas despite new information.

One reason that misinformation is reported in women's magazines and elsewhere is due to poor research or the propensity to fail to distinguish between the causes and treatment of Migraine vs. tension headache, as the two had been historically lumped together (which is one reason one often reads that stress and caffeine are triggers for Migraine, when in fact they are primary triggers for tension headache instead.)

In addition, many physicians simply do not have updated information about Migraine. For example, the average physicians PDR (Physicians Desk Reference) is 7 years old.

Luckily, medical conferences, such as the AHS conference held in November 1998, are now disseminating more up-to-date information on Migraine that, in turn, will be disseminated among the medical community and elsewhere. However, it is imperative that groups such as MAGNUM continue to dedicate time to ensuring that such information is disseminated to the general public and to the government who handles such issues as disability, insurance coverage, and certain research dollars.




Any Migraineur can call MAGNUM to receive a recommendation for a Migraine doctor or treatment facility. (MAGNUM is trying to compile a comprehensive list of such doctors. Therefore, if you have a Migraine doctor with whom you are pleased (or particularly not pleased), please e-mail MAGNUM with the name and address of the doctor so that we may add (or delete) the doctor from MAGNUM's list.)

In addition, a Migraineur can call selected neurologists' offices in their area and ask the office what the specialty of the doctor is and subsequently if it is Migraine. If the office indicates that the doctor does not specialize in Migraine, try asking for a recommendation. A Migraineur may also call their state medical board and ask for neurologists that specialize in Migraine or related head pain issues in his or her area.

Certain headache groups such as ACHE, AHS, the Rocky Mountain Headache Association, and the National Headache Foundation may have information on Migraine specialists. However, just because a neurologist or headache doctor paid dues to such group or is on the group's list, doesn't mean that the doctor is a Migraine specialist, so be sure to ask for a Migraine specialist.

The following headache centers may have recommendations or may offer treatment, including the Michigan Head-pain & Neurological Institute run by Dr. Saper; the New England Center for Headache run by Dr. Sheftell; the Comprehensive Headache Center, run by Dr. Silberstein; the Neurology Center in Virginia run by Dr. Stark; and Dr. Ramadan of the Henry Ford Hospital. Migraineurs can call these places directly, or contact MAGNUM for their number, many of which may be listed on MAGNUM's Web site. Again, be careful that when you call a headache center, ask for a Migraine specialist, not just a headache specialist.




In order to best treat Migraine, a Migraine sufferer should control triggers, consult a Migraine specialist, and follow a drug treatment regiment tailored to their Migraine, including if necessary, a combination of preventative, attack-aborting, and pain management medications.

MAGNUM has incorporated the above into what it calls its mulitfactorial approach to treating Migraine. Depending upon the type and severity of the Migraine, all three or just one type of medication is appropriate. In general, over-the-counter pain medications, including Excedrin Migraine, which is the same as Extra-strength Excedrin, does not work for Migraine but for the very mild, and in fact, overuse of such OTC medication can cause rebound headaches and a downward spiral in a Migraineur's condition. In addition to medication, all Migraineurs should control to the best extent possible their Migraine triggers.

It is important for Migraineurs to know that some triggers are controllable and some are not, and that not all combinations of triggers are the same for all people. Uncontrollable triggers include weather patters and menstrual cycles. Controllable triggers include bright light, chemical smells, second-hand smoke, particular alcohols such as red wine, aspartame, and foods that are known vasodilators such as fish, aged cheese, and MSG. To improve lifestyle, however, it is also important to identify what potential triggers do not trigger your Migraines. For example, if aspartame is not a trigger for you, or if it is a trigger only in combination with a storm front, you do not have to avoid diet sodas for the rest of your life.

Other things Migraineurs can do to improve treatment is to develop a relationship with a pharmacist who is knowledgeable about new Migraine drugs and Migraine treatment in general. This is important because, for example, some generic drugs specified by insurance plans do not work as well, if at all, on Migraine pain as does the brand-name version, such as is the case with Midrin. Sometimes patients are prescribed a brand-name drug and are unaware that a pharmacist has substituted a generic drug in its place. A pharmacist who is knowledgeable of the particulars of such Migraine drugs can prove invaluable.




How you handle Migraine at home is very important, as what your loved one think of you and your condition greatly affect your life. Misunderstanding about Migraine has led to much family difficulty, and has often resulted in divorce. Don't underestimate the difficulty a family may have in understanding and coping with the disease.

It is very important for Migraine sufferers to educate the people at home about what Migraine is and is not. It is important for you to empower yourself by bringing home material, such as doctors letters and other material, that tells family members that Migraine is not a tension headache and is not caused by stress, but is a hereditary disease. We suggest that Migraine sufferers watch news programs about Migraine with their family, but only when the sufferer is in the room so that it can be pointed out immediately if information about Migraine in the news story or in an article is wrong and outdated. If wrong and outdated information is seen by family members, the Migraine sufferer must show family members updated material from doctors and others that contradicts any wrong information related to stress or treatment.

And if you are not a Migraine sufferer, then remember the next time you offer advice to the person in your life that suffers from Migraines, make sure it's not toxic, such as; " you need to learn how to take it easy", "cheer up", "you shouldn't drink that Coke", or other well-meaning but emotionally debilitating statements. Rather, offer to turn down the lights and the TV, and let them know you understand.




How to handle Migraine in the workplace can be a difficult, and MAGNUM has some advise on what to do and not do in the workplace setting. Migraine issues in the workplace are important to both the sufferer and the employer, as 150 million work hours are lost each year to head pain, costing U.S. industry up to $17 billion dollars a year. Although most Migraine sufferers attempt to continue to work despite their Migraines, many Migraine sufferers see their income and productivity spiral over time if they are not in a work environment that lets them work around their Migraine. In fact, one of the latest studies on the economic cost of Migraine found that the unemployment rate in individuals with severe Migraine is 10% to 20%, several times higher than the general population.

The good news is that many employers are very accommodating to people with Migraine and people with other episodic diseases such as epilepsy. Before you approach your employer about your Migraine, however, MAGNUM recommends that you first see a Migraine specialist, find the best treatment regiment for you, and estimate how often you will get your Migraines and how often they will effect your work. MAGNUM then recommends that if you find that your Migraines may effect your work at times that you tell your boss and co-workers, BUT without scaring them into thinking that you will be unproductive or that you will require very special treatment.

If you don't tell people at work that you have Migraine, they will usually misinterpret what is going on and assume the worse, such as that you are on drugs (especially if they see you take an Imitrex shot to treat your Migraine or see you vomit in the bathroom), or that you can't handle your workload.

It is also imperative that you let your boss and co-workers know that your Migraines are NOT caused by stress. We suggest that you meet with your boss and tell him or her that you have Migraines and that they may cause you to have to take a break now and then or call in sick. The most effective way for you to do this is by bringing your boss a letter from your doctor stating you have Migraines and by bringing a letter from your doctor, or a letter from a Migraine specialist, stating that Migraine is an episodic disease, like epilepsy, and is not caused by stress. MAGNUM can supply you with this second letter. You can give these letters and any other material you feel is appropriate to your boss by stating that you thought that your boss may like to have these letters and material for his or her records, and that you didn't want him or her to think that something else was wrong with you, such as you were in over your head or were calling in sick because you didn't want to work. You should then let your co-workers know the same things in a way that is suited to each co-worker's personality.

If you have a Migraine attack at work but live too far away to run home and lie down without taking the whole day off, you may seek to work out with your employer a place where you can lie down now or then, and/or a place where you can work that is not brightly lit (especially with florescent lights) when you have a Migraine attack.

Overall, you should find a job that allows you to be productive despite your Migraines. If you have very frequent and severe Migraines, you may find that you cannot work productively, in the eyes of you or your employer, in a 9 to 5 job that has a structured environment. In that case, you should seek to find a job that has more flexible hours or that involves a type of work that allows you to work around your Migraines or to work at home.

In the worse case scenario, if you find that you can't work because of your Migraines, you can file for disability, or if you find that you can work productively but are being treated unfairly or are fired because of your Migraines, you do have protection under the American with Disabilities Act. But these remedies should be used in only the most serious circumstances, as abuse of such remedies can ruin the perception of and the remedies available to other Migraine sufferers nationwide.




An example of the experience of one Migraine sufferer: My Migraines are typically preceded by nausea, and are followed by a severe, throbbing pain on one side of my head. If I don't catch the Migraine in time, I must lie down in a silent, dark room. It becomes difficult to keep any medication down, and I then have to let the Migraine take course. My Migraines are not accompanied by aura, and typically last around 6 to 10 hours.

My primary trigger is changes in air pressure, which happens both when weather fronts come through and when I travel. In fact, I first noticed my Migraines when I went to college, which required me to move to California. I had had headaches before this, but none as severe and none with nausea. At first I thought, as most people do, that the head pain was due to a stress-related tension headache, but later started to question that assumption as the head pain came at many different times, not just when I had finals or when I was particularly busy. In fact, many came during spring breaks and when I traveled.

I didn't know they were Migraines until much later. I continued to have headaches after that, many during times of travel, which I did much of in my line of work. This was particularly annoying, often leading business people think that I couldn't handle the trip or, if it was a family visit, my family to believe that my nieces and nephews were too loud or that I didn't want to be there. Other things such as aged cheese and MSG become triggers for me primarily when combined with changes in air pressure.

Overall, Migraine has greatly influenced my life, but since I learned that I had Migraine, I have been able to somewhat control the frequency and severity of my Migraine by controlling triggers and taking medication. They are still disruptive to my life, as they can still be unpredictable and disabling, and hard to explain, since most people mistakenly think and read that Migraine are caused by stress, which is particularly difficult as a working women. However, many strides have been made in Migraine research over the last four to five years, which has improved both the perception of and treatment of Migraine.

I finally learned that I had Migraine vs. tension headache. I also learned that my Grandmother had suffered from Migraine all of her life, something she tried to hide. I do remember that she often said she didn't feel well and had to lie down. Finding out I had Migraine vs. tension headaches was very helpful, as not only did the headaches begin to make sense, but I was able to treat them more effectively through medication and by controlling my triggers. In addition, I have learned to take medication when I feel nausea coming on, as this usually for me means that a Migraine is coming. Doing these things reduced the number of headaches I had to only one every two months or so. When I got pregnant, and since I had a baby, my Migraines have been reduced to practically zero, which happens in many women due to the hormonal changes in the body.

I am an example of someone who by controlling triggers and taking medication early, I can reduce the frequency and severity of my Migraines. Many people, such as a friend of mine, are more sensitive to all triggers, including air pressure, making it much more difficult for him to control and treat his Migraine. He has had to change jobs to work around his Migraine and depends upon a proper drug regiment program to control his Migraines.




MAGNUM is a non-profit public awareness group focusing on Migraine issues. MAGNUM stands for Migraine Awareness Group: a National Understanding for Migraineurs. Unlike other national non-profits, such as the National Headache Foundation, AHS, and ACHE, MAGNUM is dedicated to Migraine disease alone, vs. headache and Migraine disease, and therefore acts as a dedicated spokesman for Migraine. MAGNUM's board of directors includes Migraine sufferers, non-Migraine sufferers, top neurologists, pharmacists, and others. It is important that a group dedicated to Migraine exists because in recent years, it has been discovered that the causes and treatment of Migraine are very different from those of tension headache. Therefore, it is important for a group such as MAGNUM to be dedicated to addressing the many myths about Migraine (such as Migraine is just a bad tension headache or Migraine is caused by stress, which it is not) and the misinformation still reported in national media and in outdated medical literature. There is also a danger that groups who deal with both headache and Migraine issues (with an historical dedication to headache issues) do not adequately distinguish between Migraine and tension headache in the information they disseminate, confusing both Migraineurs and those who treat them. MAGNUM and its medical advisors, on the other hand, are dedicated to disseminating information about Migraine and its treatment, information that distinguishes between Migraine and tension headache, therefore offering the best and most up-to-date information on Migraine.

MAGNUM was formed in late 1993 to educate the public and the government about the serious nature of Migraine disease and to address much of the misinformation about Migraine in the media and in certain outdated medical literature.

MAGNUM has several different audiences, which include:

  • Migraine sufferers, and specifically women Migraine sufferers, as there are particular issues which are unique to women;
  • Co-workers, family members, and friends of Migraine sufferers;
  • The media;
  • The medical community; and
  • The government.

Overall, MAGNUM educates people about the myths and facts surrounding Migraine, disseminates the latest information and treatments for Migraine, and works with the government on disability, insurance, and research issues surrounding Migraine and its treatment.

MAGNUM therefore:

  • Acts as the delivery system of Migraine information to sufferers and others;
  • Teaches people how to handle Migraine at work and at home;
  • Directs Migraineurs to quality medical providers and facilities;
  • Attends medical conferences;
  • Has Migraine awareness shows around the country;
  • Speaks at Migraine workshops for corporations;
  • Appears on TV and in print articles;
  • Works with Congress and the White House;
  • Works with the medical community on disseminating the most up-to-date information on Migraine and its treatment; and
  • Offers a state-of-the art web site that gets approximately a million hits a month if someone searches for the word "Migraine" or "Migraines" on the Web, MAGNUM's site will appear typically as number 1-5, depending upon the search engine. We have maintained a Number One placement on almost every search engine at various times due to our constant vigilance in maintaining the most current site about Migraine disease. was ranked as a Top 200 website for the whole Internet, not just medical sites, by Access Magazine, the popular Internet publication. As well as being the Number 1 most popular visited site for the searches for Migraine treatment on Internet according to Direct Hit.




In General

Migraine is a women's health issue for several reasons, both medically and socially. In fact, the premier AHS headache medical conference held in November 1998 devoted a whole symposium, for the first time, to Migraine issues unique to women. First, approximately 80% of Migraine sufferers, or 18 million Americans, are women. Overall, about 26 million Americans suffer from Migraine. Approximately 1 in 5 women gets Migraines, while only 1 in 16 men gets Migraines.

In addition, because hormonal changes in the body greatly effect Migraine, certain events associated with Migraine are unique to women, such as menstrual cycle, the taking of birth control pills, pregnancy, post delivery of a child, menopause, and estrogen treatment. The number of men and women that have Migraine is almost equal in early childhood, but the number of women with Migraine begins to greatly outnumber the number of men with Migraine after puberty.

Menstrual Migraine

Approximately 14% of women with Migraine have what is called true menstrual Migraine, which means that they have Migraine only when they have their menstrual cycle. Approximately 60% of women with Migraine have menstrual-related Migraine, which means that their Migraine is not exclusive to menses, but they always have Migraine with their menstrual cycle and/or their Migraine increases in frequency and/or severity with the menstrual cycle. Menstrual Migraine can be difficult to treat. However, menstrual Migraine sufferers do have the benefit of being better able to predict their Migraines. This makes the use of preventive, or prophylactic, medication, for example, more effective.

It is disturbing to know that some women have been treated for their menstrual Migraine by having a hysterectomy. However, as stated in the AHS conference in November 1998 and elsewhere, there are no studies to support that hysterectomy is effective in treating Migraine, and therefore the top neurologists and headache doctors DO NOT recommended hysterectomy to treat Migraine. A hysterectomy without removing the ovaries does not change the hormonal situation, and hysterectomy that removes the ovaries often leads to hormonal replacement therapy, which can increase Migraine. If your doctor suggests hysterectomy, explore other alternatives and/or go elsewhere.

Migraine and Pregnancy

Migraine and pregnancy is a complicated issue. Approximately 58% of women with Migraine find that their Migraines disappear or improve during pregnancy. This improvement is more likely in women whose Migraine have previously correlated with hormonal events such as menstrual cycle or the use of oral contraceptives. Migraine in these patients typically worsens again following delivery or cessation of breast feeding. 22% of women with Migraine find that their Migraines remain unchanged during pregnancy and 17% find that their Migraines worsen during pregnancy. Some women actually experience Migraines for the first time during pregnancy or following delivery.

Migraine treatment and pregnancy is a very serious issue. Because Migraine peaks in women of childbearing age, prescription of Migraine medication that does not harm a fetus becomes important. This is important not only for women who are pregnant, but for those who are trying to become pregnant or have a reasonable chance of becoming pregnant. For example, ergotamine and barbiturates taken during pregnancy, even before a woman may know she is pregnant, are dangerous to fetus, and can cause such complications malformation, retardation, stillbirth, and spontaneous abortion. Instead, narcotic alternatives and other safe medications (which may or may not include over-the-counter (OTC) medications, as all OTC medications are not safe for a fetus) should be used.

Ideally, if a women is trying to become pregnant or is pregnant, she should be encouraged to discontinue all medications wherever possible. However, because Migraine may still be severe during pregnancy, doctors should avoid telling the patient to avoid medication at all times, as this may cause the patient to seek her own remedies, such as using her old prescription mediation or using OTC drugs and herbs, some of which can be very dangerous to the fetus. Therefore, the lowest effective dose of mediations not dangerous to the fetus should be prescribed during pregnancy if needed, and drug treatment of Migraine should be delayed until the second and third trimesters when possible.

Migraine and Oral Contraceptives, Smoking, and Stroke

It has also been shown that women with Migraine with aura greatly increase their risk of stroke (up to four times) if they smoke and take oral contraceptives. Oral contraceptives can also increase the overall risk of Migraine. Therefore, if such women cease taking oral contraceptives, they should be treated for Migraine as if they may get pregnant.

Migraine and Advancing Age and Menopause

Migraine prevalence tends to decrease with advancing age, as 2/3 of women with prior Migraine improved with physiological menopause. In contrast, surgical menopause resulted in worsening of Migraine in 2/3 of women with prior Migraine. Therefore, again, hysterectomy is not an effective treatment for Migraine, despite some suggestions to the contrary. Finally, estrogen or progestin replacement therapy can exacerbate a Migraine, or can alone, or with testosterone, relive it. Overall, headache treatment can be difficult in women who require hormonal replacement therapy for menopausal symptoms but whose Migraines are triggered by the therapy. Therefore, Migraine during menopause and hormonal therapy should be closely watched.

Social Issues related to Women and Migraine

Social issues important for women with Migraine include the propensity of both the sufferer and the doctor to assume that the head pain is caused by stress without doing further examination, thereby causing a misperception that the woman is able to handle life, and may dangerously leave the Migraines untreated. In reality, the greater vulnerability of women to headache is due to biological triggers, primarily fluctuations in estrogen levels, not emotional or psychological factors.

In addition, women are more likely to read in a magazine misinformation about Migraine, as women's magazines print articles on headache more often than other magazines. Overall, it is important for women who think they or a family member may have Migraine to educated themselves on the disease and to seek the best medical advice and treatment possible.

More Information on Women and Migraine

For more detailed information on women and Migraine, and for references, please contact MAGNUM.



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