Is there a migraine personality? Does a certain emotional constitution predispose people to the throbbing headaches, glowing auras, visual hallucinations, exquisite sensitivity to sound and light, nausea, fatigue and other ruinous symptoms that can last for days, weeks and even longer?
In professional circles, the very question provokes the kind of vehemence normally reserved for debates about socialized medicine and faith healing. Most neurologists are convinced that migraines, and perhaps tension headaches as well, are triggered not by emotions but by a disorder in certain circuits of the midbrain, particularly those using the neurotransmitter serotonin.
Yet other observers, including headache specialists and psychiatrists, contend that there is a particular emotional makeup associated with the affliction. The ”migraine personality,” a lingering but much-disputed term in medicine, has traditionally signified a person who is neat, orderly, successful, self-critical, rigid and emotionally blocked.
The two camps have been slugging it out for years, but their quarrel has grown especially fierce since scientists began to describe the chemistry of the human brain. Researchers have isolated an underlying predisposition to migraine, a disturbance that causes the blood vessels on the outside of the head to constrict and then dilate. For many years, such vascular changes were considered to be stress-related and the source of migraine pain. But doctors now suspect these disturbances are an effect of chemical and electrical shifts in the brain, which are themselves the source of pain.
”Migraine is a clear-cut, unequivocal brain problem, a bona fide electrical disturbance,” says Dr. Neil Raskin, professor of medicine at the Medical School of the University of California at San Francisco. True, migraine can sometimes be a psychosomatic illness-that is, emotion-induced-but no more so than ulcers, asthma or angina, in which an underlying susceptibility is aggravated by stress.
Besides, not all migraine patients are obsessive-compulsive. ”I was impressed when I worked in a migraine clinic that I saw as many burly, extroverted truck drivers as I saw sensitive middle-class intellectuals,”
says Dr. Oliver Sacks, an author and professor of neurology at the Albert Einstein College of Medicine in New York.
Actually, about three-fourths of migraineurs, as the victims of this disease are called, are women whose symptoms have been connected to hormonal changes during menstruation, ovulation and menopause. Other physical factors also have been implicated in the disease: too much or too little sleep, dazzling light, alcohol (especially red wine), the preservative MSG, foods containing tyramine (such as chocolate, aged cheese, vinegar, and liver), and foods containing nitrite (such as hot dogs and sandwich meats). There also seems to be a genetic factor: 75 percent of migraine sufferers share the disorder with someone in their family.
Yet despite these abundant physical clues, many practitioners claim that the migraine personality is startlingly common among their patients. ”I see a definite personality construct: high perfectionism, high internal goals, a lack of self-nurturing,” says Dr. Kenneth Peters, medical director of the Northern California Headache Clinic.
Dr. Charles Adler, a psychiatrist at the Colorado Neurology and Headache Center who has studied migraine patients for more than 20 years, acknowledges that they have a physiological predisposition to the disease. But he has also found that migraineurs seem to share a certain type of emotional history. Frequently they experience what he calls ”pseudoprogression,” a precocious emotional development in childhood.
”They were hard-working kids who often came from families where the emotional requirements of the kids were secondary to the parents` emotions or rules or regulations. They didn`t like childhood too much and tried to escape by being more adult. They had a certain lack of spontaneity, and they were praised for this.”
As adults, says Adler, such people feel anxious when facing novel situations in which they must be flexible and confident. And they feel burdened by the many responsibilities they take on. ”There is a helpless resentment, a dutiful submission, sometimes breaking free in anger but sometimes breaking out in headaches.”
With scientific evidence on one side and strong anecdotal impressions on the other, how can one reconcile the debate about migraine personality?
Clearly, the mind influences the body, causing subtle physiological problems to be exacerbated by stress. Perhaps the migraine personality is more significant than brain chemists allow but less significant than pyschiatrists assert.
Since the vast majority of migraine sufferers are women whose symptoms have been linked to estrogen levels, this may seem to rule out the assumption that a specific personality causes the illnes. Yet Oliver Sacks, the Albert Einstein College of Medicine professor of neurology, believes that a tightly controlled personality may be relevant in patients who have habitual bouts of what is known as ”common” migraine. (Common migraine brings pounding pain on one side of the head; classic migraine, which occurs in about 15 percent of cases, is distinguished by visual and aural delusions.)
This minor medical furor over migraine personality mirors deeper attitudes in our culture about emotions and disease. With its transient but overwhelming pain and its vast range of hallucinations, migraine does have a certain subjective presence, as if its shattering symptoms naturally invite interpretation. For many years, migraine sufferers were considered
malingerers. ”It used to be called the vapors, and it was seen as something factitious behind which people would retreat,” explains Oliver Sacks.
Around the turn of the century, doctors hypothesized that migraine was limited to hysterical women. ”All illnesses that are women`s illnesses have not been given a fair shake in medicine,” says Dr. Joel Saper, director of the Michigan Headache and Neurological Institute. He adds that many of the afflictions we now know as brain disorders-such as Huntington`s and Alzheimer`s diseases-also once were dismissed as psychiatric problems.
In her classic essay ”Illness as Metaphor,” Susan Sontag describes the self-serving attitudes societies adopt toward diseases for which there is no apparent cure: ”Nothing is more punitive than a give a disease a meaning-that meaning being invariably a moralistic one. Any important disease whose causality is murky, and for which treatment is ineffectual, tends to be awash in significance.”
For a long time, migraine sufferers were blamed for their illness. Even today, says Joel Saper, people who can`t find relief from their attacks find little sympathy from families, friends and employers. As a result, the migraine sufferers ”become angry and hostile and hurt. And the doctor says,
`Look how angry and hostile and hurt you are-no wonder you have a headache.` ”
Pain but gain
Luckily there is now relief for most migraine patients. According to Dr. Seymour Solomon, a neurologist at the Albert Einstein College of Medicine, half will find their symptoms completely controlled by medication. Another 30 percent receive significant benefits from medication. Of those taking some kinds of drugs, about a third are further helped by lifestyle and diet changes.
For the rest-about 20 percent-no treatments seem to work. Is their unremitting distress a sign of the migraine personality at work? Charles Adler says it probably is. He borrows a thought from Dr. Graham, a veteran Boston neurologist and distinguished headache researcher. ”Migraine is like a reluctant cop,” he says. ”It`s the ticket that your brain gives you for speeding.”
Others steer clear of any interpretation that can be construed as blaming the victim, Joel Saper, for example, dismisses such psychological translation. ”Patients do take on an aura of self-deprecation,” he says. ”But what I tell them is, `You haven`t caused your illness.` ”
