Patients with chronic migraine are more stigmatized than patients with other chronic neurologic disorders, researchers report.
LOS ANGELES—Chronic migraineurs said they experienced a higher degree of stigmatization than did patients with stroke, epilepsy, multiple sclerosis (MS), Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), or Parkinson’s disease, according to research presented at the 52nd Annual Scientific Meeting of the American Headache Society.
“Patients in a headache clinic are highly stigmatized,” concluded Jung E. Park, MD, a neurology resident at Thomas Jefferson University Hospital in Philadelphia.
“Headache clinic patients with episodic migraine are similarly stigmatized as patients with other neurologic diseases, and headache clinic patients with chronic migraine are more stigmatized than patients with episodic migraines or other neurologic diseases,” she said.
Investigating Stigma
Dr. Park noted that stigma “can result in depression, anxiety, and disruption of social relationships, ultimately leading to decreased quality of life” and that it has been associated with such chronic neurologic conditions as stroke, Parkinson’s disease, and ALS. No previous research has looked at migraine’s association with stigma, however.
Dr. Park and colleagues investigated 246 patients—123 with chronic migraine and 123 with episodic migraine—at the Jefferson Headache Clinic at Thomas Jefferson University. The patients were assessed with use of the Stigma Scale for Chronic Illness (SSCI), a 24-item questionnaire that quantifies the degree of stigma in patients with chronic neurologic diseases and allows for comparison among such disorders. In addition, the researchers collected basic demographic data and performed assessments with the Migraine Disability Assessment Test (MIDAS) and the SF-12 Health Survey. They also compared the SSCI scores of both migraine groups with the mean score of a mixed panel of patients with various chronic neurologic diseases.
Chronic Versus Episodic Migraine
The overall cohort had a mean age of 42. Chronic migraineurs were slightly younger, had slightly less education, and had significantly lower incomes than episodic migraineurs.
The median SSCI scores were 54.5 in the chronic migraine group, 41.6 in the episodic migraine group, and 42.7 in the mixed panel. Thus, while the episodic migraineurs and patients in the mixed panel had comparable scores, “the chronic migraineurs were more stigmatized, compared with patients with other chronic neurologic diseases,” Dr. Park said.
The mean MIDAS scores were 60 in the chronic migraine group and 18 in the episodic migraine group—a significant difference, noted Dr. Park. Although 58% of the chronic migraineurs reported being unable to work at all, most episodic migraineurs reported having no work-related difficulties or being able to work full time, though less than their best. Furthermore, although most episodic migraineurs reported spending very little time resting or in bed, most chronic migraineurs reported spending more than half of their waking hours resting or in bed.
A weak correlation was observed between the SSCI and MIDAS. In both episodic and chronic migraineurs, the SSCI correlated negatively with the physical and mental components of the MIDAS. There were no correlations between stigma and patients’ age, gender, income, or education, however.
The Effects of Invisibility
Migraine may lead to stigma, because it “is a disease where the patient’s chief complaint is not visible, since the presence and severity is something we must take the patient’s word for,” Dr. Park told Neurology Reviews.
“An occasional headache that the nonmigraineur experiences may also serve as a basis for dismissing a true episodic/chronic migraineur’s pain and condition,” she commented. “The fact that migraine is not something we diagnose based on imaging or lab test (in contrast to other neurologic conditions, such as epilepsy and MS, which can be diagnosed with EEG, lumbar puncture, imaging, etc) may also intensify the stigmatization.”
—Jack Baney