• A woman with migraine on four days per month who
missed two workdays per year
• A woman with migraine on 20 days per month who
missed 10 workdays per year
• A man with migraine on four days per month who
missed two workdays per year
• A woman with seizures on four days per month who
missed two workdays per year.
Respondents then completed a social distance scale
that included questions about the respondent’s willingness to socialize with, trust, hire, or allow the person in
the vignette to marry into his or her family.
The researchers found that the level of externalized
stigma was the same for the woman with migraine who
missed two workdays per year as it was for the woman
with epilepsy who missed two workdays per year. Respondents believed that the person with epilepsy would
care more about whether he or she was a burden on others, compared with the migraineur. Respondents also said
that the person with epilepsy would try harder and would
be less likely to malinger, compared with the migraineur.
The gender of the person in the vignette was not associated with the level of stigma, said Dr. Shapiro. On the
other hand, men were much more likely to stigmatize
a man or a woman with migraine than women were.
In addition, the researchers found that the woman
with chronic migraine who missed 10 workdays per year
was much more likely to be stigmatized than migraineurs
who missed fewer workdays. People who missed more
workdays were less likely to be seen as trying hard, less
likely to be interviewed, more likely to be considered
malingerers, and less likely to be considered trustworthy.
Fear of Pain and Social Distance
As part of the same study, respondents completed instruments that measured fear of pain and empathy, and also
provided demographic information, including migraine
status. Overall, fear of pain was similar between migraineurs
and nonmigraineurs. Migraineurs feared migraine as much
as they feared falling down a flight of stairs or having a car
door slammed on the hand. Nonmigraineurs, however,
considered migraine to be less severe than migraineurs did.
Among nonmigraineurs, greater fear of pain was associated
with greater social distance from migraineurs. But in the
same group, greater fear of migraine was associated with
less social distance from migraineurs.
Furthermore, Dr. Shapiro’s group noted that the more
migraine is part of a person’s experience, the less social dis-
tance that person maintains from migraineurs. Similarly,
they found that as empathy
increased, the social distance
to migraine decreased.
Other findings included
that younger people were
more likely to stigmatize
migraine than older people,
and that non-Caucasians
were more likely to stig-
matize migraine than Cau-
casians. The gender of the
stigmatizer was a dominant
influence on the amount of stigma.
Reasons for Migraine Stigma
Various hypotheses offer potential reasons for stigmatizing
migraine. Approximately 75% of migraineurs are women,
and migraine changes with hormonal fluctuations. Hence,
sexism against women may be one cause of stigma.
Also, migraine has been considered a behavior problem or conversion disorder for decades, said Dr. Shapiro. One illustration of this point is that a monograph
published in 1926 identified migraine as a neurosis. In
1894, Freud described migraine as the result of a failure
to find release after sexual stimulation.
Migraine is associated with headache, and headache
has various connotations. The type of headache with
which most people are familiar is tension-type headache, thus the general public may be likely to minimize
the severity or importance of migraine. The word “
headache” also connotes “concern” or “annoyance,” which
may contribute to a minimization of migraine’s severity.
Whatever its origin, the stigma associated with migraine
often is overlooked, said Dr. Shapiro. Neurologists should
consider the potential effects of stigma on health outcomes
as they treat patients with headache, he concluded. NR
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Robert E. Shapiro, MD, PhD