When Migraine Is Treated Like a Zebra Among the Horses

One of the first lessons a medical student often learns is, “When you hear hoofbeats, think horses, not zebras.” This metaphor when applied to medicine means, if all of the symptoms fit a particular diagnosis, it is most likely the diagnosis. A physician won’t think an individual has an aneurysm when they have symptoms of the common cold. So, why do we treat a migraine as a symptom of a greater problem that can never be found?

Before a physician can treat an illness, they must make a diagnosis. The process of making a definitive diagnosis is referred to as differential diagnosis. A physician takes a medical history and rules out diseases according to test results and assessments they conduct. There is one trend I have noticed when going through the differential diagnosis having migraine. Most of the physicians I have seen treated migraine as a symptom rather than a diagnosis of its own. They treated migraine like a glorified headache that was “causing” another problem. All of the other symptoms of migraine were tossed aside as if lightheadedness, vision changes, fatigue, word finding difficulties and spasms did not equate to a migraine. It was as if I was using the word headache as a synonym for a migraine attack as far as any of them were concerned.

Migraine was a symptom of a greater unknown problem until proven otherwise, and I did not agree with the approach. Not one of these doctors considered the complexity of migraine as a neurological disease. Not one considered all of the symptoms that are experienced during a migraine attack. Not one of them spoke up to say my case was out of their area of expertise. Not one of them recognized the diagnosis of migraine was made by a neurologist and not Google. Most importantly, not one of them considered the limited knowledge we have as both a medical community and society about this complex neurological disease. All they did was keep testing.

As I was seeing each one of these doctors, they talked to me about the “cause” of migraine. Each one asked me what lifestyle choice was “causing” migraine. I listened as different individuals tried to suggest my triggers were responsible for the biological changes in my brain. Imagine, barometric pressure, altitude, food additives like MSG and sleep changes were all the “cause” of migraine. This is not the case, each one of these things can increase the likelihood a migraine attack will occur, but they are not responsible for the biological changes that are experienced in the brain.

In short, migraine is not solely the result of an individual’s choices. Migraine is a physiological change that is believed to be genetic, but we do not know the extent of the cause of migraine right now. What was clear at that time is, many specialists gave up when the cause of the single symptom headache could not be determined. However, we know a migraine is anything but just a headache.

The field of neurology is rather amazing. Cardiologists, orthopedists, and other specialists cannot directly interact with the organs they specialize in. By interacting, a neurologist knows what their chosen organ is thinking, feeling and doing. They get immediate feedback because they are trained to look for it. A neurologist is not the one who was too afraid to be a neurosurgeon. They were the one willing to challenge the abnormalities of the brain and treat them.

It is probably shocking for many to find out there are not enough doctors that specialize in migraine. According to information gathered from the Migraine World Summit, “There are 520 neurologists who specialize in migraine for 37,0000 people diagnosed with migraine.” With that kind of knowledge, no wonder no one really understands migraine. No wonder we still do not know where migraine comes from, and how to cure it.

I do not know where migraine research is headed. I do not know when we will find a cure. There are a few things I have learned from my diagnosis. I know migraine is a real neurological disease. I know there are only so many things I can do to manage attacks as they come. I know migraine is a complex combination of symptoms and not just a headache. I know others diagnosed battle the same stigmas I do, and if we could just start by recognizing migraine as a real diagnosis, with head pain being one symptom, maybe we would make some progress toward acceptance. Will migraine continue to be a zebra, or when you hear hoof beats, will you think of a horse?

Follow this journey on Desire2Access.

We want to hear your story. Become a Mighty contributor here.

Find this story helpful? Share it with someone you care about.

Related to Migraine

shades app, neck pillow and peppermint halo stick

12 Migraine-Soothing Products People Swear By

When you feel a migraine coming on, that’s the time you probably start pulling out your migraine “go-to’s” — the things you’ve learned that help you get at least a little bit of relief. You likely figured out through trial and error which techniques are your friends, and which ones do nothing or even make it worse. [...]
abstract illustration of a woman's face in a blue night sky

How My PTSD Triggered Chronic Migraines

My chronic migraines have been exceptionally difficult to treat. I’ve been on dozens of medications, tried botox, diet changes, lifestyle changes and have still barely made a dent in the number of migraines I experience each month. It’s been apparent for some time that my migraines are complicated with a mess of triggers as varying [...]
woman holding her head in pain

What 'Triggered' Actually Means When You Live With Chronic Illness

‘This triggered me.” “I was so triggered when…” Snippets like this float around me every day. And I cannot imagine what they mean. It is as if the English language that I speak is different from what my age group speaks. Granted, I’ve always loved old words and filled my speech with flowery language at [...]
Silhouette of woman sitting in bed holding her head

How Stigma Can Affect Support Given to Those With Migraine

Last month, my chronic migraine support group discussed stigma. I didn’t think I’d have much to contribute. I have supportive family and friends who have never questioned the severity of my condition. I have had amazing employers and co-workers who have made accommodations for me and supported me. I received private and Social Security Disability benefits the first time [...]