THE MIGRAINES DILEMMA

Ever since Michele Bachmann came out with her news on July 20th that she has incapacitating and debilitating migraines, everyone has been putting his oar in about the subject.

Me included. I have an article about it in Philadelphia’s “Broad Street Review”.

Predictably, there was a piece about migraines on July 26th in The New York Times Health section (“Migraine Miseries Push Patients in Ways of Coping” by Tara Parker-Pope).

As is to be expected, most people are defending the right of people with migraines to run for president on the grounds that migraines are treatable, and controllable with proper medications.

Migraines are treatable. But they can't be controlled. And there is no such thing as proper migraine medications.

There are diseases and conditions that are treatable and controllable and/or cured with proper medications: Diabetes, Hansen’s (leprosy), transplanted organs, epilepsy, psoriasis, some forms of cancer in some stages, lupus, MS in the early stages, HIV/AIDS and on and on.

But Lou Gehrig’s disease? No. Depression, anxiety and bipolar disorder? Yes, until the person goes off his meds or until the meds don’t work anymore. And then we have migraines, the disease that is now Number One on the “Defend This Disease” list.

Anyone (like me) writing about migraines and the fact (yes, fact) that no one with migraines should run for president, is not saying that migraine-sufferers are less worthy than the rest of the population.

What I am saying is this: Look at the disease and how it acts. All you doctors who are so hotly defending the medications available for migraines, take an honest look at what is happening to all the patients who are getting the best possible treatment for migraines. And what does one find?

One finds that doctors don’t know much about migraines. One finds there is no way to properly treat and control migraines. One finds that anyone afflicted with severe migraines will still have severe attacks of migraines no matter what medication is given.

One finds that most doctors who are treating migraines do not have migraines themselves. And I am not suggesting that any surgeon performing appendectomies should have performed an appendectomy on himself.

However, with migraines and the fact (yes, fact!) that so little is actually known about the malady, it would be helpful and instructive for the doctors who are treating migraines with such confidence and assurance, to at least know something firsthand about the disease they are treating.

Yesterday’s NYT column reported that, “Some migraine sufferers, including Ms. Bachmann, experience pain so severe they go the emergency room. But a recent review of emergency room doctors in Ontario found that patients were rarely treated with the proper drugs for migraine, according to a report last month in the journal Pain Research & Management…The data suggests that more education is needed.”

Well, that sounds fine and dandy. But the fact is (yes, fact), all drugs given for migraines are on a trial-and-error basis. To even suggest that there is a “proper” regimen, that there is a “proper” drug or combination of drugs, that there is a “proper” life-style that will keep migraines at bay is the worst kind of sophistry and fallacious hogwash.

 

There is no proper way to treat migraines. Whatever works, works. But anyone with migraines knows any treatment will not work all the time--it may work once and never again, and when it’s the worst possible time for a migraine to attack, that is when it will hit and that is the moment the drugs of choice--the oh-so-proper-combination--will not work.

In the NYT article, assistant professor of neurology at the John Hopkins Headache Center Dr. Satnam Nijjar, said, “If it’s not well controlled with the right combination of preventative or acute therapy, it can be very disabling. It’s probably the most common cause for time missed from work in the U.S.”

And Robert Dalton, executive director of the National Headache Foundation in Chicago, said that while migraines can be impairing, the larger problem is that many sufferers aren’t getting proper medical care. “What we want to make sure people understand,” Dalton said, “is that it’s a debilitating disease when it’s not managed properly.”

Nijjar and Dalton are just fooling themselves and desperately trying to fool you and all people who want to believe there is a way to properly manage migraines so that they don’t control one’s life.

There isn’t. At this point in time, there is no perfect, proper drug or combination of drugs and regimen for the management of migraines. Some drugs work some of the time, some drugs work for some people, some people take epilepsy drugs, some people stay away from bright lights, some people can’t drink red wine. But everyone who has severe migraines knows the day will come when they will be incapacitated and they simply will have to give in to their affliction, no matter what drugs their doctor deems proper.

And let it be said, it’s a rare doctor (and a rare patient with plenty of health insurance and cash in the bank) who will give a patient all the time he needs to explain the varied symptoms of migraines. More than a few doctors get really fed up with people whose migraines don’t succumb to the doctor’s drugs of choice, and more than a few doctors get really fed up with people with migraines.

So, at long last, here is my point.

Doctors may not want to tell you straight out and honestly, but, this is a fact: If we elect a person who has severe migraines to be our president, there will be a day when that president will have to abdicate his power to a lesser light because his migraine medications aren’t working and he is having a severe attack.

That is the day that president will be hugging a commode, vomiting his guts out, with a blinding headache and begging for relief or death. Or he will be in the hospital, sedated and uncomprehending. 

In either scenario that president will not be able to transact White House business. And we who elected him will have had prior knowledge that the day would come, as surely as death, taxes and migraines, when a severe migraine would incapacitate, debilitate and cause that president to be useless.