Migraine Headache Severity

Recently one of the Facebook groups for migraine headaches and occipital neuralgia contained and interesting post.  A migraine headache patient began by saying that she did not mean to insult anyone, but she could not understand how some migraine headache sufferers could have severe pain and still go about their lives.  She alluded that such patients could not really be having bad migraines since anything above a 4 or 5 put her in bed and she could not function with this or more severe pain.

As a surgeon, I see every day how pain is subjective.  Whenever I am discussing surgery with a patient, one of the questions is always something like “how much does it hurt?”  This is a very difficult question to answer, akin to “How much salt do like on your food?”  Everyone takes pain, and salt, differently.  I have done very similar operations to two different patients on the same day, and when I saw them the following day for their postoperative visit, one patient was crying in pain, and the other said she could hardly feel a thing.

It’s hard to understand someone else’s pain.  Imagine you have never had a migraine, and you were trying to understand how much pain a migraine headache produced.  How could you be expected to understand?

Similarly, different migraine headache patients tolerate and experience pain differently.  I can tell you that as a migraine headache sufferer, I have had severe migraine headaches where I wanted to just die.  In my general surgery residency, I had headaches like that while I was doing a liver transplant or an open heart surgery. At that moment, I couldn’t just die, and in fact I couldn’t just take a break or a moment to myself, because the patient’s life was on the line if I was not giving the operation my best.  That does not mean my pain was less severe, or more bearable than anyone else’s.  I had put myself in a situation where getting into a dark room and going to bed was just not an option.

For those who do get severe pain that lands them in bed, I sympathize with you just as much.  Pain can be a horrible thing for so many patients.  Some very brave, very driven, and very strong migraine patients I know have been simply put down by a severe bout of migraine headache.  But a single mother working to feed her children with a severe headache may not be able stop to take time for herself. If she needs to do what she must to maintain her family, she should not be thought of as having any less severe pain than another migraine patient.  We all feel things differently, and importantly we all deal with severe pain in different ways.

Lets continue to support each other, and try to understand that the subjectivity of migraine headaches makes it hard for anyone to understand exactly what another migraine sufferer is going through.

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