Overview
This lecture explores the concept of stigma as it relates to migraine, its types, impact on patients, measurable consequences, and strategies for reducing stigma in society and healthcare.
Understanding Stigma
- Stigma is a social process where certain attributes or diseases are considered deeply discrediting and lead to social sanctions.
- Migraine stigma manifests in medicine, society, and even among healthcare professionals.
- There are three types of stigma: structural (laws, policies), public (prejudice, discrimination), and self-stigma (internal shame, disengagement).
- Structural and public stigma can lead to self-stigma, resulting in depression and avoidance of treatment.
Measuring Migraine Stigma
- Migraine is among the most stigmatized of all chronic and neurological diseases.
- Studies show chronic migraine patients experience more stigma than those with episodic migraine or epilepsy.
- Stigma is strongly associated with disability and reduced mental well-being, more so than physical symptoms alone.
Public Perceptions & Predictors of Stigma
- A significant proportion of non-migraine sufferers believe migraines are easily treated or for attention-seeking.
- People familiar with migraine sufferers (family, coworkers, past sufferers) often hold more stigmatizing attitudes.
- Stigmatizers are more likely to be male, non-white, younger, have low empathy, fear pain less, and have lower income.
- Stigma is present globally, with the US and UK showing higher levels than countries like France or Japan.
Consequences of Migraine Stigma
- Migraine receives disproportionately less research funding compared to its actual disease impact.
- Patients with migraine are less likely to apply for, and get, social security disability compared to the level of disability experienced.
- Stigma exacerbates pain and disability, creating a negative cycle of worsening symptoms and internalized stigma.
- Less stigma results in more advocacy and funding for the disease.
Reducing Migraine Stigma
- Public disclosure and awareness can help reduce stigma, modeled after other illnesses.
- Empathy and understanding disability are crucial for changing attitudes.
- Labeling migraine as a "brain disease" may not reduce stigma; strategies should be carefully studied.
- Successful anti-stigma movements are typically led by patients, not physicians.
- Reducing stigma requires targeted efforts at structural, public, and self-stigma.
Language and Framing
- Preferred terminology: "migraine" (not "migraines" or "migraine headache"), and "person with migraine" (not "migraine sufferer" or "migraineur").
- Avoid terms like "medication overuse headache"; use "rebound headache" or "medication adaptation headache" instead.
- Naming migraine as a disease is recommended by patient coalitions to affirm legitimacy while avoiding unnecessarily medicalizing or stigmatizing language.
Key Terms & Definitions
- Stigma — Social disapproval and discrimination against individuals with particular attributes or conditions.
- Structural Stigma — Stigma embedded in policies, laws, and institutional practices.
- Public Stigma — Societal prejudice, stereotypes, and discrimination.
- Self-Stigma — Internalization of public or structural stigma, resulting in shame and reduced engagement.
- Chronic Migraine — Frequent migraine attacks, often associated with higher disability and stigma.
- Episodic Migraine — Less frequent migraine attacks, typically with less stigma.
- Enacted Stigma — Direct experiences of discrimination or prejudice.
- Internalized Stigma — Acceptance and absorption of negative beliefs about oneself.
Action Items / Next Steps
- Review and use appropriate language when discussing migraine.
- Increase empathy and awareness in personal and professional settings.
- Consider patient-led advocacy as a strategy for stigma reduction.
- Study and support interventions aimed at self-advocacy and reducing internalized stigma.