The challenge of describing a migraine

Abstract

the medical profession’s lack of progress, so contemporary lyricists and musicians appear similarly disappointed. Thus, the International Contemporary Ensemble, in Sometimes a migraine is just a migraine, describes a symptom and records a medic’s uninspiring response: ‘Feels like there’s a mass that’s smashing up against my skull, all you think to ask is is it sharp or is it dull’. Roberts and Vargas’ most surprising finding was that although migraine is particularly prevalent among younger women, 89% of the recording artists were male. And in a bleak comment the authors divulge that ‘[o]nly 9 songs (11%) made any reference to successful treatment, resolution or hope of any sort …’. Perhaps there may be grounds for cautious optimism where treatment is concerned. For instance, in a recent trial, Silberstein et al (2014) reported encouraging results in the treatment of chronic migraine patients with onabotulinumtoxinA (OBTA). They found not only that almost 50% of 688 OBTA-treated patients had a greater than half reduction in headache frequency, but they concluded that ‘[a] meaningful proportion of patients with chronic migraine treated with OBTA who did not respond to the first treatment cycle responded in the second and third cycles of treatment, respectively.’ However, treatment comes with its own ethical territory, a landscape which needs to be navigated with sensitivity. For example, in 1999 a 14-year-old male was admitted to hospital in California after being diagnosed with moderate-to-severe migraine. Originally prescribed morphine for pain relief, this was replaced with saline by his doctor, who told neither the boy nor his parents. When the patient’s pain became unbearable the doctor told the parents what he’d done. As Tucker (2001) notes, when the boy’s mother lodged a complaint against the doctor, and the nurses who administered the pla