Bachmann Migraine Story Underscores Lingering Stigma

Nancy A. Melville

July 22, 2011

July 22, 2011 — In a summer of unusually heated political turmoil and mudslinging from both sides of the aisle, the medical issue that has unexpectedly become caught in the crossfire seems somehow appropriate — migraines, and specifically, Rep. Michele Bachmann's migraines.

The GOP presidential candidate's migraines became big news this week following a report on the Daily Caller Web site that an adviser to Representative Bachmann (R-Minnesota) said the congresswoman suffers from "intense" migraines, that when she gets them "she can't function at all," and she "takes all sorts of pills" for the headaches.

Rep. Michelle Bachmann

Fueling further chatter on the issue was the report, confirmed to the New York Times by Bachmann's son, Lucas Bachmann, a medical resident at University of Connecticut, that his mother has observed an association between her migraines and wearing high-heeled shoes.

Although there have been no prominent studies linking high-heeled footwear with migraines, most experts agree that the suggestion is not beyond the fray and that just as migraine headaches affect individuals in varying degrees, their triggers can also run the gamut from certain foods, such as chocolate, to levels of light and even physical stressors, such as wearing high heels.

At the crux of the issue, however, is the bigger question of whether there is justification in the concern that migraines could indeed hinder one's ability to lead the country.

Fair Question

According to migraine expert Robert Shapiro, MD, PhD, a professor of neurology at the University of Vermont, in Burlington, the question is valid.

"I think it's a fair question, and it's a question that can be asked not just regarding migraines but any other disorders that presidents have actually had."

Migraines, which are more common in women, can range from mild, fleeting headaches to debilitating, nausea-inducing neurologic events and therefore can certainly affect a person's ability to perform up to par, he said.

"About two-thirds of women who have migraine will have a severe attack in any given month, and more than half, nearly 60% of those with physician-diagnosed migraine, can have attacks serious enough to reduce their productivity at work or school by at least half."

Among those calling Bachmann's migraines into question this week was rival Republican candidate and former Minnesota governor Tim Pawlenty.

"I certainly would defer to the judgment of the medical professionals, but setting that aside, all of the candidates, I think, are going to have to be able to demonstrate they can do all of the job, all of the time," Governor Pawlenty told reporters.

"If you're going to be President of the United States you've got to be able to do the job every day, all the time. There's no real time off in that job," he said.

In response to the comments and the assertion by Karl Rove, the political adviser to President George W. Bush, on Fox News that Representative Bachmann should release her medical records, the candidate produced a letter from Brian Monahan, MD, the attending physician for the US Congress.

In the letter, quoted in the Washington Post, Dr. Monahan describes Bachmann as being "overall, in good general health."

"Your migraines occur infrequently and have known trigger factors of which you are aware and know how to avoid," he wrote to Representative Bachmann. "When you do have a migraine, you are able to control it well, as needed with medication."

The response suggests Representative Bachmann's condition is manageable, Dr. Shapiro said.

"If we take Representative Bachmann's statements at face value that she has infrequent migraine events which are well controlled under the medications she's taking and the migraines are sufficiently infrequent in that she does not require daily preventive medications, then she may not have significant disability from this."

Migraines have in fact been associated with previous presidents, including Thomas Jefferson and Ulysses S. Grant, Dr. Shapiro noted. Interestingly, however, reports of migraines among more recent presidents are less prevalent — which may be more a reflection of better PR than fewer migraines.

"There's no question that there is a very significant stigma related to migraine," Dr. Shapiro said.

The main reason is likely that many simply don't believe migraines to be any worse than average headaches.

"Because headache is a nearly universal experience, many people infer that the experience of migraine is perhaps just as mild and tolerable as what they've experienced, and there are no distinctive physical findings among migraine sufferers to reflect otherwise," Dr. Shapiro explained.

"As a consequence, migraine has been interpreted historically more as a character flaw than as the brain disorder that we know it to be, and to make matters worse — it is associated with menstrual cycles, so it tends to be regarded as character flaw related to women," he said.

Nearly 20% of the population — men and women alike — will experience a migraine this year, however, so there's a good chance that, behind their raised eyebrows over the news of Representative Bachmann's migraines, a good number of the congresswoman's political rivals could have had raging migraines of their own.

"With the high prevalence of migraine, it's very likely that there are people in high office who have migraine right now, apart from Representative Bachmann," Dr. Shapiro said.

Positive Spin

Representative Bachmann's aides — and her physicians — are meanwhile in the awkward position of being pressured to put a positive spin on the story by downplaying the effect of migraines on the congresswoman while trying not to dismiss the potentially serious nature of the condition, said Brett Kessler, MD, a professor of neurosurgery at the University of Cincinnati, Ohio, and member of the American Academy of Neurology.

"It is tricky — as neurologists, we want to increase awareness about migraines, and so we release statistics about how common migraine is and how debilitating it can be, and those are true statistics," he explained.

"At the same time, the truth is people that recognize their migraines and are aware of them and get treatment can manage the condition.

"There are a lot of great treatment options for migraines," Dr. Kessler added. "Even if you have bad migraine headaches, you can abort them with the appropriate treatment, such as triptans, or take daily medicine to prevent them, or identify triggers to reduce them to where they are a minor issue."

Many neurologists meanwhile welcome the extra attention that Representative Bachmann's case has placed on migraines because, despite the fact that there is still substantial mystery surrounding migraines' true causes and only 1 innovative drug developed specifically for migraine treatment has been approved by the Food and Drug Administration (FDA) in 49 years, migraine research is woefully underfunded by the federal government.

"[There is] egregious underfunding of NIH [National Institutes of Health] research on migraine and headache disorders," Dr. Shapiro said. "This is a huge issue that affects the 60 million Americans that will have migraine this year."

Dr. Shapiro has disclosed no relevant financial relationships. Dr. Kessler has been a consultant for Allergan, maker of Botox, which has received FDA approval for the treatment of headache prophylaxis in chronic migraine.

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