Why every physician should have a migraine

September 4, 2009

Over the many years of my medical practice, it has repeatedly occurred to me that we might be better caregivers if we had a more visceral rather than purely intellectual understanding of what our patients are experiencing.

"How many babies have you had?" she asked. "This hurts. Give me the pain medication!"

I realized immediately that her life experience trumped my book learning. I ordered more medication for her.

So without wishing terrible disease and suffering for all of my colleagues, I humbly offer the following six suggestions, which might help us to do a better job.

EVERY PHYSICIAN SHOULD HAVE A MIGRAINE

I do have migraines, and if you are lucky enough not to have them, believe me that no textbook explanation comes even close to capturing how terrible a good migraine can be.

First of all, you feel like you are going to die. No matter how many articles you have read, even a physician like me finds it impossible to believe that pain this severe can happen without a space-occupying lesion in the brain.

Second, you want to die. The pain is that bad.

Third, you cannot control your behavior. You grimace, gag, speak incoherently, and flop around. That is why patients with migraines can be categorized as drug-seeking or crazy; trust me, they are neither. In the midst of a severe migraine, you just can't control your behavior. Fortunately, there are now good agents for treatment and prevention of migraines, but my own experience has taught me how severe the pain can be even in the absence of structural disease-and how emotionally overwhelming such pain can be.

My own experience as a migraine sufferer has given me a better respect for pain and the impact it can have on our patients. You have pain? I will deal with it.