People act like I get migraines because I’m pissed off and sad and don’t exercise enough, but I actually am pissed off and sad and don’t exercise enough because I get too many fucking migraines.
The framing of research on migraine co-morbidities kills me. People with migraine, especially chronic migraine, tend to have a bunch of other problems, like anxiety, depression, fatigue and sleep problems. Fatigue is just a straight up symptom of migraine and perhaps you, not being a migraine researcher, would think it is too obvious to even mention that being in near constant pain that is exacerbated by things like the noise and motion of your daily commute – not to mention the sound of your own goddamn heartbeat – makes people fucking miserable and exhausted and unable to sleep well.
So you might think that a study on whether a drug that makes people’s migraines better also reduces the “common co-morbidities” of migraine would never have a chance of getting published because it’s equivalent to asking “does fixing a broken leg also help you walk?”
Most migraine articles (and the people writing them) seem to assume either that those “co-morbidities” are independently occurring problems in migraine patients or even that patients get migraines because they are anxious, depressed, fatigued, or sleep deprived. So when I saw the headline OnabotulinumtoxinA Effective in Reducing Depression and Anxiety Symptoms in Chronic Migraines, I was torn between rolling my eyes until they got stuck in the back of my head so I never had to deal with another headline that was blatantly pandering to the stock price of Allergan at the expense of my healthcare – and – writing an angry screed about the gendered stigma of migraine and the soul crushing experience of trying to get access to like, life, in the face of it. Because botox does not and cannot treat anxiety, depression, fatigue, and insomnia.
But then I made it through the whirling cesspool of my emotions and realized that despite the headline,the paper is actually pretty strong evidence that the fatigue I experience isn’t happening independently of my migraine. And the depression from being in constant pain and excluded from work and social spheres isn’t causing my migraine.
Because botox does not and cannot treat anxiety, depression, fatigue, and insomnia. If botox fixes migraine co-morbidities, that’s because migraine causes them and botox reduces migraine attacks.
So the next doctor or acquaintance who pushes anti-depressants or sedatives or yoga or meditation or cognitive behavioural therapy on me when I actually need something to soak up all that CGRP my nerves are pumping can go fuck themselves.
There are real feedbacks between migraine symptoms and effects and migraine attacks, but the best point of intervention is at the starting point – the goddamn fucking migraine, not my fucking feelings about migraine.