By Dr. William B. Young
When someone says, “My migraine is caused by stress (or the weather, or menses, or red wine),” they are wrong. They are trivializing and damaging people who have a serious disease. Don’t let them get away with it.
There is a difference between a trigger and a cause. A trigger starts something that is primed to happen; while a cause is the reason for something to happen. A trigger is a small thing, and in the case of migraine ignores the things that are most important about why migraines happen. When a person does not make the distinction between trigger and cause they are harming themselves and other people with migraine.
If I said my leg broke because I stepped on it too hard there might be a certain truthfulness to it. But, if I neglected to say there was a tumor with the consistency of Jell-O that had replaced 99% of the bone where it broke, I would be neglecting a much more important truth about my condition. When you let someone (maybe yourself) get away with thinking of migraine as caused by a trigger, it either makes it your fault (you ate that cheese after all) or hopeless (you are screwed; you can’t control the weather). It is like blaming a driver hitting a pothole on a road that has millions of them. It would be better to blame the road; then maybe it would get fixed.
I am not saying one shouldn’t manage stress, sleep better, and avoid certain food triggers. These are simply not causes. Migraine is a serious brain condition caused by things going wrong in the brain and pain nerves. The cause is complicated, argued about, and worth spending hundreds of millions of dollars to understand better. The cause of migraine includes genetic factors, brain remolding from exposures, and physical and other injuries that occur over a lifetime. In truth, it is hard to explain, and that is why it is difficult to get away from the oh-so-easy (but wrong) mind trick of flipping trigger and cause.
So let me suggest that the next time someone makes this mistake in your presence you say: “____ is just a trigger. You can’t live a real life and avoid all or even most triggers.” Be prepared for the question, “So what causes migraine?” My suggested answer is: “Migraine is a genetic and acquired predisposition of the brain’s pain, nausea, and light sensitivity centers to turn on together and incapacitate a person.” A nice flourish might be to add, “Do you realize it is the seventh most disabling medical condition? Mixing up trigger and cause belittles what is often a very serious disease.” Then turn it back to the perpetrator and ask them to use the word trigger if that is what they mean, not cause.
The words we use matter. They help to determine how migraine is framed in subtle and often quite negative ways. This little effort might do a great deal to change the way migraine is perceived. So please, take the pledge: “I will never let someone get away with mistaking trigger for cause.”]]>