Starting the conversation about stereotypical images of migraine and how they impact the community
When you think of migraine, what images come to mind? Powering through a work meeting because you can’t take another sick day. Rubbing your shoulders to relieve the tension. Going about life looking “normal,” but battling a disabling disease inside, a disease that affects millions of men, women and children all around the world.
A study published in the Headache® Journal found most people migraine view the disease through stereotypes. “The Stereotypical Image of a Person with Migraine According to Mass Media,” examined stock images of the search term “migraine” to explore how people with migraine are portrayed.
We sat down with Dr. Rashmi Halker Singh, a headache specialist at Mayo Clinic and member of the AMF’s editorial board, to discuss the implications of what the researchers found and how people living with migraine can help reverse this portrayal.
After examining almost 300 of the most popular stock images, researchers found that the most common image of migraine was an adult white woman with an ectomorph (meaning thin) body type. The majority of images portrayed migraine through stereotypes, with the subject’s eyes closed and hands on both temples. The researchers point out that this is an inaccurate portrayal of migraine. The pain isn’t always bilateral. It often resides on one side of the head and also around the neck and shoulders.
Migraine is an unpredictable disease that affects millions of people and strikes at any time. So it stands to reason that there’s no one image of migraine. “Migraine can affect all people. It doesn’t really matter what your background is,” says Dr. Halker Singh. “If we represent only one demographic in imagery, that excludes a lot of people from the conversation, and that’s a problem.”
Under-recognition of Migraine
“One of the big barriers to diagnosis is under-recognition,” says Dr. Halker Singh, and the inaccurate representation of migraine in mass media can contribute to the under-recognition of the disease. Imagine looking up “migraine” because you suspect that your recurring headaches are actually migraine. You only see pictures of people who look nothing like you in terms of gender, age and race. You might be less inclined to think that you have migraine and not seek the help you need.
The types of people represented in the photos could lead to misunderstanding about who migraine impacts. For example, children made up just 2% of people pictured in the studied images. But we know that migraine affects 10% of children, a much larger proportion than the imagery suggests. The authors note that the gender breakdown (82% women and 18% men) is in line with large population studies of migraine. But the overwhelming number of women pictured reinforces the long-held notion that migraine is a “women’s disease.”
“Men experience migraine too, and their experience is completely discounted by portraying it this way,” says Dr. Halker Singh.
Making Light of the Migraine Experience
The inaccurate portrayal of migraine also makes light of the problem and adds to migraine stigma. The photos studied overwhelmingly showed subjects with their hand or hands to their head. “If I have a migraine attack, I’m not just going to sit here with my hands like this,” says Dr. Halker Singh, who lives with migraine. “Depending on the specific attack, I might be able to function and work. I might be calling in sick, I might be just feeling miserable and trying to get on with my day. I might be irritable, I might be canceling plans with friends. It just totally depends.”
Another difference between the studied images and reality is the overrepresentation of people in informal attire (71%). The burden of migraine peaks during the most productive years of life, when individuals are trying to advance in their careers. The lack of pictures of people in work attire conceals the fact migraine is a huge problem in the workplace. It also ignores that many people go to work during an attack out of fear of stigmatization and career setbacks.
Despite advocacy efforts throughout the community, migraine is often misunderstood because of these stereotypes. Just two years ago, Elle magazine and others wrote about the “migraine pose,” which involved putting your hands on your temples and pushing up “as if you had a, well, migraine.” The pose was lauded for tightening the face, emphasizing cheekbones and drawing attention to manicures, but it outraged the migraine community for trivializing what was for many, a real and painful experience.
“I think it trivializes the disease and it puts up another barrier to understanding because there’s a lot of misconceptions about what migraine is and there’s a lot of stigma,” says Dr. Halker Singh.
What’s Next for Migraine Representation
It’s important that media portrayals of migraine are accurate and legitimizes the disease for what it is instead of through stereotypes. Dr. Halker Singh thinks this research started an important conversation about what representation looks like now. Hopefully, the discussions will direct what it should in the future. “I’ve been in headache medicine for about a decade now and this wasn’t a conversation that we were having way back when I was training,” she says. “To have a study published in Headache®, a respected medical journal, that brought a lot of these things into our forefront and made it really important.”
Doctors, educators and patients all have a role to play when it comes to making migraine more representative of the people it affects and how it affects them. “A lot of this is unconscious,” she says, “We see a lot of these images, but we don’t always think about them.” As a headache specialist and educator, Dr. Halker Singh is mindful of the patient she references in her presentations and the images that she chooses. This is to remind other providers that migraine affects all kinds of people.
As a person with migraine herself, she believes that patient advocates can help show the rest of the world what it’s like to live with migraine, and encourages those who feel comfortable to share their story publicly or with their friends and family. “I think showing the true face of migraine is really important to help combat that stereotype and open up people’s minds as to the fact that migraine really does affect everyone.”