Chronic Migraine and Epilepsy Study: Stigma Still Attached

The extent to which patients experience stigma was similar for those with chronic migraine and those with epilepsy and greater than that for those with episodic migraine in a study conducted by Young and associates in the Department of Neurology at Thomas Jefferson University in Philadelphia.

Stigma correlated most strongly with inability to work and was greater for chronic migraine than for epilepsy or episodic migraine because patients with chronic migraine had less ability to work.

The researchers studied 123, 123, and 62 patients with episodic migraine, chronic migraine, and epilepsy, respectively, in a clinical setting to investigate the extent to which stigma attaches to migraine.

Patients with migraine and those with epilepsy completed a demographic questionnaire; the stigma scale for chronic illness (SSCI), a 24-item questionnaire suitable for studying chronic neurological diseases; and the short form of the medical outcomes health survey (SF-12). Patients also completed a rankable series of questions on their actual or potential disability.

Patients with migraine completed the migraine disability score and answered a rankable series of questions on the degree of resting necessitated by their headaches; patients with epilepsy completed the Liverpool impact of epilepsy scale.

Study results included the following:

• Patients with chronic migraine had higher scores on the SSCI than patients with episodic migraine or epilepsy.

• Patients with migraine reported greater inability to work than those with epilepsy.

• Stigma correlated most strongly with the mental component score of the SF-12, followed by ability to work and migraine disability score for chronic and episodic migraine and the Liverpool impact on epilepsy scale for epilepsy

• Ability to work was the strongest predictor of stigma as measured by the SSCI.

Of the patients with epilepsy, 33.9% had a history of surgery, 3.2% had a history of both surgery and vagus nerve stimulator insertion, 1.6% had a history of vagus nerve stimulator insertion, and 61.3% did not have any history of surgery or vagus nerve stimulation.

Chronic migraine was shown to incur more stigma than epilepsy but only because in their sample patients with chronic migraine experienced more disability and were less able to work, according to the authors. Chronic migraine incurs more stigma than episodic migraine even when all factors are taken into account, perhaps because episodic migraine aligns best with public perceptions of the disease.

The authors noted that theirs is the largest study of stigma in migraine; the first study of stigma in migraine that uses validated scales, including the SSCI; and the first study of stigma in migraine in the United States.

They suggested that stigma has important public health implications that ought to be addressed through education, advocacy, and legal and policy interventions; at the organizational level, through training programs for clinicians; and at the intrapersonal level, through counseling, therapy, support, and empowerment programs.