Bachmann, Migraine and Work Impairment

There has been recent interest in the issue of migraine and work impairment related to Michele Bachmann, a candidate for the Republican Party in the 2012 presidential election.  Bachmann has acknowledged that she suffers from migraine headaches.  The attending physician to Congress released a letter stating representative Bachmann's migraine headaches are infrequent, related to known triggers and managed on as needed medications including sumatriptan and ondansetron.

This issue prompts a review of some the key elements in the epidemiology of migraine.  Migraine is a common disorder with prevalence rate estimates of 18% in women and 6% in men.  The female predominance is noted beginning in adolescence.  Prior to puberty, boys and girls have equal prevalence rates.

Below is a chart that examines the prevalence rates for migraine across the life cycle.  The rates suggest a significant decrease in prevalence after age 50.  If you are going to make the claim migraine excludes someone from taking on important roles, you will be excluding many individuals, the majority being women during their key ages of work productivity.

Triggers for migraine headaches include:

• Change in sleep pattern (reduced or increased sleep time)
• Weather/weather changes/temperature changes
• Menstrual cycle phase or hormonal issue
• Alcohol (beer and red wine)
• Psychological stress
• Sensory stimuli (noises/lights)
• Foods including MSG, aged cheeses and chocolate
• Caffeine or caffeine withdrawal

The level of work impairment is attributed to migraine will be dependent on the frequency and the severity of the each migraine headache.  There is a great deal of variability in the frequency and severity of migraine headaches.  Studies estimate that up to 60% of individuals with migraine experience one or fewer attacks per month.  An additional 15% report two to three migraines per month with the remainder (25%) experiencing four or more attacks monthly.

Whether experiencing few or many attacks, the majority of individuals with migraine report some or significant headache-related impairment.  It is not uncommon for individuals with migraine to require a period of rest in a dark environment while medications are used to abort the attack.

Medication treatment options typically focus on attack treatment or prevention (or reducing the frequency) of migraine attacks.  Preventive treatment strategies typically are commended for those with more frequent and more severe attacks.  Representative Bachmann's medication fall in the attack treatment category.

Although individuals with migraine may require temporary work restrictions, they can be awakened if sleeping and make decisions.  This is pretty analogous to people without migraine who are required to be awakened to make urgent decisions during the course of sleep.

Successful women who have migraine have demonstrated their ability to succeed in the face of the condition.  There is no research evidence to support migraine as a contraindication to pursuing or performing important leadership roles. 

Listing of triggers for migraine from the Mayo Clinic website.

Figure is author original generated from data provided in the Buse et al manuscript.

Disclosure:  The author of this post has contributed small donations to presidential election campaigns of Barack Obama, Mitt Romney and Michele Bachmann.

Bigal, M., & Lipton, R. (2009). The Epidemiology, Burden, and Comorbidities of Migraine Neurologic Clinics, 27 (2), 321-334 DOI: 10.1016/j.ncl.2008.11.011

Buse, D., Rupnow, M., & Lipton, R. (2009). Assessing and Managing All Aspects of Migraine: Migraine Attacks, Migraine-Related Functional Impairment, Common Comorbidities, and Quality of Life Mayo Clinic Proceedings, 84 (5), 422-435 DOI: 10.4065/84.5.422