CLI NI C AL I N SIGHT
Sponsored by Eli Lilly and Company
Changing Misperceptions
About Migraine to Address
Stigma to Improve Care
L
iving with an invisible yet debilitating condition comes
with a unique set of challenges. For the more than 30 mil-
lion adults living with migraine in the U.S., those challenges
are amplified by a general lack of understanding in our society
about this complex neurologic disease.1 Many aren’t aware that
migraine is much more than a bad headache or the extent of
the impact migraine can have on everyday life. Ultimately, these
misperceptions can negatively impact migraine care and out-
comes for individuals living with migraine.
Understandably, many may feel the need to put on a
brave face and push through the pain even as they poten-
tially experience migraine-related stigma from coworkers,
friends, and family. Eli Lilly and Company’s OVERCOME
study—the largest population-based web survey of its kind
in migraine and, to our knowledge, the first to examine
migraine-related stigma at a population level—found that
more than 40 percent of individuals without migraine who
knew at least one person with migraine felt that it is used
as an excuse to avoid family, work, or school commitments,
and almost 1 in 3 people believed those with migraine make
things more difficult for their co-workers.2 On the con-
trary, the study revealed that approximately 1 in 3 people
diagnosed with migraine believe they have experienced
migraine-related stigma often or very often and that others
minimized the burden of migraine or that others viewed
migraine as being used to obtain or avoid something.3
The migraine-related stigma individuals face may cause
them to downplay their symptoms. Among those who experi-
ence migraine symptoms, approximately half hesitated to seek
care for migraine for a variety of reasons, including concerns
their migraine would not be taken seriously and not believing
their migraine attacks were serious or painful enough. 4 And
of those who seek care, many are not receiving the treatment
or care they need. In fact, half of those seeing a neurologist for
migraine did not discuss impact at their most recent visit.5
Because stigma may lead individuals to minimize the
impact migraine has on their lives, even in conversations
with their care team, there must be a renewed focus on
effective provider-patient conversations and an effort to dis-
2  CLINICAL INSIGHT NOVEMBER/DECEMBER 2022
cuss symptoms, impact, and treatment outcomes every visit.
As a health care provider, it’s crucial to consider potential
issues that might interfere with effective communication and
help patients feel more comfortable sparking open and hon-
est conversations about migraine. Talking to your patients and
asking important questions such as how many days migraine
impacts their life, including the burden between attacks, can
lead to more informed treatment decisions. Asking such ques-
tions can also help health care providers when recommending
certain medications to a patient. Less than 1 in 3 individuals
impacted by migraine have sought care for migraine, or have
been diagnosed with and are taking recommended acute
medication for migraine.6 Among individuals who are candi-
dates for preventive treatment, less than 1 in 5 have sought
care for migraine, or have been diagnosed with and are tak-
ing recommended preventive medication for migraine7 (ie,
people with migraine are not receiving the care they need or
deserve). With consistent communication during every visit,
you can better help migraine patients determine a personal-
ized plan for managing their condition.
Although there is no one-size-fits-all approach, we, alongside
healthcare professionals and people living with migraine and
their loved ones, can help support the migraine community.  n
To learn more about the OVERCOME study and addressing
stigma to improve care, please visit Lilly.com.
©Lilly USA, LLC 2022. All rights reserved.
1. Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive therapy.
Neurology. 2007;68:343-349.
2. Shapiro R. et al. Stigmatizing attitudes about migraine by people without migraine: results of the OVERCOME study.
Headache. 2019:59(S1):14-16.
3. Shapiro R. et al. Migraine-related stigma and its influence on disability, interictal burden, and migraine specific quality of
life: results of the OVERCOME (US) study. Headache. 2022;62(S1):34-35.
4. Shapiro R. et al. Reasons for Hesitating to Consult for Migraine Care: Results of the OVERCOME (U.S.) Study. Poster
presented at: 63rd Virtual Annual Scientific Meeting of the American Headache Society (AHS), 2021; June 3, 2021.
5. Grosberg BM, et al. What patients report discussing during their most recent visit for headache with a neurologist or
headache specialist: association with being diagnosed with migraine. Headache. 2022;62(S1):48.
6. Hutchinson S, Nicholson RA, Vargas B, Samaan K, Zagar A, Kim Y, Pearlman EM, Buse DC, Reed ML, Ashina S, Lipton RB.
Seeking care, diagnosis, and acute prescription for migraine among those with headache-related disability: results of the
OVERCOME study. Headache. 2020;60(S1):132-133.
7. Ashina S, Nicholson RA, Vargas B, Samaan K, Zagar A, Kim Y, Pearlman EM, Buse DC, Reed ML, Hutchinson S, Lipton RB.
Identifying barriers to care-seeking, diagnosis, and preventive medication among those with migraine: results of the
OVERCOME study. Headache. 2020;60(S1):127-128.
PRACTICAL NEUROLOGY SPECIAL SECTION