Thank you for your article about migraines – a maligned, misunderstood condition (The truth about migraines: what causes them – and how to find relief, 19 July). But framing it around the headache understates what it is: a systemic neurological event in which head pain is only one component.
For me, until perimenopause, the head pain was minor. The disabling symptoms were profound fatigue, body aches and cognitive fog, which dominated even the “prodrome”. This is why my migraines went undiagnosed for decades, blamed on a “poor immune system” rather than a neurological disorder.
The piece also underplays how little control sufferers have. Telling patients to manage their triggers ignores those navigating puberty, or women whose reproductive years bring hormonal shifts entirely beyond their control. Many face a predictable menstrual attack plus a second at ovulation, which in severe cases can consume up to half the month. In perimenopause, hormonal triggers can be daily; the nervous system responds by lowering the threshold until attacks come ever easier. I’ve had daily migraine for over two years, prodrome and postdrome overlapping without pause.
This is also why migraine cannot be left to neurologists alone. When the driver is fundamentally hormonal, gynaecological care matters – yet very few gynaecologists understand the migraine brain, and some prescribe perimenopause treatments that actively worsen it.
With regard to treatment, gepants have been transformative, and GPs can now prescribe Rimegepant where triptans fall short. Yet access remains a postcode lottery.
Migraine is not a banging headache. Until medicine treats it as a genetic, multi-system condition, sufferers – disproportionately women – will keep getting dismissed, even though treatment is available.
Sarah Khan
London
While all the new research pathways are interesting, the most important thing is go and talk to your GP; don’t suffer in silence trying to self-manage, avoiding triggers. For me, it was only after years that a pain management consultant finally said: “Why has nobody ever prescribed you triptans?” Now I get on with life the best I can, with some emergency tablets in my pocket.
Rab Hallett
Edinburgh
