book review: The Migraine Brain

Published just last year, The Migraine Brain: Your Breakthrough Guide to Fewer Headaches, Better Health, by Carolyn Bernstein, MD, and Elaine McArdle, has gained quite a bit of publicity, being featured on The Today Show and NPR, as well as winning a number of awards. In fact, I had to wait almost a month to get a copy of this book through my local library.

The best part of the book is probably expressed in the book flap introduction:

You know that your migraine isn't just a headache. But you may not know that migraine actually is a neurological disease. ... it's a debilitating, complex, and chronic condition that manifests in a combination of symptoms that can include excruciating head pain as well as other distinctive physical and emotional effects. Yet it's also a disease that you can get control of, improve, and manage ...

It is refreshing to find a publication with such wide reach finally referring to Migraine as a neurological disease. Other positives include:

• Discussion of how the Migraine brain is different from a non-Migraine brain;
• Description of the four phases of a Migraine attack;
• Explanation of the importance of identifying triggers;
• Focus on a three-pronged treatment plan: prevent, abort, rescue;
• Exploration of various treatments, including complementary treatments; and
• Review of the components of an effective wellness plan.

The negatives, however, would make me reluctant to recommend this book to other Migraine sufferers.

First, Dr Bernstein gives only a passing mention to Status Migrainosus (also referred to as Status Migrainous), saying, "... it can be serious. If you get a migraine that lasts more than seventy-two hours (three days), you should seek medical attention, not only to ease your pain but also to ensure you don't become dangerously dehydrated due to vomiting, inability to hold down liquids, or diarrhea" (23). Where is the mention of increased stroke risk? It gets worse: "... 'status migrainosus', a severe migraine that can last over a week. It isn't necessarily dangerous" (66). In fact, the word stroke is not mentioned on the same page as status migrainosus even once in her book.

Second, Dr Bernstein's terminology is not consistent with the International Headache Society's International Classification of Headache Disorders. She uses a number of outdated Migraine terms, including complicated Migraine, ocular/ophthalmic Migraine, basilar Migraine and Migraine equivalent. Her brief descriptions of the various Migraine types also do not match up with the IHS's classification described in detail on MyMigraineConnection.

Third, she overemphasizes the risk of addiction to pain medications, while underemphasizing the risk of Medication Overuse Headache (MOH). In fact, she refers to MOH as rebound headache, another outdated term. She also does not draw a clear distinction between addiction and MOH. Since many Migraineurs end up in MOH cycles, the lack of a clear explanation of this serious problem is worrisome.