Dr. Graham on Migraine Lifestyle

John R.  Graham on treatment for migraine

The New England Journal of Medicine November 10, 1955

Author's comment--John R. Graham was a headache expert who formed the Graham Headache Center in Boston in 1970.  For some time it was the largest in the United States.  He was a headache expert who has now gone on and this is a statement from an article he wrote in the New England Journal of Medicine in 1955 which I think is still timely for all migraine patients.

“It is important from the onset in prophylaxis that the physician, the patient, and the patient’s family have an understanding of the disease, the method of approach to the problem, and the limitations and duration of treatment.  All parties to the therapeutic program need to understand the following facts and behave accordingly:

That at present, there is no magic medicine or formula of treatment that universally “cures” migraine.

That the patient is “not to blame” for having inherited the migraine trait.

That the pain and misery of the migraine attack are very real and not “imaginary.”

That neither the patient, doctor, nor husband (or wife) should be intolerant, but rather all should work for better understanding of each other.

That the patient and family have the greater burden in therapy, and that the doctor is going to act as a friendly guide rather than as a “miracle man.”

That the whole program will require a considerable period, with frequent reviews of progress, temporary setbacks, changes of therapeutic signals and gradual re-education.

That the most rewarding long-term therapy will be concerned with adjusting the patient’s way of living to his or her capacities rather than with an endless round of medication.

That the patient cannot be expected to make all the necessary adjustments overnight.

That the changes in psychologic attitudes become real only through actual practice rather than through verbal instruction.

That there is definite hope for improvement through conscientious effort of both patient and physician, but that complete freedom from migraine is rarely achieved by any therapeutic program.

Errors in living

Presented below is a list of common deviations from hygienic living that many persons may well practice with impunity but that are frequently a source of headache to the sufferer from migraine.  Behind these errors in living lie attitudes in the patient that serve both to bring them about and to intensify the damage that they create.  Such errors may have to be arbitrarily eliminated at first, but as treatment progresses it is important and fundamental to ultimate success for the patient to gain insight into his attitudes and personality traits that brought them about and to attempt suitable alteration.  The errors are as follows:

Poor meals-skimpy breakfasts and lunches and large dinners eaten in a state of fatigue.

Irregular hours for meals.  Postponing lunch for an hour may give anyone a mild headache but may produce a bad sick headache for the migraine patient.

Morning deadlines.  Too little time is allowed between the rising hour and the scramble for school and the office.

Sleeping late on Saturdays, Sundays and holidays.  The patient with migraine needs a good deal of sleep-but not in the morning.  Excessive cerebrovascular dilatation probably takes place, and breakfast is delayed.  Conversely, getting to bed early is important since, to date, the only real cure for fatigue is rest.

Lack of breaks in the day.  A short rest in the morning and afternoon, regularly obtained, is helpful.

Overcrowded schedules.  Patients usually try to work in too many events in a day.  They need to spread their activities more evenly over several days.

Failure to take proper vacations.

Failure to get away from their own children periodically.

Excessive participation in community and church activities.

Over anxiety regarding preparations for guests, shopping trips and vacations.

Long automobile trips.  The migraine patient usually wishes to go 500 miles in one day and ends up with a headache.

Acting as Chairman, because nobody else will accept.  Migraine patients do not delegate work to others.  They do it all themselves.

Making up for lost time.  As soon as the patient is over one attack, she usually rushes to repair her losses.  Consequently, the next attack comes sooner.

Suffering petty wrongs in silence until they mount to unbearable heights.  It would be better to settle differences while they are small.

Aiming for impossible goals and worrying when they cannot be obtained.

Lack of exercise.

Lack of recreation.”