Migraine is not a headache. That sentence needs to be said plainly, because the trivialization of migraine — in clinical settings, in workplaces, in families — is part of what makes this condition so difficult to navigate.
Migraine is a complex neurological disease affecting approximately 39 million people in the United States. Women experience migraine at approximately three times the rate of men. The relationship between hormonal fluctuation and migraine triggers is well-documented, yet most women with migraine report that this connection was never explained to them — not by their family doctor, not by their OB-GYN, not by the neurologist they eventually reached after years of inadequate care.
Alia Markman’s experience follows a pattern that is frustratingly consistent among women with migraine: years of symptoms that were not recognized as migraine, treatments that were inadequate because the diagnosis was delayed, and a clinical environment in which she had to repeatedly advocate for herself to be taken seriously.
The Diagnosis Delay
“I kept being told it was stress,” Alia recalls. “I was told to drink more water, to sleep more. Nobody looked at the pattern.”
The pattern — migraine attacks that correlated with her menstrual cycle, that had begun to increase in frequency, that were affecting her ability to work — was not invisible. It was simply not being looked for. The diagnostic criteria for migraine are clinical; there is no biomarker test, no imaging finding. Diagnosis requires a physician who asks the right questions. For Alia, that physician took years to find.
What Changed
A referral to a neurologist with specific expertise in headache medicine changed the trajectory of her care. “She listened differently,” Alia says. “She asked about my cycle. She asked about family history. She explained what was actually happening in my brain. I felt like I had been given a diagnosis that explained my life.”
With appropriate preventive therapy and an acute treatment protocol, Alia’s quality of life improved significantly. The years of undertreated migraine had taken a toll — on her career, her relationships, her sense of her own reliability. That toll was not inevitable. It was the product of a system that had not been looking for the right things.
What She Wants You to Know
“We need to do better for women. We need to educate physicians. Migraine in women is not treated with the seriousness it deserves, and part of that is because it’s a women’s disease. I don’t think that’s a coincidence.”
She is right. Migraine in women is undertreated relative to its burden, underresearched relative to its prevalence, and underacknowledged relative to the impact it has on women’s lives. This is not a clinical mystery. It is a clinical choice — and it can be reversed.
Alia Markman shared her experience with the Society for Women’s Health Research as part of their Women’s Health Perspectives series. Her account is reproduced here in adapted form with the goal of educating health care providers and policymakers about the lived experience of migraine in women.