FAQ Episode 70: The six blind men and the migraine elephant
A cautionary tale about simplistic answers for problems in life, medicine and migraine.
My father taught me to read at age four. One of the earliest stories that I remember reading for myself from back then is the tale about the six blind men and the elephant. It’s said to date back to ~500 B.C., originating from somewhere on the Indian subcontinent. Yes, its told as a child’s fable, but it is also one that seems to explains so much about the world we live in. It also helps to illuminate the state of medicine in migraine therapy. Let me start by sharing a short version of the story:
“There were six blind men, who always wanted to know what an elephant looked like. One day they encountered one, and each man touched a different part of the great animal. One touched the tusk, and the others the legs, the side, the tail, the ear and the trunk. The blind man who feels a leg says the elephant is like a tree trunk; the one who feels the tail says the elephant is like a rope; the one who feels the trunk says the elephant is like a huge snake; the one who feels the ear says the elephant is like a large hand fan; the one who feels the side says the elephant is like a wall; and the one who feels the tusk says the elephant is like a spear.
They then compare notes and learn they are in complete disagreement about what the elephant looks like. As their argument unfolds, a sighted man walks by and takes in this scene. He learns that the men are blind, and he explains to them: “All of you are technically correct, but the elephant is a very large animal, and each of you encountered only one part. Perhaps if you put the parts together, you will see the truth.”
This parable depicts an aspect of medical practice that frustrates many patients, and a few doctors, as well. It is human nature to try and put a complex problem in a tight little box, with a label and a diagnostic code, and then use a focused “if you have problem A, B or C, you take treatment or drug X, Y or Z” approach to care. As I entered medical practice it took only a few years to find that individual humans and their problems were complicated! One needed to take into account:
each person’s genetic “weak links” as variables
wide variations of lifestyle choices in diet, exercise and other habits
past variations of exposures to toxins or trauma
personality styles of how each of us manage these challenges
our willingness to self-educate or make indicated changes over time. We often mean well, but life gets in the way…
Migraine: the “as many versions as there are patients” disorder.
If you’re reading this, I can predict that you’ve tried a lot of different fixes for your headaches. A common thread is “I found something that worked for awhile, and then it ‘quit working’.” This is where it’s useful to consider the “full cup theory” of migraine headaches. Think of the clinical expression of a problem, such as a migraine, as the overflow of an 8 oz cup.
Think of this overflow as being the direct manifestation of a migraine headache and its associated symptoms. One might ask, which of the eight ounces in the middle cup caused it to overflow? The right answer is: all of them.
Many people consider that last half ounce to be the ‘trigger’ that we think caused the migraine. The other underlying ounces are the root causes that fill the cup to where a seemingly casual trigger event is the last straw. That trigger could be a weather front, a certain food, glare from headlights, ‘that time of the month,’ or a dozen others.
But, if the cup is almost full most of the time, it doesn’t take much more to overflow. Virtually anything could push it over the edge, multiple times a month and for multiple different ‘reasons’.
But, if we could identify your specific root factors and reduce the volume in the cup to only one, two or three ounces, we now have built in a reserve where it would then take a much larger volume of triggers, say five, six, or seven ounces in this example, to hit your headache threshold, if at all.
When you do one or two interventions, its like grabbing the tusk and the tail of the migraine elephant, but missing the big picture. Almost everyone with a migraine has taken a nutritional supplement like magnesium, or riboflavin. And most have tried at least one prescription drug. Did they help…some? Were they enough? That you are reading this Substack page and post strongly suggests there is room for improvement.
So here’s what I recommend:
From where ever you find reliable sources, continue to get educated on which migraine root cause factors apply to you and in that process, combine the therapy options most specific to your story as you move toward day-to-day migraine relief. Keep in mind that for most people, there will be more than one and more likely several root cause factors to identify and manage in order to “empty the cup” sufficiently for migraine relief.
Find a good primary care physician, and as indicated, a neurologist for consultation, as health care partners who can employ their tools and talents on your behalf, along with appropriate pharmaceutical options they can offer.
Keep up on the free “Frequently Asked Questions” Episodes I’ll be posting here at least weekly. Not each of them will specifically hit the nail on the head for you, but you never know when one of them will give you a key insight about your optimizing your brain biochemistry and the ongoing repair process needed to minimize migraines.
Consider working you way through my Natural Migraine Relief course, and using it’s Migraine Action Plan to correlate and triage therapy options that are the best fit your story. At a paid subscription of only $7 per month, on a month at a time basis, migraine self-education doesn’t get more cost effective than this.