Migraines are often undiagnosed in individuals with severe intellectual disabilities or autism who are non-verbal, according to Dr Sally Cheseldine, a retired consultant clinical psychologist. In a letter published in the Guardian, she reflects on her clinical experience, noting that these patients cannot articulate that they have a sore head, leading to a high level of damaging head-banging.
Head-banging as a pain response
Dr Cheseldine observed that among non-verbal patients, there was a very high level of damaging head-banging. She notes that others with migraines say they feel tempted to do the same if they don't have access to rapid pain relief. This behavior, she suggests, is often misinterpreted rather than linked to undiagnosed migraine.
Link between migraine and cheese cravings
Referring to a recent article on migraines, Dr Cheseldine comments on the suggestion that cravings for cheese might be caused by migraine. Cheese contains tryptophan, and research from the 1990s (McDougle et al) showed that people with severe autism who had very low levels of tryptophan exhibited dramatic increases in stereotypic behaviors, including banging.
Diagnostic overshadowing
Dr Cheseldine emphasizes that in addition to headaches being misdiagnosed, there is a significant part of the population in which migraines are completely undiagnosed due to the “diagnostic overshadowing” effect of other labels. This has harmful consequences, as the underlying pain is not treated.
