The pain can be excruciating, ranking with kidney stones and childbirth. And all it may take to trigger a migraine headache is a few missed meals, fitful sleep or stressful working conditions.
Migraines, as the almost 30 million Americans who suffer them know, are nothing to take lightly. So reports of the severe migraines experienced by Republican presidential candidate Michele Bachmann have raised questions about how the condition may affect her ability to handle the nation's highest office.
The Minnesota congresswoman said in a statement that migraines have never kept her from functioning and wouldn't keep her from serving as commander in chief.
Headache specialists agree that migraines don't have to be debilitating when properly managed with medication and lifestyle measures. Though Bachmann released a physician's statement Wednesday, without detailed medical records not enough is known to predict how she might fare under Oval Office pressures.
Someone who has accomplished as much as Bachmann surely has strong coping skills, noted Dr. Kavita Kalidas, a headache specialist and neurologist at Tampa General Hospital and the University of South Florida.
Certainly, the presidency is no stranger to medical problems.
"We certainly have had presidents with illnesses that were more serious," said Dr. Diana Pollock, a neurologist at Morton Plant Hospital in Clearwater. She noted that migraines are prevalent in all walks of life.
"I don't think it should eliminate anybody from holding the office of president."
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Migraines are characterized by pulsating pain, often on one side of the head. They can be accompanied by nausea and intense sensitivity to light and sound. Without treatment, a migraine typically lasts four to 72 hours.
Women are three times more likely than men to suffer from migraines, which can be triggered by hormonal changes.
"We've come a long way in the management of migraines," Kalidas said. "Initially, this was considered some sort of hysteria and a women's problem, or it's-all-in-your-head type of diagnosis."
For many patients, she said, modern medications taken at a migraine's onset can relieve pain in as little as 10 to 15 minutes. Drugs used to treat seizures and control blood pressure, as well as antidepressants, also are effective in reducing frequency and severity of headaches.
Bachmann, 55, said she controls her condition with prescription medication. She said the condition has not gotten in the way of her campaign schedule or her congressional duties.
She released a letter Wednesday from the attending physician to Congress stating she is "overall in good general health" and experiences migraines "infrequently."
"Your migraines occur infrequently and have known trigger factors of which you are aware and know how to avoid," wrote Dr. Brian Monahan. "When you do have a migraine, you know how to control it."
The Daily Caller website drew national attention to her migraine history with a report late Monday that Bachmann experiences episodes once a week on average and can be "incapacitated'' for days.
Citing unnamed sources, it reported that on at least three occasions, she has been hospitalized due to migraines.
In July 2010, Bachmann missed eight House votes while being treated for a migraine at a Washington hospital, according to POLITICO.
Even when suffering, Kalidas said, most patients still can make decisions at work and continue everyday tasks. Still, many with severe pain will need to lie down, said Pollock, noting that drug therapies are most effective when begun right when symptoms begin.
Dr. Lucas Bachmann, the candidate's son and a medical resident at the University of Connecticut, told the New York Times that his mother began experiencing migraines about 15 years ago.
Bachmann's son, who does not treat his mother, said she has sought emergency treatment in urgent-care centers at least twice while traveling. She received nonnarcotic injections and was monitored by doctors, but did not require overnight stays.
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Stress and an irregular schedule — both hallmarks of political campaigns and the presidency — are frequent migraine triggers.
While some patients have to change jobs to lower their stress, most learn how to cope without such drastic measures. Dr. Michael Franklin, a neurologist and headache specialist at St. Anthony's Hospital in St. Petersburg, has long battled migraines.
He said the headaches often occur after he has been on call, when he doesn't get enough sleep and misses meals.
When he feels a migraine coming on, he takes his medication and gets relief within an hour.
"I think I am an example of someone who can suffer from migraines and then go through a pretty demanding job and a responsible job," he said.
Dr. Merle Diamond, of the respected Diamond Headache Clinic in Chicago, noted that migraine sufferers, including herself, do experience disabling moments.
Still, she doesn't see migraines as a reason not to vote for a candidate. "Didn't Mr. Cheney have horrible heart disease and yet he was able to function in his role as vice president?"
Times staff writer Irene Maher contributed to this report, which includes information from USA Today. Letitia Stein can be reached at firstname.lastname@example.org or (727) 893-8330.
Common migraine triggers