Patients’ and Health Care Workers’ Perception of Migraine Images on the Internet: Cross-sectional Survey Study (Preprint)

BACKGROUND The representation of migraine in the media is stereotypical. Standard images of migraine attacks display stylish young women holding their head in a pain pose. This representation may contribute to the social stigmatization of patients with migraine. OBJECTIVE We aimed to analyze how patients with migraine and health care workers perceive online images of migraine. METHODS The study consisted of an anonymous web-based survey of patients with migraine at the Headache Center of Charité – Universitätsmedizin Berlin (migraine group) and employees and students at our university (health care group). A total of 10 frequently used Adobe Stock photos of migraine attacks were presented to the participants. Each photo was rated on a scale of 0% to 100% based on how closely it resembled a realistic migraine attack (realism score). Patients with migraine also indicated how much each photo corresponded to their own experience of migraine as a percentage (representation score). We calculated the mean realism and representation scores for all photos and conducted further analyses using the categories male or female models, younger or older models, and unilateral or bilateral pain pose. RESULTS A total of 367 patients with migraine and 331 health care employees and students completed the survey. In both groups, the mean realism score was &lt;50% (migraine group: 47.8%, SD 18.3%; health care group: 46.0%, SD 16.2%). Patients with migraine identified their own migraine experience in these photos to a lesser degree (mean representation score 44.4%, SD 19.8%; <i>P</i>&lt;.001 when compared to the realism score). Patients and health care workers considered photos with male models to be more realistic than photos with females (<i>P</i>&lt;.001) and photos with older models to be more realistic than those with younger people (<i>P&lt;</i>.001). In the health care group only, a bilateral pain posture was deemed more realistic than a unilateral pose (<i>P</i>&lt;.001). CONCLUSIONS Standard images of migraine attacks are considered only slightly or moderately realistic by patients and health care workers. Some characteristics perceived as more realistic such as male sex or older age are in contrast with migraine epidemiology. A more accurate representation of migraine in the media could help to raise awareness for migraine and reduce the associated stigma.