Migraine described as systemic neurological event, not just headache
13 reported
A letter published in The Guardian on July 24, 2026, from two readers, Sarah Khan and Rab Hallett, responds to a previous article about migraines. The letter argues that migraines are a systemic neurological event, not merely a headache, and that head pain is only one component. The authors state that for one of them, until perimenopause, head pain was minor while disabling symptoms included profound fatigue, body aches, and cognitive fog. The letter says these symptoms led to migraines going undiagnosed for decades, being blamed on a "poor immune system" rather than a neurological disorder. The authors also contend that the previous article underplays how little control sufferers have, noting that hormonal shifts during puberty, reproductive years, and perimenopause are beyond their control. They report that some women face predictable menstrual attacks plus a second at ovulation, which in severe cases can consume up to half the month, and that in perimenopause, hormonal triggers can be daily. The letter states that migraine cannot be left to neurologists alone, as gynaecological care is important but few gynaecologists understand the migraine brain, and some perimenopause treatments can worsen it. Regarding treatment, the authors say gepants have been transformative, and GPs can now prescribe Rimegepant where triptans fall short, but access remains a postcode lottery.
What’s reported
The letter responds to a Guardian article titled "The truth about migraines: what causes them – and how to find relief," published July 19.
The authors describe migraine as a systemic neurological event, not just a headache.
For one author, until perimenopause, head pain was minor; disabling symptoms were profound fatigue, body aches, and cognitive fog.
These symptoms dominated the "prodrome" phase.
The author's migraines went undiagnosed for decades, blamed on a "poor immune system."
The letter says the previous article underplays how little control sufferers have over triggers like hormonal shifts during puberty, reproductive years, and perimenopause.
Some women face a predictable menstrual attack plus a second at ovulation, which in severe cases can consume up to half the month.
In perimenopause, hormonal triggers can be daily, lowering the threshold for attacks.
One author has had daily migraine for over two years, with prodrome and postdrome overlapping.
The letter says migraine cannot be left to neurologists alone; gynaecological care matters, but few gynaecologists understand the migraine brain, and some perimenopause treatments worsen it.
Gepants have been transformative; GPs can now prescribe Rimegepant where triptans fall short.
Access to treatment remains a postcode lottery.
The letter is signed by Sarah Khan of London and Rab Hallett of Edinburgh.
Key figures
Sarah Khan, letter co-author, London
Rab Hallett, letter co-author, Edinburgh
Sources: The Guardian
