Why migraines are often undiagnosed | Letters

Dr Sally Cheseldine reflects on the experience of people who cannot articulate their pain and the significance of cravings

During my clinical career, I noticed that migraine was rarely diagnosed in individuals with severe intellectual disabilities or autism who were non-verbal and therefore unable to say that they had a sore head (Letters, 24 July). Instead, there was a high level of damaging head-banging, something that others say they feel tempted to do if they don’t have access to rapid pain relief for their migraine.

I was interested in the suggestion that cravings for cheese might be caused by migraine (The truth about migraines: what causes them – and how to find relief, 19 July). Cheese contains tryptophan, and it was shown in the 1990s (McDougle et al) that people with severe autism who had very low levels of tryptophan showed dramatic increases of several stereotypic behaviours, including banging.