You’re not hobbling around on crutches and you don’t wear a cast or have surgery wounds you can show off. There’s no blood, no stitches, no bruising. In fact, to all the world you look perfectly fine.

Migraine pain doesn’t show up on the outside, so it’s often hard to get people to believe just how bad the pain is. Many people get headaches, and to most it’s little more than an inconvenience. Headaches are swiftly dealt with by over the counter medication and within half an hour or so the sufferer can get on with life as though nothing happened.

That’s why it’s so hard to explain to non-sufferers why migraines are so painful and debilitating

A Hidden Disability

Migraine isn’t just a headache. As Dr. Robert Shapiro, University of Vermont College of Medicine neurology professor, said in an article published by CNN, “Migraine is a state of the brain. Headache is just one of many symptoms that reflect that brain state.”

75 percent of the 29.5 million American migraine sufferers are women, and around $20 billion is lost in wages every year despite most sufferers trying to work through the pain. In the same article Dr Shapiro says, “It remains an enormous source of hidden disability.”

Because triggers and symptoms vary from person to person, the difficulty in getting those around you to understand what you’re going through becomes even harder. It’s as though people think you’re putting it on, dramatizing the headaches everyone gets, and making excuses for a day off or to escape responsibility. Getting family or friends, co-workers or teachers to give you the space and time you need to recover can be as exhausting as the pain itself, especially if you’re in the throes of an attack while trying to communicate. In fact, disruption in your ability to communicate is a common symptom, making the task doubly difficult.

Understand Your Triggers

If you need to, start keeping a diary about your migraine attacks. Note down:

• What you ate
• Where you were
• Who you were with
• Noise levels
• Light levels
• Smells
• Everything in your environment when the symptoms started

You may find you have several triggers, or even different triggers at different times of the month. The more you know about your individual migraine patterns, the more clearly you can communicate your condition to others so they can help you avoid those situations and deal with them should they arise.

Don’t Wait Until You’re in Pain

It’s human nature to avoid talking about distressing situations when everything is fine. But the very best time to talk about your migraines is in between attacks when you feel okay.

Pick a quiet time when those nearest and dearest to you are together, and explain what happens when migraine descends. Tell them about the other symptoms: the aura, the nausea, and the stomach pains. Explain how suddenly an attack can start, for instance many people find that just driving down the road with the sun flashing between buildings is enough to trigger an attack.

When family and friends understand all the other symptoms that go alongside the head pain, they’ll understand how much more than a headache a migraine is.

Be Open with Co-Workers and Bosses

It’s hard to bring up personal health issues and make them common knowledge. We’re not suggesting you hang a banner off your desk.

Sensitive employers will do all they can to create an environment that doesn’t make you ill, and those you work closest to will be more sympathetic once they understand your situation.

It’s not easy telling someone their perfume gives you a headache, but if you explain it in terms of allergy (which more people understand) and make it clear it’s really not personal, most people won’t take offense.

Invite Questions

Often, people don’t like asking personal questions about someone’s illness. Those around you may feel that way about your migraines. Tell people you don’t mind them asking questions about how you’re feeling or what they can do to help. Yes, you may get some inconsiderate comments, but most people will relax more around you when they realize it’s okay to talk about it.

Share Books, Leaflets or Web Links

You probably have a good store of information on migraine headaches, so don’t keep it to yourself. While you’re talking to family or friends is a good time to offer the loan of books or share links to helpful sites that delve deeper into migraine suffering.

The more you can do to help those around you understand what you’re feeling, the more they can help you in return. Just because you have no outward signs of injury doesn’t mean you need suffer in silence.