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.

In addition to headaches being misdiagnosed, I would also suggest that there is a significant part of the population in which it is completely undiagnosed due to the “diagnostic overshadowing” effect of other labels, with harmful consequences.
Dr Sally Cheseldine
Retired consultant clinical psychologist