This new year has been a bit rough, we are only in the second month of 2014, and I have had about 10 days where I have not had some form of migraine pain. Which is, needless to say, making me a wee bit grumpy. These continuous sort of migraines over a span of days, or as of now weeks, I like to describe as being similar to a North Korean radio, you can turn it down but you can never turn it off. *rim-shot* Ha! Thank you! You’re a lovely audience, I’ll be here all week folks! Try the veal!
Migraine pain can really ruin your day (or weeks!) it can be crippling pain that makes it hard to think, or do anything really. The pain can cause nausea, issues with your vision (I get bright spots of light as a precursor, sometimes I have “tunnel vision”), plus the fun muscle spasms in your head, neck and shoulders. In its worst stages the pain reduces me to a feeble, trembling being, only able to beg for water, and the pain to end. You feel like your mind has fractured, and it is hard to think. It feels like your head has exploded and then has grown too small. Any sort of movement or light can increase the pain, and the pain can be so extreme you start vomiting. For me, the pain can be soul crushing at times, you hurt so much it hurts to even think. The best image I can find to convey how I feel when I suffer an attack is this.
On the good days, it is just background pain, which thankfully allows me to still function, and even if I really don’t feel like doing anything, I can force myself into living life like pain isn’t there, as much as I can. That pain though, it doesn’t leave it only turns down. It lurks behind your eye, sometimes it sneaks around in the back or side of your head. Always there, waiting. Reminding you that things could get worse at any time it would like it to. The fear of that sort of pain can stop your life completely. It can also make you stop your normal routine, and frankly it can be hard to fight the thoughts of “if I go do X, will it all get so much worse?” And this is where you have to say to yourself, “Well self, it could come back, and I could spend all my time avoiding everything because it might hurt, but where is the fun in that?” Sometimes it even helps to keep the charade of routine, distraction from the pain by focusing on other things can help a lot. The biggest help is keeping a pain diary, writing down things that are outside of routine, or just normal routine (if there are no changes) should be noted. Doing this helps a lot in finding patterns that will help you deal with your migraines possibly ahead of time, as well as allowing yourself and your doctors treat your pain more effectively.
Migraines have been studied by doctors for thousands of years, even the ancient medical Eber’s Papyrus mentions some of the symptoms, and the school of Hippocratic medicine knew of migraines and symptoms like visual disturbances with possible relief from vomiting. Galen referred to them as hemicrania (half-head), which lead to the term migraine – which has evolved from a corruption of the original Greek term he applied to the syndrome. In historical times trephination was frequently used to treat migraines, thinking that there was pressure in the head that needed to be released, or in some cases “evil spirits.” Even though these surgeries occurred as far as 7,000 BCE, they did not always end in death, as there is evidence of bone mending around a large percentage of the skulls.
What is a Migraine?
So really, what makes the difference between a headache and a migraine? Migraines are so well known, we probably have all heard the term, and it is because of this notoriety it becomes easy to fall into the self diagnosis trap of any extreme headache must be a migraine. But, what is a migraine? Migraines are defined as an attack lasting from 4 to 72 hours, characterized by throbbing pain in the head on one, or both sides of the head. The throbbing headache is accompanied by other symptoms which are usually diagnosed by doctors using the “5, 4, 3, 2, 1 criteria“:
- 5 or more attacks fulfilling the next two below listed requirements, apparently if you suffer from migraines with aura 2 is enough to diagnose. Episodic is less than 15 days a month and chronic is more than 15 days.
- 4 to 72 hour duration of the migraine untreated or treated.
- 3 at best or at least 2 of the following symptoms – unilateral (sometimes bilateral) location of pain, pulsating or throbbing pain, “moderate to severe pain intensity” (that means near crippling where everything just seems to suck , to crippling pain where everything does suck , especially movement). Finally if movement aggravates the pain – this is the sort of pain that if you make any sort of movement you get an increase in pain, that means something as simple as sitting up or moving makes you wish you didn’t and it causes you to avoid movement or normal tasks.
- 2 symptoms listed, but you need just one of them to be diagnosed- nausea and/or vomiting, or light and/or sound sensitivity (sometimes you get just one, sometimes 2 sometimes all 4, depends on the sufferer and that days migraine)
- 1 there is only 1 thing it could be, that means all other possible issues are ruled out and all that is left is a migraine.
If you don’t meet these qualifiers, you may want to look into tension headaches since that is the most common painful headache that is not as extreme as a migraine. Tension headaches can become migraines sometimes, so it is always best to discuss symptoms with a doctor to be sure you are being treated correctly. It is really important not to self diagnose with migraines, if you are suffering from extreme headaches there could be other, and possibly life-threatening causes. It is best to get an official doctor’s diagnosis, than find out too late you have a brain tumor.
So now we know what sort of symptoms manifest with actual migraines, and what criteria a doctor would use to diagnose your headaches. If you have all of these symptoms, you should know how a migraine works so that you can note things in your pain diary that are precursors or even possible triggers (we will go over triggers further on). To make it easy, we will look at how migraines work broken out into the four medically recognized stages:
- the prodrome phase – this is a fancy medical term, but what it basically means is the pre-symptoms. Everything that happens before you get a migraine that makes you go, “oh wait, this might be a migraine.” That is the prodrome. This can include mood swings, depression, mania (extreme happiness), fatigue, food cravings, neck spasms, bowel issues, or even sensitivity to sounds and light. Usually for each person what they get is different, no one sufferer has the exact same precursors as another. These warning symptoms can be noted and acted upon to reduce migraine pain once it hits. Careful notation of your mood and other things daily will help you to find out what your prodrome symptoms are, and then you can work out how best to fend off your migraine.
- the aura phase – put your Stevie Nicks outfits away, this is not what you’re probably thinking. Auras are a visual disturbance (ie. hallucination of sorts see examples here). Not all migraines have visual disturbances, but if you are going to have it, it comes after the precursor symptoms of the prodrome. It can be small points of dancing light like I have, or could be blurriness, squiggly lines, blind patches, all sorts of visual issues. Other symptoms that may occur in this phase are “pins and needles” feeling in arms or legs, and some experience speech issues.
- the pain phase – my least favorite phase. This is the migraine rubber meeting the migraine road, this is when you have that pain in your head. That throbbing with every heartbeat, that pain that makes it difficult to move and sometimes triggers vomiting, and sensitivity to light for me. Others may also experience sensitivity to smells, general nausea, and fatigue. There are a few more symptoms listed, and I find a lot of sites list irritability as a symptom, but really who isn’t a bit grumpy when they hurt? Classically this is pain only on one side, or unilateral, but some migraine sufferers of “no aura” migraines will have bilateral pain (that means both sides of the head hurt).
- the postdrome phase – these are the after affects, lingering pain, and that headache hangover feeling are what I tend to see after mine. You can also experience, mood swings still, cognitive issues, stomach upset, and even weakness. You may not get any of these or you may have all of them, some people even feel even better than before the migraine afterwards, so every body and its post-migraine reactions are all different for everyone.
Different Types of Migraines
There are also different types of migraines, not just one! Just like there isn’t just one type of headache! They are grouped by symptoms to help differentiate between the types. These terms are set by International Classification of Headache Disorders which is the group that releases the official classification of headache as used by the World Health Organization. The ICHD is published by the International Headache Society, which is a charity organization for headache sufferers of all sorts that has formed to advance the cause of headache sufferers.
The ICHD lists the different types of migraines one can have, they are grouped together based on the symptoms one experiences:
- Common Migraine – This is the most common form of migraine, and was previously known as hermicrania simplex. It is a neurological disorder and is characterized by a “throbbing” headache usually only affecting one side of the head (in fancy science terms that is called unilateral) but mostly centering on the right side of the head. This is classified as a moderate intensity type of migraine and can cause nausea, sensitivity to sound and light (that is phonophobia and photophobia in fancy science terms), but does not cause the seeing of auras. This is a visual disturbance that can be caused by other migraines, and is different to the spiritual auras that most are probably thinking of when auras is mentioned. These can be like lights, blobs, lines, all sorts of things and they are not present in this sort of migraine. Menstrual migraines are a subset of this group.
- Classic Migraine – this sort of migraine has the symptoms like the one above, except it can manifest with auras, but it doesn’t always have them. Along with visual disturbances more severe symptoms could include neuropathy, motor weakness, difficulty speaking and other symptoms. This sort has two subgroups of migraine types. Basilar type migraines are thought to be caused due to spasms in the basilar artery (that supplies the brainstem) and this type manifests some of the more extreme symptoms like difficulty speaking, vertigo, and other brain stem related symptoms. The other type of migraine subgroup is familial or sporadic hemiplegic migraine, sporadic if you have them occasionally and familial if someone in your family also has them. Both of these manifest with normal pain and auras, but only the classic type of migraine is also accompanied by possible motor weakness.
- Childhood Periodic Migraines – also like or sometimes referred to abdominal migraine. This one is debated and it generally causes a lot of migraine symptoms, sometimes without an actual migraine. Some think these could be a herald of migraines later in life.
- Retinal Migraine – ocular migraine is another name you may have heard of, there are visual disturbances, a patch of vision loss, or there will be loss of vision in one eye. These also tend to include symptoms of light sensitivity, the throbbing headache, and nausea.
- Chronic Migraines, status migrainosus & everything else – If your migraines last for more than 15 days a month for 3 months, those are chronic migraines. If they last more than 72 hours that is what is known as status migrainosus, which is just a fancy science term for never ending migraines. Then there is everything else that doesn’t fit in these groups lumped in here.
What causes a migraine? What are Triggers?
Migraines are a bit like other neurological and pain disorders in that there are a lot of theories as to what causes a lot of them but no one really knows fully why they happen. They are a neurological syndrome, but all of the details of them still elude us. There are a few theories on what causes them, some think there is a lot to do with genetics, since some can run in families but this doesn’t hold true for everyone. Also women are more likely than men to experience migraines, and there are even menstrual migraines that specifically occur around a cycle. There also seems to be ties with facial nerve compression, TMJ issues, muscle spasms in the neck and head (which is not just a cause but a symptom too), diet, exercise, weight, hormones, mental disorders (such as depression, anxiety etc), strong smells, changes in the weather/barometric pressure, and even change in routine are some of the things thought to “trigger” migraines.
Triggers are what seems to cause your migraine attacks, everyone’s are going to be different. To find out easily what your triggers are, you should keep a pain dairy of what occurs when you do and don’t have migraines and eventually you will be able to zero in on what is triggering your headaches. A fellow student in my Tai Chi school told me her’s were just triggered by excitement mixed with a change in routine. This meant birthdays for her could be extremely challenging. She has been able to listen to her body enough to where she now can regulate her migraines through controlling things that trigger them, as well as medications. It is so important to listen to your body, it will always tell you when something is going wrong. Be observant, notice patterns in changes with activities, changes in weather or foods, and you will find what triggers your attacks, and hopefully help avoid pain for yourself. For myself changes in weather always triggers pain and migraines, so I watch the weather closely, and when a large front is headed my way, I know I am going to be more likely to have an attack. So I try to minimize stress, and keep my routines in the time leading up to a weather shift, and this seems to help reduce severity of attacks.
Treatment of Migraines
Back in the old days they used everything from Coca-Cola, to pretty much straight cocaine, and laudanum (alcohol and opium), to treat pain and migraines. As well as a plethora of other “snake oil” cures that you could find in the local pharmacists. Some of them made some crazy claims on how effective they were.
Now treatments are becoming more advanced as we learn more and more about how the brain and nervous system work. So how do you treat these nasty migraines in the modern day, if we still don’t know what causes them? Well are finding newer better drugs, or therapies, on the market but as of now there are three main ways of treating migraines – analgesics and/or NSAIDS, triptans and/or ergotamines, and migraine medications.
Analgesics – you’ve probably seen this word before pop up on this blog, Analgesia means “relief from pain.” Anything that can relieve pain can be lumped into this group. Specifically for migraines some narcotic analgesics are used as well as NSAIDS (we will go over next). Narcotic drugs can be taken orally and intravenously, depending on severity of the pain and can be administered by an ER doctor or your pain doctor. For me, I find the injections to relieve the pain a lot faster than a tablet but should also be only used in a real pain emergency. Personally due to my extended migraines, and pain levels I was prescribed hydromorphone (most commonly known as Diluadid) which is like morphine, and a very powerful opiate painkiller. This is a rescue pill that I only take in extreme situations, I find that my normal a pain medication sometimes works, and have had success with my herbal remedies. But sometimes even that isn’t enough, and when you would consider selling your own soul to end the pain, it is a welcome relief to have handy. One should always use narcotics of any strength with caution, they are not only highly addictive but rough on your body.
NSAIDS – this stands for Non-steroidal Anti-inflammatory Drugs, that means things other than narcotics or corticosteroids to treat pain. Aspirin and Ibuprofen (commercially known as Advil) are the most commonly known of these, Naproxen (commercially known as Aleve) is another one that you will find in most stores. Paracetamol (commercially known as Tylenol) isn’t in this group since it also includes a mild anti-inflammatory aspect. These are all much less addictive than any narcotic medications, though they can have side effects like blood thinning, they can have an effect on your liver, and they are rough on the stomach. Overall though, these are a great choice due to their lack of addictive substances, and are over the counter medications that anyone can obtain.
ProTip: Excedrin Migraine was not listed up there since it is sort of a blend of things, it contains the same chemicals as Tylenol and Aspirin, but also has caffeine. If you are sensitive to things like that you may want to avoid this option, but you may want to opt for it though if you regularly consume caffeine and get headaches from lack of your daily does since this can also be a cause of migraines.
Triptans – These are specific migraine drugs, there are a few that are common on the market one well known one is Sumatriptan (Imatrex), there are many others, but this seems to be the most common one I run into, and also take it. How these work is they cause the serotonin receptors to constrict and this means that chemicals that cause inflammation are not able to be released, they seem to have an effect on nerve cells and blood vessels as well. These you need to take early in the attack to have these work, and are not as effective if you take it later in the attack. They are also not as effective for long term migraine attacks (attacks that span over a few days). These can be in tablet form, inhaler form and in injections, so this is a drug that can be administered even if there is vomiting with the migraine pain.
Ergotamines – this is an older medication and not as frequently prescribed these days, you may have heard of ergot before as well. Ergot is a type of fungus that grows on grain plants that humans consume (rye, wheat, barley, etc). This type of fungus can cause hallucinations, and is suspected for being a driving factor in inexplicable behavior in humans in history, like the Salem witch trials. It is a pretty complex chemical so unless you are familiar with brain chemistry, just know it causes a lot of chemical reactions that are pretty complex but end up relieving migraines effectively (and if you are read the wiki on it, pretty interesting stuff). The possible reason it is still so effective is the lysergic acid in the ergot, and could explain why the fungus psilocybin has been so effective in treating painful cluster headaches and for some migraine sufferers. This is an older medication as mentioned previously but it is still being prescribed for those with migraines that last more than a normal attack, like with status migrainosus. Like the triptans they also need to be taken early in the attack, when taken at the first signs of attack they prove to be most effective.
Anti-migraine Medications – this is sort of a lump all the rest here group. There is all sorts of other medications that has been used to treat, and hopefully prevent, chronic migraines. Botox is one I am intimately familiar with, I have had this procedure twice and hope to have a third soon. Botox is a “watered down” form of the Botulinum toxin, best known for ruining canned foods in the early days of canning (after cans, but before can-openers). This is a neurotoxin that is injected for therapeutic purposes in spots around the head and neck, this then pretty much paralyses them into relaxation and hopefully reduces or completely prevents migraines. I have found this to be an effective treatment, the only down sides are it is expensive, and it only lasts a few months before you need to be “topped up.” Besides botox there are a few other sorts of medications that have been used, anti-depressants, especially tricyclic antidepressants, have proven to be effective in treating some sorts of migraines. Another would be anti-convulsants, example like topiramate (commercial name Topamax), that is used to treat migraines and seizures. Finally Calcium and beta blockers have also proven effective for relaxing the blood vessels, and hopefully preventing migraines. These are more extreme measures to treat the more vicious and frequent attacks, and generally are considered some of the last lines of defense in combating migraines.
Alternate Treatments – Acupuncture is a great option, as well as massage, Graston, and just focused relaxation exercises work as well. I recently was inspired by a fellow sufferer, and new information on placebos, to try to “trick” my brain into thinking that a bandanna tied on my head would “hold” my head together (since frequently it feels like it has exploded, or soon will. The pressure of the fabric helps make that area feel like it is held together, and was in a recent attack the difference between pain to where I vomit and pain, but no vomiting. It is now the “magic bandanna” for migraines. I have also used cold and heat, I tend to prefer heat but sometimes cold works better. And of course there are always herbal options I have listed, and tried, for preventing or assisting with relieving your migraines and headaches.
So, now you know more than you probably ever wanted to know about migraines! And hopefully will be a bit more understanding, if you weren’t already, of any suffer of a migraine. They are not the run of the mill type of headache as you can see. The best thing as always though is to stay positive about your treatments and keep searching with your doctors to find what works best for you and then stick with it.
If you would like to read more information on migraines here are some good resources:
- WebMD Information on Headaches and Migraines
- Migraine Research Foundation
- American Migraine Foundation
- The Mayo Clinic – Migraine Definitions
- The International Headache Society
- The International Classification of Headache Disorders