Coping, Symptoms

Can Feeling Weird Predict a Migraine Attack?

Do you ever feel like you can predict a migraine is coming on because you just feel “off”? You’re not crazy. This is the first phase of a migraine attack, called prodrome, which occurs before the pain — and often visual aura — set in. It can start a day or two before a headache or visual aura.

The long, long list of possible prodrome symptoms:

Visual (aka aura)

  • a bright shape that spreads across the visual field of one eye
    and appears to block some or all of the vision; can be seen whether the
    eye is open or closed
  • flashes of light and color
  • wavy lines
  • geometric patterns
  • blurred vision
  • partial loss of sight

Sensory

  • numbness or tingling on the face or upper extremities
  • a sense that limbs are a distorted shape or size
  • smelling odors that aren’t actually present (like natural gas or something burning)

Motor

  • partial paralysis
  • weakness or heaviness in the limbs on one side of the body

Language

  • difficulty finding words
  • problems understanding spoken or written language

Cognitive

  • mental confusion
  • disorientation
  • transient global amnesia (similar to amnesia that follows a concussion)

Digestive

  • food cravings (particularly for carbohydrates, candy and chocolate)
  • stomach rumblings
  • constipation

Fluid Disturbances

  • increased thirst
  • bloating/fluid retention
  • frequent urination

Mental/Personality

  • mood changes
  • irritability
  • high energy
  • lethargy

These are only part of little-known migraine symptoms. The Many Symptoms of Migraine describes symptom in the active migraine phase and the letdown, or postdrome.

Migraine: The Complete Guide is the source of these lists. It is my very favorite headache book, but is outrageously outdated. Perhaps if we mention it enough, the American Headache Society will consider updating the 14-year-old book.

Doctors, News & Research

A Headache Specialist’s Comments

Christina Peterson, a neurologist (and migraineur), is a blog reader who leaves terrific, educational comments. I always learn a lot from her. Some of her comments on recent posts are so informative that I want to be sure you all see them.

Warnings Proposed for OTC Painkillers

This is a really important post–it can’t be overstated.

In fact, the NYT article, if anything, understates the matter. The truth is that at this time, over 50% of all liver transplants are necessary because of the medical use of acetaminophen. It’s such a big problem that even the makers of Tylenol have run a commercial asking people not to exceed the recommended amount.

Gastritis and ulcers are no fun, and most people have been made aware of the cardiac and blood clot risks of anti-inflammatories like Vioxx and Celebrex, but a lot of people tend to think that ibuprofen and acetaminophen are benign.

They aren’t.

It’s also important to know that a lot of prescription analgesics, like Vicodin, Percocet, Fioricet, Amidrin (and all their generic names), also contain acetaminophen–so don’t double up.

If you are an intermittent migraine sufferer, and not a chronic headache sufferer, a double-blind randomized controlled trial has established that acetaminophen has no role in the treatment of acute migraine. There are better options available.

Men & Women Experience Pain Differently

This is vastly oversimplified. (Well, OK, it’s a newspaper…) But I trust this blog readership to be more sophisticated than the sixth grade level general readership a newspaper shoots for. So.

Most of the studies that have recently emerged have indeed shown a difference in pain processing between men and women. The major difference is that pain processing in women fluctuates with estrogen levels. (Estrogen–it’s our theme of the week, isn’t it? 🙂

Some of the studies available are simplistic and misleading–lab animals were injected with estrogen, and pain thresholds decreased, which led researchers to conclude that therefore, women were weak, and couldn’t tolerate pain as well as men. (Can anyone say, “Researcher bias”?)

But if you think this through, it is counter-intuitive. It makes no sense. Pregnant women have very high estrogen levels–estrogen levels climb throughout pregnancy, until they are very high by the time labor begins.

And menstrually-associated headaches occur when estrogen levels are at their lowest–the day before menstruation begins is the most common day for a menstrual migraine, and that is the day for a drop in estrogen.

Dr. Nancy E.J. Berman, who has done very important research on the effects of hormones on trigeminal neurons and the effects on orofacial pain, TMD, migraine and fibromyalgia, and who won the Wolff Award this year from the American Headache Society, also wrote the chapter on “Sex Hormones” in the book, The Headaches. She has noted that migraine improves both during pregnancy, when estrogen is high, and after menopause, when estrogen is low. She feels that this suggests that it is rapid changes in estrogen and progesterone that serve as a trigger for migraine attacks.

Some studies suggest that women tolerate pain better than men when estrogen levels are higher, and less well than men when estrogen levels drop–we are still discovering whether it is the rate of drop that is critical (likely), or whether it is also the estrogen:progesterone ratio that has an effect.

Other studies have shown that postmenopausal women process pain similarly to men.

I will say this, though: when I do Botox injections in the office, it’s generally not the women who get faint on me. 😉

Birth Control Pill News

This is all well and good…if you are young, and if you do not have migraine with aura.

Please refer to the following from the ACHE website: Will Using Oral Contraceptives Increase the Risk of Stroke?

It is the standard of care amongst headache experts to advise that women with migraine with aura either not use oral contraceptives at all, or use them very judiciously and with aspirin cardiac prophylaxis, and only if there are no significant cardiovascular risk factors. It is also recommended that women who have migraine without aura discontinue oral contraceptives after age 35. Smokers who have migraine should not use oral contraceptives at all.

I recall reading a recent article that surveyed migraine sufferers, and found that a significant proportion of primary care physicians were not aware of current recommendations regarding migraine and oral contraceptives. (I cannot, however, find the article in my giant stack-of-articles-to-be-filed. So, no citation for you–sorry. I think the author was Dr. Elizabeth Loder, but Google is not bringing it up.)

There is also newer data regarding the increased risk of heart disease in women with migraine, which was published in JAMA recently.

This study looked at women over 45, but estrogens, contained in the vast majority of contraceptives, are also a cardiac risk factor.

So–if you are going to proceed with this, be certain your physician knows you are a migraine sufferer (if you are), and research your family history and personal cardiovascular risk factors.

To learn more about and from Dr. Peterson, visit her websites, Migraine Survival and Headquarters Migraine Management.

Community, Society

Painters and Migraine

Last night I came across a website that examines depictions of migraine in art. One section lists painters commonly thought to be migraineurs but probably aren’t, and artists who possibly, likely or definitely had migraine. In each category, the artists’ names link to paintings influenced by auras or headaches.

Some well-known painters included on the site are Pablo Picasso (probably not a migraineur), Georgia O’Keefe (likely a migraineur), and Salvador Dali (a self-reported migraineur).

Even though I don’t get auras and don’t recognize many of the artists, it’s an interesting site to explore.

Symptoms

Advance Warning

About a month ago, I was in a nasty cycle where I’d have a migraine, have three hours off, then have another migraine. On the third day of this, I already had plans to go out for coffee with a friend and thought I was coming out of the cycle, so I went. I expected to be dragging a little, but I had tons of energy. I couldn’t keep a train of thought and I had a terrible time finding words, but I couldn’t stop talking. No more than 10 minutes after I got home, another migraine hit.

Not long after that, I went to my book club meeting and, again, was charged. I felt like energy was practically flowing out of my joints. When I got home that night, a migraine hit.

I’ve since realized these bursts are part of prodrome, the period before a migraine. I’m always fascinated when I learn how migraines affect the body beyond pain, but more importantly, abortants are most effective when taken during prodrome. Figuring out what your prodrome symptoms are is easier said than done. They’re a study of contradictions.

You could be sad, easily annoyed, yawning and tired or hyper, talkative, having trouble finding words and slurring the ones you do find. You might be hungry or have no appetite, have food cravings (especially for carbohydrates) or be disgusted by certain foods. Maybe you’re sensitive to light or sound and your muscles are stiff. You might have constipation, bloating, diarrhea and have to pee all the time. You could have any of these symptoms in any sort of combination and they aren’t necessarily consistent from one event to another.

Tempting as it is to dismiss these as just a funk, a good mood or an upset stomach, being aware of prodrome symptoms might help you get better treatment. If your migraines are close together, something that seems like a hangover from the previous headache (postdrome) could actually be prodrome. Knowing that taking a triptan early may keep your headache bay makes a good case for keeping a headache diary. I definitely know now that when I’m bouncing off the walls, I should have a triptan handy.