A Warning

A warning may precede a migraine. In the hours or days before the headache, symptoms may include:

• A change in mood

• A change in behavior

• A change in the level of activity

• Fatigue

• Bloating

• Tense muscles

• Yawning

• Food craving or decreased appetite

• Nausea, vomiting, diarrhea

• Sensitivity to sound or light

An Aura

Some migraines are preceded by an aura. The most common aura is visual. The aura lasts about 15-30 minutes and may produce the following sensations:

• Flashing lights, spots, or zig zag lines

• Temporary, partial loss of vision

• Speech difficulties

• Weakness in an arm or leg

• Numbness or tingling in the face and hands

• Restlessness

• Confusion

• Dizziness, lightheadedness

• Speech disturbances

• Cognitive dysfunction

The Migraine Headache

Migraine pain starts within an hour of the aura ending. Symptoms include:

• A headache, usually on one side but may involve both sides. Typically, the headache feels:

• • Intense

• • Throbbing or pulsating

• • More severe with movement

• Nausea or vomiting

• Diarrhea

• Sensitivity to light or sound

• Sore or achy muscles

• Lightheadedness or dizziness

A Post-headache Period

Migraines usually last from 4-72 hours. They often go away with sleep. After the headache, you may experience:

• Food intolerances or cravings

• Trouble concentrating

• Fatigue

• Sore muscles

• Irritable

• Restlessness

• Mood changes

Medications

Pain medications are often required to ease or stop the pain. Over-the-counter pain pills may ease mild symptoms.

Warning: Continuous use of some over-the-counter medications may cause what is called a "rebound headache" when you stop taking the medication.

Some prescription medications act directly to stop the cause of the migraine headache. These include drugs that:

• Quiet nerve pathways

• Reduce inflammation

• Stimulate receptors for the brain hormone called serotonin

These drugs can be taken by mouth (swallowed), but they may act more quickly in forms that dissolve in the mouth, are inhaled through the nose, or injected. Your doctor can help you choose the medication and route of administration most effective for you. Abortive medications include ergots, triptans, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDS).

Other drugs can help prevent migraines for people suffering from frequent migraines. Preventive drugs are taken every day, even if you do not have a headache. Classes of preventative medications include beta-blockers, calcium channel blockers, tricyclics, and anticonvulsants.

Self-care During the Migraine

• Apply cold compresses to painful areas of your head.

• Lie in a dark, quiet room.

• Massage your scalp and temples.

• Try to fall asleep.

Lifestyle Changes

• Keep a diary to help identify what triggers migraines and what helps relieve them.

• Learn stress management and relaxation techniques.

• Consider talking with a counselor to learn new coping skills and relaxation techniques.

• Exercise regularly.

• If you are a smoker, quit. Smoking may worsen a migraine, and it probably also increases the rare chance of stroke occurring during a migraine attack.

• Avoid foods that trigger migraines.

• If low blood sugar precedes your migraines, eat small meals more often.

• Do not change your regular sleep pattern during the weekend or during vacation.

Patricia is a 32-year-old criminology professor at a state university. She is married and has a five-year-old son and a three-year-old daughter. They live in the suburban area where her husband grew up.

What was your first sign that something was wrong? What symptoms did you experience?

I first had a problem in graduate school when I developed a rapid pulse rate and high blood pressure for no understandable reason. I would also get hot flashes. Shortly thereafter, I developed the worst headache I’d ever had behind my right eye and on the right side of my head. I went to the university clinic to see a doctor there. After an initial exam, he concluded I had a migraine, along with other problems. He prescribed some medication that helped a bit.

What was the diagnosis experience like?

I saw various doctors at the university clinic. I had insurance that only covered my visits to the clinic and really did not cover specialists. I was referred to a cardiologist eventually, but not a neurologist or headache specialist until just about 6 months ago (I’m now in a new state with new insurance).

What was your initial and then longer-term reaction to the diagnosis?

I had heard of migraines, and discovered that my mother experienced “painless migraines”. I was very uninformed and just assumed it was a headache, something I’d deal with from time to time. Now I realize that migraines are not just headaches, and dealing with chronic migraines is more of a challenge than I’d ever have imagined.

How do you manage your disease?

I am currently managing this disease, but not very well. I have tried several types of medication: five migraine abortives, eight rescue pain medications, and five migraine preventives. I am currently taking two preventives—Prozac and Atenolol. I use two abortives—Amerge and Relafen (which is more of a rescue) when a migraine hits, and I use either Darvocet or Fioricet as a rescue, but only 2 times a week—same for the Amerge and Relafen.

Recently, I began to have menstrual migraines for the first time. For this type of migraine, I am now trying Relafen 2 times a day starting 2-3 days before I expect the headache (which is hard for me because I am irregular). I also use Benadryl (generic), ginger, and/or Reglan (generic) for nausea. Now I can knock out the nausea within an hour, which is a new and wonderful thing!

I am also trying “alternatives”—I recently started taking 500 mg of feverfew every day, and I do see some improvement. I also take magnesium and vitamin B2. Since I am prone to stomach ulcers, I have to be careful with the feverfew, B2, and Relafen. So I also take ginger for nausea or upset stomach, and drink chamomile tea when my stomach hurts. I take Tums during the day if necessary, but not within two hours of taking any medication.

Without my husband, I couldn’t do what I do. He’s learned what to do when a migraine hits: he immediately gets me coffee or diet coke, makes toast for me to eat when I take medication, etc. And even my five-year-old son will trot over with sunglasses, because light (even from the television) hurts my eyes.

I joined two on-line support groups to get and give support. I did not realize there were so many people struggling with the same disease. I have done a lot of research—books, websites, journal articles—on migraine, stroke, epilepsy, anything I can get my hands on.

Most importantly, I was referred to a headache clinic and work with a doctor and nurse practitioner who specialize in migraines and work closely with me. I’ve had to take my health firmly into my own hands and help direct my care. I’m not particularly assertive, but this disease has made me so, at least as far a migraine care is concerned.

Did you have to make any lifestyle or dietary changes in response to your illness?

I’ve made LOTS of changes. I go to bed at the same (early) time every night now. I get up early in the morning to avoid any “sleeping in” headaches that can morph into a migraine. I drink just about the same amount of caffeine every day—not too much, not too little—to avoid caffeine withdrawal headache and allow the caffeine to help me. I kept a food journal for four months, trying to identify a food trigger (to no avail). I drink almost no alcohol now because I fear it might trigger a headache. I try to exercise almost daily to release endorphins that might help.

I cut back on committee work on campus to avoid very heavy stress, since stress is the only trigger I identified. I also make sure to drink as much water as I can every day, because that seems to help. And mostly, I just try to stay healthy. I take a lot of vitamins now. I recently bought some books on meditation and relaxation and plan to look into this as well.

Did you seek any type of emotional support?

I seek emotional support from my family and from the two online support groups. Sometimes people who do not have this disease do not understand it. They have the attitude, “take some aspirin and get over it.” But it’s not that easy. So it’s really helpful to know others have the same problem and go through the same stuff.

Did/does your condition have any impact on your family?

Well, both my five year old and three year old know what a migraine is. I have missed some birthday parties (for their friends), trips to the theater, school parties or events, trips to the zoo… all because of the migraines. That can upset my kids, but all in all, they handle it well. My husband is nothing but supportive, though I don’t think he really understands the disease—but then, neither do I. The rest of my family lives far away, and I don’t think they have any idea what migraines have been like for me.

What advice would you give to anyone living with this condition?

I would tell anyone living with this condition several things:

Read as much as you can about this disease so you can have an informed conversation with your doctors.

Find a specialist right away—not just a neurologist, but a headache/migraine specialist.

Listen to that specialist—give the medications and/or therapy a try no matter how bizarre it sounds.

Most importantly, trust yourself. If a medication is making you sick or making things worse, tell your doctor firmly that you need to discontinue it.

Try alternative therapies like herbs, acupuncture, etc. under the direction of your doctor (or at least informing him/her).

Tell your family and friends what migraines are like so they can have some understanding of what you are going through.

Know your rights at work, in case you need to take a step back and slow down.

Find people who will listen to you and not judge you—online support groups are really great that way!