Migraines: Plan of Attack

Migraines are complex.  Their effects, diagnosis, treatment, and prevention are personal and can vary from patient to patient, which is why I sometimes think of them as MYgraines.


My goal is to provide a framework in this three-part blog series, to empower you or someone you know that feels overwhelmed or is already losing out on enjoying life to the enemy--migraine.  In Part 1, we will study the enemy, in Part 2, we will map the battlefield, and in Part 3, we will explore weapons to fight back.


Migraines involve a dynamic process, and, as such, the treatment and prevention plans may require changes in course for different scenarios or different times in our lives.  Moreover, we may think we know our migraines’ every move, but some still surprise us, some seem eager to pounce at every opportunity, and some hold us captive without headache-free days.  Establishing a solid working relationship with a neurologist you trust can be an invaluable ally.


Part 1: Study your enemy


Migraines can be intimidating so let's begin by breaking them down.  Migraine headaches are primary headaches, meaning they are not a symptom of a secondary condition or disease (such as tumor, structural brain or blood vessel abnormality, stroke, bleed, infection, or medication effect).  Because they are primary headaches, there is an innate and likely genetic predisposition to why we develop these headaches.  While they can wreak havoc on our lives, migraines themselves are not dangerous as are some of the secondary headache causes.  There are multiple other primary headache syndromes, but migraine is by far the most common of that group.


Migraine is more than just a bad headache.  To keep an eye out for trouble before it gets out of hand, we should not simply recognize migraines by the intensity level of the headache but by the company it keeps.  There can be increased sensitivity to light (sunlight or fluorescent lights may seem more bothersome than usual) or to sounds in our environment (your kids/TV/radio volume seem louder than usual!).  Sometimes we might not realize we are more sensitive or irritated by things, but we can appreciate that we prefer to be in a more dim, quieter place, away from it all.  For others, they may instead feel nauseous, queasy, loss of appetite, and can lead to vomiting for an unfortunate group of migraineurs.  Other classic characteristics of migraines is that the headache climbs in intensity over time, can be throbbing/pulsating, or can feel worse with even basic physical activity, such as bending down or walking.


Some migraines come with warnings called auras before the actual pain strikes.  Note that auras can occur at the same time as the headache or even without any headache at all!  Migraine auras can include: vision changes (blurriness or loss of vision in different patterns, flashing/flickering lights, colorful/dark spots, wavy lines, jagged or zig-zag patterns), sensory changes (pins & needles sensation or numbness that can affect the face, tongue, arm or leg), language abnormalities (trouble getting words out or misspeaking), and rare motor auras (weakness on one side that must thoroughly exclude other serious causes before arriving at a hemiplegic migraine diagnosis).


In addition to headaches and auras, other symptoms of migraines can include vertigo, dizziness, and lightheadedness. It is important to note that some patients can have autonomic symptoms, including sinus-area pain, red or watery eyes, nasal congestion or runny nose, eyelid puffiness or droopiness.  It’s no wonder why so many people blame sinus problems and allergies for what may actually be migraines!


Now you are better equipped to identify the number one enemy of headache sufferers, migraines. In the next blog post, we will map out the battlefield and explore the various minefields that can set off this complex enemy.


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