All About Excrutiating Migraine Headaches by a Victim

Everyone has the occasional headache, but about 10% of the population worldwide suffers from migraines. Migraines are one of those things that most people do not fully understand until they have experienced one. I am one of the unlucky 10% that suffers from them almost weekly. I started having migraines about ten years ago after a car accident left me with a permanent neck injury. I also have a family history of migraines. I decided to write this article to help those who do not suffer these horrible headaches understand those who do. I have been researching migraines ever since I was diagnosed and I have learned quite a bit.

I am sure everyone reading this knows what a migraine is, so here is a brief definition:

Migraine: a severe headache localized to one side of the head associated with a pulsating pain, nausea, sensitivity to light and sound, and the urge to crawl into a black hole and die which can last anywhere from four to 72 hours and sometimes longer.

OK, I added the black hole part, but when I get a migraine, that’s all I want to do!

Migraine severity can range from a dull throb to excrutiating . The excruciating migraines are the ones with the infamous pounding hammer in the head, nausea, and vomiting, extreme sensitivity to sound and the vampire-like aversion to light. This headache is the one that makes me want to crawl into a black hole and die.

There are four stages to a migraine. The prodrome is the first stage and occurs hours or days before the actual pain starts. Prodrome symptoms include any or all of the following:

• Euphoria
• Scotoma (partial loss of an area in the peripheral vision)
• Disorientation
• Aphasia (impairment of language ability, which can vary from not being able to remember words to not being able to speak, read or write.)
• Photosensitivity (light sensitive)
• Altered Mood
• Depression
• Fatigue
• Irritability
• Yawning (excessive)
• Excessive sleepiness
• Craving for certain foods (one of the most common is chocolate)
• Stiff muscles (especially the neck)
• Dizziness and/or Vertigo
• Hot Ears
• Constipation or diarrhea
• Increase or Decrease in Urination

This is one of the main reasons a migraine diary can be helpful. Knowing what prodrome symptoms you have prior to a migraine can be invaluable in stopping the migraine before it even starts. My prodrome starts with an insatiable craving for chocolate (which is also a migraine trigger, lucky me) along with irritability, yawning, aphasia (I typically forget medical information that normally I could just rattle off) and stiff neck muscles. You might notice all of these are also PMS symptoms. Migraines are triggered by hormones as well, but we’ll talk about triggers in a few minutes.

The next phase of the migraine is the aura. The aura only affects about 20%-30% of migraine sufferers and gradually builds in intensity over a period of five to 20 minutes. The headache starts either during the aura or within 60 minutes of the end of the aura. In silent migraines, there is no aura; the prodrome is the only warning.

The third phase is, of course, the migraine itself. The pain is an intense, pounding or throbbing sensation. In typical migraines, it is located on one side of the head and starts gradually. The pain peaks and then starts to subside. All of this can last from two to 72 hours or even longer in adults. In children, migraines typically last one to 48 hours. Atypical migraines can be located anywhere, and can be a throbbing sensation or excruciating ache. This is the phase where you turn into a vampire, crawl into your bed with a bucket next to you on the floor, and pray no one opens the door and yells “MOMMY I’M HUNGRY!” The pain is exacerbated by any movement at all including breathing. Sometimes I think my heartbeat makes the pain worse. The only thing that really helps a migraine (aside from awesome medication) is sleep.

Remnants are the residual leftovers from the migraine. It’s a sore sensation where the pain was located, some people even experience problems in their thought process. You know, the “that-neuron-just-doesn’t-want-to-fire” feeling otherwise known as “brain farts.” This phase of the migraine is called the postdrome, and can last one to several days.

Migraines are caused by blood vessels in the brain constricting and then dilating quickly. New scientific evidence has shown this constriction and subsequent dilation is triggered by a drop in serotonin levels. Serotonin is the “feel good” neurotransmitter that affects mood, pain sensation by the brain, and sleep. When serotonin levels drop, the blood vessels in the brain constrict and then dilate rapidly. This dilation is what triggers the migraine; however, the fundamental cause of migraines remains a mystery. The medical reason sleep is so effective in treating a migraine is because when we go into a sleep state, serotonin levels rise. Both sleep and exercise are the brain's reset button. Exercise also raises serotonin levels while causing the release of endorphins, the brain's painkillers.

There is much debate over possible migraine triggers. Stress, food (including chocolate and MSG), fatigue, hunger, weather changes and hormones are just a few of the possible triggers. Menstruation is typically blamed for migraines in women (I can vouch for this) as is pregnancy I can vouch for this one too) and menopause (can't vouch for that one quite yet). Scientific research has not been able to prove consistently a connection between these triggers and migraines.

What many people don’t know is that muscles in the neck are a common trigger for many headaches, not just migraines. Neck muscles can cause compression in the vertebra just below the skull, specifically C1 (cervical vertebrae one), C2 and C3 (I know this because this is the cause of my migraines). When compressed, these vertebrae can constrict the flow of the cerebrospinal fluid (the fluid that is supplied to the brain via the spinal cord) which can trigger a drop in serotonin levels, and well you know the rest. These migraines are considered atypical, and the pain is usually located on one side of the head but near the back of the skull just above the neck. Pushing on one side of the vertebral column near the base of the skull during a migraine can indicate where the migraine was triggered. These headaches have the same symptoms as typical migraines, and they hurt just as bad.

Prophylaxis is the main “treatment” for migraines. Preventative medications like beta-blockers such as propranolol, metoprolol and atenolol; calcium channel blockers such as amlodipine (brand name Norvasc) and verapamil; anticonvulsants such as sodium valproate and gabapentin (brand name Neurontin); and tricyclic antidepressants such as amitriptyline (brand name Elavil) have proven to be effective in decreasing migraine frequency by 50%. Other treatments such as biofeedback, neurostimulation, Botox injections, and herbal remedies have proven helpful as well. Atypical migraines caused by tight neck muscles respond well to muscle relaxants and manual traction (decompression of the vertebrae using the hands). I’ve had a migraine during a manual traction session with my physical therapist, and the second my therapist pulled open the vertebrae, my headache was gone.

There are several herbal remedies that have been said to prevent migraines. Feverfew and black cohosh have proven beneficial. Feverfew needs to be taken on a long term basis to gain the benefit of the herb. Results are usually seen about six months after the initial dose. I took feverfew for about 18 months. For 12 of those months, I had no headaches. However, the headaches started coming back about three months later. Increasing the dose of the herb had no effect. 

In California, Cannabis is prescribed for the treatment of migraines, but has not shown to be helpful in prevention, only treatment. Its anti-inflammatory properties make it an excellent treatment for atypical migraines caused by neck injuries. It also treats the pain of any spinal injury among other things.

During a migraine, the most common treatment is a vasoconstrictor, or “triptan.” Sumatriptan (Imitrex) is the most well known of this class, more recent triptans include Relpax, Amerge, Zomig, and Frova. These medications work by increasing the serotonin levels in the brain and constricting blood vessels. They work quickly, alleviating migraines within 30 to 90 minutes in the majority of sufferers. Overuse of these medications can cause rebound migraines, however. Non-steroidal anti-inflammatory medications such as Ibuprofen (Advil) or Naproxen Sodium (Aleve), along with medications containing caffeine, can provide relief as well.

I don’t think migraine diaries really get enough attention. Keeping track of every migraine, it’s severity, duration, treatments and their effectiveness, and other details can be invaluable in predicting future attacks and preventing them. Even keeping track of how you feel daily can make a prodrome apparent. Migraine diaries can be given to your medical doctor who can help you pinpoint patterns of triggers you may not have seen. There are many digital diaries now available for your smartphone that can make a migraine diary available to you at all times.

Migraines have been around for centuries. Treatments have moved from the archaic trepanning (drilling a hole into the skull) to the less invasive Botox injections and everything in between. Hopefully some day, medical science will discover the real reason behind migraines and find a cure. Until then, I’ll continue to make the drug companies rich.

© Copyright 2012 by Daughter of Maat ALL RIGHTS RESERVED