The Migraine Brain

by Bernstein, Carolyn; McArdle, Elaine

  In the same way, The Migraine Brain is creating a partnership with you. You and I are going to face every aspect of your migraine disability. We’ll address each facet of your life—your family, job, healthy history, personal goals—to devise an individualized treatment approach that works for your body, your personality, and your lifestyle. No two people are alike when it comes to migraine, and what works for your friend or neighbor probably won’t work for you. It may take trial and error to find the right mix of treatments for you, but I am certain that, with some time and thought, you can feel much, much better.

  Beware of anyone who promises you a “migraine cure.” Migraine isn’t curable—not yet. I can’t promise you that you’ll never have another migraine. But migraine is a treatable disease. Most of my patients see a significant, measurable increase in their well-being when they follow their treatment plan. Through a healthy lifestyle—regular exercise, not smoking, regular and healthy meals, enough sleep—you, too, can reduce the number of attacks you get. And, on those occasions when you do get a migraine, despite your best efforts to avoid it, there are still plenty of things you can do to minimize the pain and disability—even stop the attack in its tracks. With the right approach, you can lead a much happier, healthier life with fewer migraines and much less pain.

  I want you to realize that you are not alone. Until very recently, we migraineurs tended to suffer in silence because we often felt we weren’t taken seriously—except by each other. In the company of other migraineurs, we got the understanding we needed. We empathized with each other, and shared migraine stories and advice on how to fend off an attack. The Migraine Brain’s stories from your fellow migraineurs show just how widespread this illness is, yet how differently it presents itself in each person. These stories—some funny, some heartbreaking—also highlight our many examples of success, to show you that you, too, can see significant improvement.

  For the first time in history, our disability is emerging from the shadows and starting to get the attention it deserves. Many athletes, artists, and celebrities get migraines including NFL giants Terrell Davis and Troy Aikman, tennis great Serena Williams, basketball superstar Kareem Abdul-Jabbar, and baseball stars Jon Papelbon and Johnny Damon; actors Ben Affleck and Whoopi Goldberg; musicians Loretta Lynn, Carly Simon, and Jeff Tweedy. As they step forward to discuss migraine in their lives, they raise public awareness and dispel myths and misunderstandings. We hope you will share this book with your family and others in your life. We want your loved ones, co-workers, and the general public to understand what migraine is—and what it isn’t.

  Thirty million people in the United States get migraines. Almost half have never been diagnosed with migraine, and another 25 percent have been misdiagnosed with other ailments.

  I’ve continued to get an occasional migraine over the past twenty years. Sometimes I’ve ended up lying on the floor of my office, so sick I’m unable to move. But today, with the option of many new treatments and a commitment to a healthy lifestyle, I’ve reduced the number of headaches I get. I know what I can do to make them less likely to happen, and how to treat them when they come—so I can enjoy my life. That’s my hope for you, too. While migraines aren’t something you can completely avoid, you’re not going to let them run your life, either.

  We’re in this together. And together, we can all lead happier, healthier lives.

  Our Migraine Mantras

  Migraine is a treatable illness—you can feel much better.

  You have a right to make your health a priority.

  Controlling migraines is 50 percent education and 50 percent treatment.

  Three keys to keeping migraines at bay:

  Prevent them by making sure you do not set off the chemical reaction that leads to an attack. This means making your health a priority, and identifying and avoiding your personal migraine triggers.

  Abort them when they get started. You’ll learn how to halt a migraine in its tracks when you feel one coming on—before you get sick.

  Rescue the situation: When you aren’t able to prevent or abort a migraine, you can still reduce the severity of the pain, and the length of your attack.

  Migraine Quiz

  Before you read The Migraine Brain, take this quiz to see how much you know about migraine.

  True or False?

  Migraine is just a type of headache.

  People with migraines have a low pain tolerance.

  Migraine can be fatal.

  Migraine attacks include weird visual changes like flashing lights before your eyes.

  People with migraines are more likely to be depressed.

  Migraine attacks tend to peak when you’re in your thirties and forties.

  Chocolate, red wine, and bananas cause migraines.

  Women get migraines more than men.

  Children rarely get migraines.

  Migraine pain is always felt on only one side of the head.

  Answers

  1. Migraine is just a type of headache.

  False. This is the single biggest misunderstanding about migraine. Migraine is a neurological illness caused by an abnormality in your brain chemistry. A migraine attack almost always includes at least several physical reactions, sometimes dozens of symptoms. Headache is just one of migraine’s many possible symptoms.

  2. People with migraines have a low pain tolerance.

  False. Actually, studies show that people with migraine develop a very high pain tolerance since the head pain is typically severe and they learn to function despite it.

  3. Migraine can be fatal.

  False. Migraine usually is a benign illness: once the migraine attack is over, the symptoms go away and there’s normally no lasting medical effect. But migraineurs often are so sick they feel like they’re dying: 75 percent report the pain as severe to extremely severe. This is how one patient describes her attacks: “Imagine the worst seasickness you’ve ever had, with violent vomiting and then endless dry heaves. And horrible pain in your head, like an iron pole being thrust in and out of your eyeball with each beat of your heart.”

  4. Migraines attacks include weird visual changes like flashing lights before your eyes.

  Not for everyone. Fewer than 20 percent of migraineurs get visual changes during a migraine attack.

  5. People with migraines are more likely to be depressed.

  True. People with migraines have a higher incidence of depression. Even between migraine attacks, they report a lower quality of life than people with diabetes, hypertension, osteoarthritis, or asthma. The more migraine attacks they get, the lower their sense of well-being.

  6. Migraine attacks tend to peak when you’re in your thirties and forties.

  True—sort of. For many people, migraine attacks typically peak when they’re in their thirties and forties, just when life is at its most demanding—when you’re juggling work, kids, aging parents, and finances.

  But here’s an important rule about migraines: there aren’t many rules. Each person’s migraine profile is different in its symptoms, triggers, and the treatments that work, as well as the point during his or her life span when migraines are at their worst. Most women patients begin getting migraines around the time of puberty, but I have patients who never got migraines until they were in their fifties or older. Others got migraines as children that went away when they reached their teens.

  7. Chocolate, red wine, and bananas cause migraine attacks.

  False. First of all, foods or other factors don’t cause migraines—abnormal brain chemistry causes migraines. But for some people, certain foods can set off or trigger that abnormal brain chemistry. This is true of only a minority of people, however, recent research shows. The foods—if any—that trigger migraines vary from one person to the next.

  8. Women get more migraines than men.

  True—by a 3 to 1 ratio. While some of this has to do with women’s menstrual cycles, a new study out of UCLA suggests that women’s brains may be more susceptible to ex
citation—meaning they react more easily to stimuli—than men’s brains, leading to the chemical chain reaction believed to cause migraines.

  9. Children rarely get migraines.

  False. One in twenty grade school children gets migraines (although they may get what we call “abdominal migraines,” which are stomachaches without any headache), and 15 percent of high school students get them.

  10. Migraine pain is always on one side of the head only.

  False. For most people, migraine headaches are usually felt on one side of the head, but this isn’t true for everyone. Some feel pain on both sides of the face or head, or on the top of their heads, or in the back of the head or neck.

  We hope these facts dispelled some common migraine myths you may have heard. Many new studies show that a variety of factors—including sleep, gender, exercise, and serotonin levels in your brain—affect the brain’s susceptibility to migraines.

  In The Migraine Brain, you’ll find the latest, most important information and advice—everything you need to feel better and keep your migraines at bay.

  Part One

  CHAPTER 1

  Is Yours a Migraine?

  “I’ve had a couple of migraines where I curled up into a ball and cried. Every noise, every light, every sensation felt like knives and squeezing at the same time, all over my head but especially piercing through my temples, and a stabbing feeling across the front of my head.”

  —Nonnie, 31, temp worker

  “I clearly remember my first migraine because it was so dramatic. I was thirty-four or thirty-five years old, and I was coming home from the movies with my elderly parents in the car. I suddenly got this incredibly blinding headache. I’d never had anything like it before. The lights of the oncoming cars were killing me. I remember thinking, ‘I can’t get my parents home safely, I can hardly drive, I can hardly see!’ I remember thinking, ‘I’ll be lucky to get home.”

  —Olivia, 64, executive director

  of a human services agency

  Karen is a thirty-two-year-old single woman. Every month around her period, she gets a moderately painful headache along with a little dizziness. By drinking a few cups of coffee and popping an ibuprofen, she usually keeps the pain under control. But sometimes it gets so bad she has to lie in a dark room and sleep. Her ob-gyn says these headaches are part of PMS and there’s not much she can do.

  Samantha, twenty-six, is a nursing student without any obvious health problems. One evening after a stressful day of exams, she suddenly got a severe, pounding headache unlike anything she’d ever experienced. She lost all feeling on the left side of her body and began slurring her words, and the pupil in her left eye became fixed and dilated. Doctors feared she’d suffered a life-threatening stroke or aneurysm, but an MRI showed no sign of damage. A month later, it happened again. Samantha’s doctors think she has a brain bleed that the tests somehow are missing.

  Brian, fifty-three, never gets headaches. His only health problem is an odd one that’s not even painful: Sometimes, after a hard day at work, he sees strange flashing lights in front of his eyes, or black-and-white abstract figures that march along his line of sight. His ophthalmologist believes Brian’s eyes are overly sensitive to sunlight and has recommended prescription sunglasses.

  Ben is a sixty-two-year-old ironworker. As a boy, he got strange stomachaches at unpredictable times. When he was a teen, they went away, but he began getting severe headaches several times a month, and he feels better only after he vomits violently. His family views him as frail, and his boss and co-workers think he’s a whiner. His doctor sent him to a psychiatrist, who says Ben’s illness is psychosomatic: he’s making himself sick in order to avoid work.

  Actually, all four were misdiagnosed. They all have migraines.

  Only 25 percent of people with migraine get the correct diagnosis. The rest are misdiagnosed with ailments such as sinus trouble, dental problems, psychiatric illness, eye disease, or other kinds of headaches besides migraine, or they never see a doctor at all about these symptoms.

  This strange disease has puzzled doctors and sufferers for thousands of years, partly because its symptoms are so varied from one person to the next. It can be time consuming to diagnose as well as to treat. It’s very painful—but it won’t kill you and probably won’t cause lasting damage, and the symptoms go away between attacks. Migraine can’t be seen on an MRI or other diagnostic test (although a new study has found detectable differences in the brain structures of long-term migraine sufferers). And some people’s symptoms are so strange—excessive weeping, bloodshot eyes, hunger pangs—that their doctors are thrown far off the trail as they try to diagnose them.

  Migraine is such a complicated illness that it’s not easy to get a handle on it. One person may get visual or other aura, sensory disturbances, such as a change in vision or hearing, another does not; one has a migraine every two months, another gets them daily. Some people get migraine pain on both sides of their heads, which can confuse medical personnel who believe that the head pain is always one-sided. One patient may find her headaches are triggered by stress, which stumps her doctor, whose prior migraine patient got attacks only during her monthly period.

  If you have painful headaches, strange visual or hearing symptoms, or abdominal problems you can’t explain, you may have migraines. But you, like so many others, may not realize it—or you may have been misdiagnosed. You may have been told you have another kind of headache, or PMS, or low blood sugar. Even if you’ve been diagnosed with migraine, you may have gotten bad information about it. Maybe you were told it’s your fault for working too hard, or that you’re looking to escape your problems by sleeping through the day, or that you’re exaggerating how bad you feel. You may have been told a lot of things about migraine that aren’t true, and you may have been spoken to in a condescending or paternalistic way.

  If so, forget what you’ve heard.

  Migraine is not your fault. But there’s a lot you can do to feel much, much better.

  The Biggest Myth: Migraine Is a Kind of Headache

  The biggest myth is that migraine is a type of headache. This is wrong. Migraine is a complex neurological disease that affects your central nervous system. Headache is one of its symptoms, but migraine almost never consists of head pain alone. There are many other possible symptoms, including nausea or vomiting, sensitivity to light or sound, tingling or strange sensations in your skin, visual changes, hunger pangs, and slurred speech. Almost everyone experiences several symptoms during a migraine attack.

  Migraine is caused by abnormal brain biochemistry. See Ch. 2. Migraine is not something you’ve somehow caused. It is not an emotional response to problems in your life, or some unconscious effort to get sick so that you can take a break from your daily challenges. Migraine is a genetic difference, in most cases inherited from one or both of your parents. It is a chronic illness, meaning you cannot get rid of it. You can do a lot to manage your disease, but you can’t simply wish it away.

  While headache is the most common symptom of migraine, it’s by no means the only one. In fact, not everyone with migraine disease gets a headache. (Migraines without headache are called “migraine equivalents.”) Some people get “ocular” or “ophthalmic” migraines, with strange visual changes such as seeing geometric shapes before their eyes, but no accompanying headache. Some have sensitive skin, many feel nauseated or need to vomit, and most have such a strong aversion to light and sound that they want to crawl into a dark, quiet room and pull a pillow over their heads. Some symptoms mimic more serious illnesses. People with “complicated migraines” can become paralyzed or unable to speak, which is particularly frightening because it appears that they are having a stroke.

  “There is probably no field in medicine so strewn with the debris of misdiagnosis and mistreatment, and of well-intentioned but wholly mistaken medical and surgical interventions.”

  —Oliver Sacks, Migraine

  With such a huge range of migraine experience,
it’s no wonder doctors—let alone laypeople—are confused.

  Related Myth: All You Need to Treat a Migraine Is a Good Painkiller.

  Even though painkillers are commonly prescribed to treat migraine, they are not the best treatment. There are many better, more effective treatments that address the full range of migraine symptoms beyond headache. Meanwhile, there are many drawbacks to using painkillers or even aspirin to treat migraine, including potential serious side effects. See Ch. 9. Painkillers can help with other kinds of headaches but not much with migraine because it’s a chemical process that eventually involves your entire body. New drugs called triptans can stop the chemical chain reaction so that a migraine never fully arrives; in fact, triptans can end the attack completely in many people. For anyone who doesn’t want to or can’t use triptans (for example, some people with heart disease), there are other migraine medicines as well as complementary and alternative treatments that often work much better than painkillers. There are times when a painkiller may be necessary, if your other treatments haven’t worked—but they should be considered only as a last resort. That’s why it’s essential to know if what you have is a migraine.