The Migraine Brain

by Bernstein, Carolyn; McArdle, Elaine

  Phonophobia—Sensitivity to Sound. Most people during a migraine attack can’t stand loud sounds because these cause their heads to throb even more. Even normal-volume sounds can seem too loud and very irritating. For some, loud or repetitive or annoying sounds can trigger a migraine attack.

  Ringing in Ears and/or Hypacusia (sounds sound louder than normal). We don’t know why this is connected to migraine, although a significant percentage of migraineurs experience this. Some people lose hearing in one ear for a short time.

  Pain Gets Worse with Physical Exertion. For many people, any kind of physical exertion makes the head pain of migraine feel worse, which is why they seek a quiet place to lie down and remain still. Even the simple motion of rolling over in bed can aggravate migraine head pain and also worsen nausea. For this reason, while exercise is very effective in helping prevent migraines, it’s of limited use once an attack has begun. You may be able to try mild exercise at the beginning of an attack—walking or yoga, for example—to help stave off the migraine by increasing endorphins, the “feel-good” chemicals in your body that act like painkillers. But once you’re in the middle of a full-blown attack, it’s unlikely you’re going to want to move much at all, let alone exercise. It’s hard to imagine running two miles when you’re crouched over the toilet throwing up.

  You Get Warning Signals Before the Migraine. Most people who get migraines can tell you when an attack is about to happen, even before head pain arrives. How? Because they get warning signals, whether they can identify anything specific or not. They just know that they feel different, and they associate this feeling with an imminent migraine. The presence of warning signs is a classic symptom of migraine. With other kinds of headaches, the head pain appears without heralding its arrival.

  They can take all kinds of forms, from tingling in your scalp to hunger pangs to sudden exhaustion, and are part of the chemical changes in your brain during a migraine attack, which we’ll discuss in Chapter 2. Knowing your signals is going to be an important aid in warding off a migraine.

  You Get Aura. About 20 percent of migraineurs get aura, sensory disturbances such as changes in vision, hearing, or the way your body feels. We think aura are caused by the chemical changes in your brain during a migraine.

  You Experience Partial Paralysis or Slurred Speech. Because these symptoms mimic stroke or other serious problems, they can be particularly scary, especially losing the ability to move your arms or legs. If you’ve experienced them before, it’s much less likely that they are signs of anything serious. You may be experiencing a “complicated” migraine, a rare type that includes symptoms localized to different parts of your body.

  Please take these symptoms seriously. You must tell your doctor so he can evaluate you and make sure they aren’t signs of some other disorder. This is especially important the first time. Remember: the key word is change. Anytime your migraine pattern changes, tell your doctor right away.

  Someone in Your Family Gets Migraines. Studies show that 70 to 80 percent of migraineurs have a family history of migraine. This makes sense, since migraineurs have a different kind of brain chemistry from other people, which they likely inherited from one or both parents. It’s possible that someone in your family has migraines but doesn’t know it, since an overwhelming majority of migraineurs have been misdiagnosed or have never seen a doctor about their symptoms.

  Or…Is It a Tension Headache?

  To be more thorough in our evaluation, let’s look at the characteristics of the two other types of headache: tension headaches and sinus headaches. Tension headaches (also called tension-type headaches) are the most common and are what most people mean when they say they have a headache. They typically feel like a tight band around your head and can be quite painful, although rarely as severe as migraine, and often the pain is more annoying than unbearable. About 88 percent of women and 68 percent of men will have a tension headache at some point in their lives.

  Tension headaches are the result of tight muscles in the neck or scalp caused by stress, fatigue, anxiety, bad posture, or a neck injury. In distinct contrast to migraines, tension headaches are not the result of abnormal brain chemistry that’s “triggered” by such things as hormones, food, or weather.

  Here are the most common characteristics of tension headache:

  The pain is throughout the head, often felt as a tight band around the head.

  The pain is usually described as dull and steady rather than throbbing.

  The headache appears without warning signals.

  The pain may be mild to severe but usually isn’t bad enough to wake you up from sleep.

  The headache doesn’t include other symptoms such as nausea, vomiting, or vision problems.

  The headache can be triggered by stress, bad posture, or fatigue.

  If you have two or more of these symptoms, your headaches may be tension type.

  If you suffer regularly from tension headaches, focus on prevention. Avoid muscles spasm caused by such things as bad posture (be particularly careful when sitting for long periods at a computer), eyestrain, or clenching your jaw. Examine the ergonomics of your work set-up, so that your desk, computer, and chair are at a healthy height that isn’t aggravating your muscles. Regular exercise, yoga, and massage are often helpful for relieving the causes of tension headaches. Your headache doctor may make other suggestions, including referring you to an eye doctor for a new eyeglass prescription or a dentist for a mouth guard to wear at night if you grind your teeth.

  To treat a tension headache, you may need pain relief such as an over-the-counter pain reliever, which are often very effective (but not so effective with migraines).

  Some people get tension headaches frequently—as often as several times a week—which is called chronic tension headache. These can be difficult to treat. Medications typically don’t work long-term because you build up a tolerance and you need more and more to feel better. (Please note: taking more medication than advised is unhealthy. Never exceed the recommended dosage, even with over-the-counter medicines, without talking to your doctor.) The better approach is to find out and correct the cause.

  With almost every health issue, there is a psychological piece and a physical piece, and you have to address both if you want to feel better. The most successful approach to wellness and to any particular disease is to evaluate your lifestyle and your health choices. For treating tension headaches, behavioral changes may be the best choice: Get more exercise; check your posture while you’re working at the computer, watching TV, and elsewhere; use relaxation techniques; and consider psychotherapy to address emotional issues that may be contributors.

  Mixed Headaches

  “I would look at all of those charts that describe whether you’re a migraine sufferer, and I wouldn’t necessarily fit into any category. I’d get chronic headaches but they had different characteristics from different types of headaches. When I went to Dr. Bernstein, I was able to realize that I don’t have to label myself as a migraine sufferer or a tension-headache sufferer. I can be both. I’m sort of in-between.”

  —Tabitha, 38, social worker

  People with migraines can get tension headaches and other types of head pain, too. Usually they can tell the difference between these headaches and a migraine very easily, since the pain and other characteristics are so different.

  Sometimes, however, it’s hard to diagnose which kind of headache you have. Or you may have a hybrid of two types of headache. Some people’s migraines and tension headaches begin to blend, which makes it hard to get an accurate diagnosis and even more difficult to treat. Some tension headaches can feel like a throbbing pain, which is more characteristic of migraine, and sometimes a migraine will be on both sides of your head and feel like a dull pain, which is more typical of tension headaches. Migraines can lead to tight muscles, which in turn can trigger a tension headache that lingers after the migraine is treated and gone. These hybrids are called mixed headaches.

  In treati
ng mixed headaches, the best approach is to decide which symptoms are the most troubling and try to address those first. If you have a throbbing headache—and you have high blood pressure—you might do well on a kind of drug called a beta blocker, which will help reduce your blood pressure and reduce the throbbing you feel. Calcium blockers would be another treatment choice.

  If you get headaches that don’t meet the diagnostic criteria for migraine yet seem to arise when you’re under particular stress, you might benefit from using stress-reduction approaches such as biofeedback, meditation, and other relaxation techniques. See Ch. 12.

  Sinus Headache—Migraine in Disguise?

  Be skeptical if you receive a diagnosis of sinus headache. A number of recent medical studies show that almost all “sinus” headaches are actually migraines. One study of thirty people diagnosed with sinus headaches found that twenty-nine were really suffering from migraines. Headaches only rarely accompany sinus infections. In fact, two leading medical organizations that study sinus disease do not recognize sinus headache as a medical condition.

  However, sinus problems can be closely connected to migraines. Sinus pressure due to a cold, allergies, or weather changes can trigger a migraine attack in some people. As we’ll see in Chapter 2, anything that annoys your brain—including sinus irritation or infection—can trigger a migraine in susceptible people. You may end up with both a sinus infection and a migraine.

  However rare they are, sinus headaches are worth understanding. They generally are caused by pressure or an infection in your sinuses, the air-filled cavities in your face behind your eyes, at the tops of your cheeks, and above your eyebrows. Sinuses can also become clogged when you have a cold, and clogged sinuses can become infected, which is called sinusitis. With a sinus headache, your face—especially your cheeks and along the sides of your nose—may be sore to the touch because your sinus membranes are inflamed and sinus passages are blocked. Your eyes may also feel sore and your teeth may ache. People with allergies can have this problem frequently. You may be nauseated from nasal drip (since migraines can cause nausea, too, this symptom can confuse doctors). If you have frequent allergies and a headache accompanies your symptoms, or if you get a headache along with a cold, you may have a sinus headache.

  But, again, be cautious in concluding that yours is a sinus headache. Migraines can have some of these characteristics, too. If you’re unsure, it’s better to get a doctor’s advice than to self-diagnose incorrectly.

  Treatment for sinus pain is very different from treatment for migraine. It may involve an over-the-counter pain reliever and/or a decongestant to unblock the sinuses. You may also need allergy medication if allergies are part of the problem. Using a humidifier in your home may help by keeping the air moist, which keeps sinus passages from becoming inflamed and congested. Irrigating your sinus passages with saline helps many people, including by using a neti pot, a yogic practice that’s grown very popular in the West.

  When Do You Get Headaches?

  If you’re still not sure which kind of headache you have, let’s look at when you get them—and whether you have other illnesses. This can give us more clues:

  Were you carsick as a child? There’s a strong connection between childhood car sickness and migraine, and most adult migraineurs have a tendency toward motion sickness. They may not be able to tolerate amusement park rides or long car rides. (I can’t even stand swinging on a swing!) What is the connection between motion sickness and migraine? We don’t really understand it yet, although it may be related to the abdominal aspects of migraine.

  Do you often have cold hands? Do your fingers or toes turn blue, red, or pale after you drink a cold drink? The tendency toward cold hands is often a symptom of migraine. And a condition called Raynaud’s syndrome, a vascular disorder that causes decreased circulation in the fingers and toes, is also connected in some people to migraines. Even migraineurs who don’t normally have cold hands and don’t suffer from Raynaud’s syndrome may find that the temperature in their hands drops during a migraine attack. Biofeedback can help you learn to raise the temperature of your hands and may stave off a full migraine attack.

  Do you suffer from irritable bowel syndrome (IBS)? People with IBS are 60 percent more likely to get migraines, although we don’t yet understand the connection between them. Symptoms of IBS include bloating, gas, abdominal pain, and mucus in your stool.

  Do you have a heart condition called PFO, or patent foramen ovale, a condition in which there’s a hole between the upper chambers of the heart? Recent research shows a connection between PFO and migraines, and that closing the hole in the heart may end migraines. See Ch. 2.

  Does anyone else in your family suffer from terrible headaches? Seventy to 80 percent of migraineurs have a family history of migraines.

  Do you get a headache after you eat certain foods? This is your Migraine Brain telling you it is hypersensitive to that food. See Ch. 12.

  Does your headache appear on a Saturday or Sunday morning after you sleep late? This may be a caffeine-withdrawal headache because your brain isn’t getting its caffeine fix at the same time it does during the work week, when you’re up early. But caffeine withdrawal can trigger a migraine in some people. And if your headache appears on a weekend, it could be a migraine caused by changes in your sleep patterns. See Ch. 12. The combination of lack of caffeine plus a change in your sleep habits may be a one-two punch in triggering a migraine.

  Does your headache appear on Monday mornings or late Sunday night? This may be a tension headache, perhaps related to tense muscles caused by the stress of returning to work. However, stress can trigger migraines, too.

  Are you depressed? And/or do you suffer from an anxiety disorder such as OCD, social anxiety phobia, or generalized anxiety (excessive worrying without cause)? These disorders are strongly associated with migraine.

  Do you go months or even years without a headache and then suddenly get a series of severe, stabbing, or burning headaches that occur in clusters, each day, usually at around the same time in the day? This is may be a cluster headache (see more below).

  Do you get a headache after a stressful event is over? Do you hold yourself together—for a work project, say, or a wedding, but get a headache when it’s passed? This is may be a “letdown migraine,” possibly triggered by the sudden decrease of certain hormones like adrenaline when the stress is over. If you get migraines on weekends, when the work week is done, it may be the result of this letdown syndrome—and/or a change in sleep patterns—and/or not getting your caffeine dose on time. All three together may result in a “perfect storm” of triggers that leads to a ferocious migraine.

  Other Kinds of Headaches

  This book focuses on migraines, but there are a few more headache types you should know about:

  Ice Cream Headache—When you eat ice cream or drink a cold smoothie or other cold drink too fast, you may feel “brain freeze,” also known as an ice cream headache. The pain is usually in the forehead, caused by cold stimulating nerves. Don’t worry. These headaches are harmless and typically last less than a minute. You can speed up the recovery by placing your tongue along the roof of your mouth to warm the trigeminal nerve and calm it down. An ice cream headache can trigger a migraine in some people.

  Caffeine Withdrawal Headache—Caffeine is a mild drug, so when you stop using it—or are even a few hours late giving your body its daily fix—your body reacts, typically with a headache. The symptoms of caffeine withdrawal headache are similar to migraine—a throbbing headache, nausea or vomiting, depression—so it may be hard to tell which one you have. The International Headache Foundation gives three criteria for a caffeine withdrawal headache: each month, you drink at least 15 grams of caffeine—about 130 cups, or 4.3 cups a day; your headache appears within twenty-four hours after you last had caffeine; and your headache is relieved within an hour of ingesting 100 mg of caffeine, about one cup of coffee. If you’re trying to quit coffee or other caffeine, don’t go cold tu
rkey. Wean yourself gradually in order to avoid a headache. Dr. Christiane Northrup, the author of numerous excellent books on women’s health, has helpful advice on reducing your caffeine intake. For more information, see www.drnorthrup.com

  Orgasm Headache—You’re in the middle of enjoying sex, just reaching orgasm, when—of all buzzkills—you get a sudden and severe headache. This is an orgasm headache, which strikes men more than women, by a ratio of 4 to 1. For the most part, these headaches aren’t dangerous. See Ch. 13.

  Rebound Headache—A rebound headache is caused by overusing medications, whether prescription or over-the-counter (OTC). What happens is this: the pain medication shrinks your blood vessels, so the headache pain stops. But when the medicine wears off, the vessels expand and give you a headache. In response, you take more medicine, and soon, you’re living on medication, far over the recommended dosage.

  How much medicine is too much, in terms of setting off a rebound headache? Some books seem set on the number two—they say that using any drug, even a triptan (a migraine medication), more than two times or twice a week will lead to a rebound headache. This isn’t true for everyone, however, and sticking to this formula can actually cause some people to suffer needlessly. You should stick to the prescribed amount and never go over it without your doctor’s consent. But your doctor can help you determine if it’s safe for you to use a triptan more than twice a week without developing a rebound headache.