Migraine Awareness Month Blogging Challenge #7: List Topper

There are SOOO many myths and misconceptions about Migraine. But, I think the biggest and most common one is the idea that "Migraine is just a headache."

Migraine is a genetic, neurological disease. It affects a person in every aspect of his/her life. In fact, some migraines (such as, abdominal migraines), don't even have the head pain that most people identify Migraine with. There are four different phases:  prodrome, aura, headache, postdrome. Some of the most common Migraine symptoms are:  throbbing pain, light sensitivity, sound sensitivity, nausea, vision changes, vomiting, aura, neck pain, weakness, dizziness, sensitivity of smell. Migraine attacks last for at least four hours, and may last for days (or longer).

Migraine disease is much more complex than most people know or understand. I try to help minimize the myths and misunderstanding, by trying to keep myself educated and open to sharing with others what Migraine disease truly is. Hopefully this will bring about a better understanding of the severity of Migraine and other headache disorders... leading to increased interest, research, and new treatments.

This post was written as part of the Migraine Awareness Month Blogging Challenge (MAMBC), which is initiated by www.FightingHeadacheDisorders.com and the National Migraine Awareness Month is initiated by the National Headache Foundation (NHF).

Postdrome

POSTDROME (aka. migraine hangover) is the last stage of a Migraine attack that some Migraineurs experience, once the headache pain has subsided. The postdrome symptoms may continue for several hours or even days. Symptoms of this postdrome may include:

• Fatigue
• Weakness
• Irritability
• Mood changes (e.g., anxious, depressed)
• Scalp tenderness
• Cognitive and concentration difficulties
• Feeling "hungover"
• Head pain

My postdrome experience really is feeling "hungover" from everything that having a Migraine attack entails, but I also have a medication hangover from the meds I take for my worst migraines. Having both of these at the same time is rough. It's taxing on my body, and my mind starts to wonder when the next attack will be. I think I experience all of the above symptoms, though I believe my irritability is worse during the prodrome phase. Even my hair hurts. It's incredibly exhausting.

I'd like to add that it's just as annoying to tell a Migraineur experiencing postdrome symptoms that you've also had hangovers... as it is to tell a Migraineneur that you get headaches, too. They're NOT the same! NOT even close to the same! Now, I've never actually had a hangover from drinking too much alcohol... but when you get a hangover from drinking too much, that's YOUR choice and YOUR mistake - if you don't want a hangover, don't drink so much... simple! Getting a hangover from a Migraine attack is out of a Migraineur's hands... we know it's coming, but there's nothing we can do to prevent it.

• Headache does NOT equal Migraine attack.
• Migraine hangover does NOT equal hangover from drinking too much alcohol.

Prodrome

I'm starting to recognize some signs that I might get a migraine (usually the following day or so)...

PRODROME (aka. premonitory phase, pre-headache) is the first stage of a Migraine attack (I've written about this further in Premonitory Symptoms, and more information can be found here and here). However, not all Migraineurs will experience this phase, and the Migraineurs that do may not experience it with each attack and/or may not recognize the often subtly symptoms / warning signs. Some symptoms of prodrome may include:

• Appetite changes and/or cravings
• Cognition and concentration difficulties (such as, having difficulty finding words and/or speaking)
• Cold extremities
• Bowel changes (e.g., constipation, diarrhea)
• Excitement / hyperactivity
• Mood changes (e.g., irritable, depressed, impatient)
• Fatigue
• Frequent urination
• Memory changes
• Weakness
• Excessive yawning

My prodrome experience includes most of the above: cravings (specifically for breakfast foods), frequent yawning, irritability, and / or being more talkative (maybe like an energy rush - not sure, since I've only just recently recognized this one). Closer to the head pain onset, I sometimes get mumbly in my communication, and my ears feel full and/or hot. I have a constant sinus congestion / post-nasal drip problem going on - could be a combination of allergies and something with my migraines... not sure.

I think that it's important to try NOT to jump to conclusions, when interacting with other people (I'm not good at this, in practice... but, I'm working on it). For example, relating to Migraineurs:

• Frequent yawning does NOT necessarily mean that someone is tired and/or bored.
• Cravings do NOT necessarily mean that someone is pregnant.
• Talkativeness does NOT necessarily mean that someone is cured or otherwise over the chronic illness.

The Hangover

I've been away with a bad migraine attack. Yesterday, as I was all medicated up with migraine meds, I watched the movie, The Hangover. Today, I'm living the migraine attack hangover. The headache pain has come and gone all day. I'm irritable, unbalanced, indecisive, and feel like I'm living in a fog. I'm hoping that this is just the postdrome, rather than the start of yet another migraine attack.

Phases of a Migraine

There are 4 distinct phases in classic migraine:

1)  Prodrome
The symptoms of the prodrome phase typically occurs hours or days prior to the actual onset of headache pain. Prodrome symptoms can include:

• Fatigue or excessive sleepiness
• Frequent yawning
• Altered mood
• Irritability
• Depression or euphoria
• Muscle stiffness (especially in the neck, back and face)
• Food cravings
• Difficulty concentrating

2)  Aura
Not all migraineurs experience an aura preceding or accompanying the actual headache pain. The aura phase typically begins minutes or hours prior to the onset of headache pain. Aura can be visual, sensory, or motor in nature. Visual symptoms include:

• Blurred vision
• Appearance of floaters (tiny specks that float before the eyes)
• Flashes of light or color
• A blind spot or even complete blindness in one eye
• Double vision

Sensory and motor symptoms include:

• Numbness or tingling of the hands, feet, and/or face
• Stiff neck
• Weakness
• Vertigo or Dizziness
• Loss of balance
• Ringing in the ears
• Difficulty talking
• Slow thinking or confusion
• Problems with concentration
• Changes in mood and activity level
• Hypersensitivity to touch

3)  Headache
This phase is the experience of the headache pain. For some, the pain is a one-sided,  throbbing or pounding pain. For others, the pain is all over the head. The migraine pain typically lasts between 4 to 72 hours. "Status migrainosus" are headaches that last longer than 72 hours, and require immediate medical attention. This is the most disruptive of the phases, and migraineurs often stop all activity and remove themselves from certain triggers (light, sound, odors). The headache phase often includes the pulsing / throbbing head pain, as well as some other symptoms, including:

• Extreme sensitivity to light, sound, and smell (photophobia, phonophobia, osmosphobia)
• Nausea
• Vomiting
• Increased pain with physical activity (such as walking or going up or down stairs)
• Blurred vision
• Scalp tenderness
• Stiffness and tenderness of the neck
• Problems with concentration
• Mood changes
• Vertigo, hotheadedness, and/or faintness
• Extremities feel cold and moist

4)  Postdrome
Some migraineurs experience symptoms after the headache pain has subsided. The postdrome symptoms may continue for several hours or even days. Symptoms of this phase can include:

• Fatigue
• Weakness
• Irritability
• Anxiety
• Depression
• Scalp tenderness
• Cognitive difficulties (difficulty concentrating)
• Mood changes
• Feeling "hungover"
• Head pain

Premonitory Symptoms (continued)

I continue to think about the premonitory symptoms that many migraineurs experience. These symptoms preclude a migraine attack and include fatigue; muscle stiffness (especially in the neck, back, face); change in appetite / food cravings; changes in mood (including depression, irritability); difficulty concentrating; feeling cold; and sensitivity to light or sound.

What's going on in our heads that causes these changes? And, what causes these changes to take place up to several days before a migraine attack? It should come to no surprise to me that there is no answer to my question, since there is still no clear answer as to the cause of migraines. But, it still makes me wonder...

Premonitory Symptoms

As I finally ended one horrible week-long migraine, had a day of "relief" (still bad headache, just not debilitating), and began to have another migraine attack... I got to thinking. Around the times that I have my worst migraines (both before and after), I tend to get extremely irritable, snappy, and on edge. And, sometimes I get a burst of energy before...and then a migraine hits and stops me in my tracks.

So, I did some research online to see if other migraine sufferers experience extreme mood changes around the time of a migraine attack. I came across an article in the New York Times (August 4, 2010), where Dr. Dodick responds to this very question:

"Migraine is too often “bookmarked” by the start and stop of the headache, but migraine is frequently associated with symptoms other than headache before, during and after the onset of head pain. About 75 percent of migraine sufferers will experience non-headache premonitory symptoms prior to the headache pain. Patients experience a range of cognitive, emotional and physical symptoms in this phase; the most common include feeling tired and weary, difficulty concentrating, stiff neck, dizziness, light and noise sensitivity, yawning, and depression or irritability.

These non-headache symptoms usually occur within six hours before and resolve within six hours after the headache. But in a sizable minority of people, the symptoms can start within 24 hours of the pain and take more than 24 hours to resolve.

This range is important to recognize for a few reasons. First, it reflects the fact that the changes associated with a migraine attack are occurring in the brain up to three days before and one day after the headache pain begins, and therefore, the disability associated with attacks cannot be measured by the duration of the pain alone..."

You can read the entire article in Consults.

It is unfortunate that many of these premonitory symptoms are so subtle that we may not notice until the migraine has already struck. Even those that have migraine with aura (as I do) cannot always count on the "warning." I don't always get an aura, or at least not the same type of aura (usually visual or auditory, though there are many different experiences that fall under the term "aura").