Rant and Rave

Better understanding of the phases typically involved in a migraine attack seem pretty useless to me, at this point... Prodrome... Aura... Headache... Postdrome... I have symptoms of all of these phases all of the time. I don't know where one migraine ends and another begins!

© 2009 David Madden Photography.

This is (and has been) taking a huge toll on me, as well as my husband. I am truly blessed to have a wonderful husband. He doesn't understand any of what I'm experiencing (he doesn't even get headaches, much less migraines); and, yet, he's there by my side to take care of me. It breaks my heart that this disease affects my moods (we're talking big-time irritability) and weight (a lot of weight loss, which I can't afford to lose), and causes him to worry about me. But I'm so grateful that he loves me, and that he tries to help me in any way that he can. I thank God every day for my husband.

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

Headache Care Center

This video is very informative about migraine and its treatment. I believe that a interdisciplinary approach to treating chronic pain is the best possible option. Migraine is a very complex disease that is very misunderstood and under-treated.

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").

Glimmer of Hope

I have finally "broken" the week-long migraine, so now I am just trying to recover from the aftermath of that storm.

I have been looking online at a lot of different websites and blogs about migraines and chronic pain. I came across a wonderful blog, Chronic Warrior. I was touched by many of the things posted on the site. Perhaps God's purpose in my chronic illness/disability is to bring me closer to Him... to work through me to glorify Him.

I have definintely not yet come to terms with (or accepted) having chronic pain or the changes and limitations that I now have in my life, but this site brought me 1) a new perspective of chronic pain, and 2) hope that this can actually bring me closer to God.

"You will seek me and find me when you seek me with all your heart." (Jeremiah 29:13)