I experience my first migraine while pregnant with my first child. Then started having aura with my migraines at least 3 times a month. I'm 70 and have been dealing with migraines with aura for 40 years. I went to a new neurologist who suggested Botox injections on my neck and top of head. That was 10 weeks ago and I have not had one headache. Not one. I felt one "coming on" but it never materialized into an aura event. I'm ready for my next set of injections and I cannot say enough about them. It's been a miracle in my case. I'm not even obsessive of carrying a bottle of water with me to take Advil and Nuratec.
As a migraineur myself, it's been super helpful in relating to my patients. I went from classic migraines with vomiting that mimicked the exorcist, to perimenopausal changes that now lead to milder headaches. They run the gamut from what feels like neck muscle or tension headache, to dizziness, to profound fatigue. What always helps me identify it is that one side of my body feels normal and the other side hurts. I find that barometric pressure is a huge trigger - so I had rare migraines when living in Southern California, and frequent HA with the labile weather of DC. I have found that Riboflavin and magnesium glycinate supplements are helpful for prophylaxis without causing the GI side effects of mag oxide.
It's hard finding a neurologist, and more primary care doctors should educate themselves about migraine treatment. It is an exciting time in migraine treatment - so much more understanding of causes and so many options for treatment. They are very gratifying to treat!
Great insights ... thank you so much for sharing your history and thought, Aparna! I totally agree that we PMDs need to educate ourselves about migraines esp in the current landscape where it's nearly impossible to get into specialists (eg neuro)
Migraine syndrome is debilitating. Having survived it—choosing that term carefully—over half a century, I anger to hearing people think it is simple. It drives life. I am lucky enough to have health care allowing me medicine to address it but, in this era of stupid cuts to health investment, we need more research on this syndrome. It’s not just an occasional headache as your superb description, Lucy, provides. Thank you, as always.
Thank yo so much for this! So very helpful to understand the phases and be able to take steps beyond taking pain meds when the headache occurs. I’m 61 and have had migraines since my early 20’s. It would have helped so much to have this framework then, and I’m glad to have it now. The doctors I’ve talked to over the years have focused on the pharmaceutical interventions at first sign of headache. I’m curious about connection between fibromyalgia and headaches.
I have had migraines since my teens, but as I have aged (70 yrs now) the headache phase has gotten less severe and less frequent. I'm surprised that you didn't mention more about triggers since that has always been the approach that I have been asked to consider by health care professionals (i.e., avoiding triggers such as chocolate, wine, etc.). For me, it seems that caffeine use is correlated with the frequency of migraines. I am an intermittent caffeine (coffee or tea) user, often going long periods without caffeine and then having 1-2 cups a day for a prolonged period. In the last decade or so, my migraines are much more frequent during the periods when I am on caffeine (1-2 migranes per month) as opposed to when I am off caffeine (1x per year). I don't think caffeine is a trigger because the aura & headache phase often occur when my caffeine titer is low (middle of the night, early morning, that is, when I haven't had caffeine in a while). Perhaps caffeine increases stress which then interacts with other neurological factors to increase the probability of migraine cycle initiation.
In answer to one of your questions, I do feel differently in the 24 hours before a migraine, but I only recognize the symptoms post hoc. After reading your post, I will work harder on recognizing them in advance and recording the symptomology. One thing I remember feeling regularly is a low level of body ache during which I need to stretch regularly to relieve the low level discomfort. I suppose this can be described as stiffness, especially in the legs and shoulders and neck. In addition, I think I also feel thirsty during this period, but drinking doesn't seem to alleviate the thirst.
Several health care providers have suggested having a very strong cup of coffee at the onset of the aura (which in my case lasts 20-30 minutes). I've done that on several occasions, but cannot attest to whether it reduces the pain of the headache phase or not--sometimes it seems to be effective, other times it seems to have no effect.
At this point in my experience of migraines, the 1-2 day hangover period is often worse than the headache itself. I want to return to normal life, but my ability to get stuff done is impaired (reduced but not entirely in capacitated). In fact, I can now often do productive work through the headache.
My question for you is this: is there any evidence that migraines have a long-term negative effect on cognitive function?
Thanks for sharing this. Common triggers are barometric pressure changes, hormonal shifts, neck/jaw/muscle tension, certain foods like wine or chocolate, additives like MSG, looking into bright lights, emotional distress, emotional stress "let down," caffeine withdrawal, certain medications, and a whole host of other triggers.
No evidence that I know of that migraines negatively affect cognition - but certainly it's a great question given the acute fuzziness people often feel post-migraine
So fascinating, thank you so much for this. I experience just the aura phase, thankfully without the headache but, yet, a weird sense of not being well/fatigued for the rest of the day. It's hereditary on my mother's side, and starts with a weird blind spot in my vision, then the zig-zag crescent, which flashes and gets bigger until reaches peripheral vision and disappears. Started in my 20s, and I am sure stress and hormone-related (has also given me pause when thinking about which kind of HRT to take). The idea of the "The "Neurological Symphony of a Migraine" is amazing.
An excellent cranial sacral massage therapist can resolve the migraines in 1-2 visits. I had them for years monthly or more and they were debilitating. The best neurologist in the area (Raleigh NC) gave only medication that made me feel horrible. Occasionally they come back and I head straight to her. If I could afford to go at least monthly I think they would be gone completely.
I, too, have intermittent ocular migraines. I’ve never been able to identify a trigger, but I have come up with a home remedy that helps greatly to mitigate the pain. At the first sign that an aura is developing, I take an Excedrin and drink a large glass of caffeinated Diet Coke. Simultaneously, I’m running hot water over my hands, until the aura passes. At that point my pain is minimal or non-existent. Of course, this works best when at home, but I always keep an Excedrine and caffeinated soda nearby, when on the road. Your thoughts, Dr. Lucy?
I have suffered migraines with aura since I was 12; and I have passed them to both of my children ( but their symptoms differ from mine ) . Mine are tied in deeply with hormones ( isn’t everything ?) but of course also sleep, hydration, weather, stress, allergens. Thank you for this article.
And I get several types; including vestibular ! And yes I have noticed clear symptoms in the cycle ; I tend to stutter or use the wrong words ( or have trouble finding a word) a day or two beforehand.
Thanks so much Dr. Lucy talking about this. I always thought I had tension headaches, but finally found that Sumatriptan works for me, which I think is for migraines. I gave up NSAIDs and now when I get that awful pain behind my eyes, I take one Sumatriptan and feel better in 15 minutes. I usually take 1 per month. If I don't, I find the pain will last 3 or more days. Mine are definitely cycle-related. Caffeine withdrawal is a trigger for me too. "Headache Relief" by Seymour Diamond taught me so much headaches and how the menstrual cycle is involved: https://openlibrary.org/books/OL9871365M/Headache_Relief
I am 81 and have not been a migraine sufferer. When I got covid I went to the ER. Among oter things I had a migraine with an aura. Since then I occasionally get the aura, followed by a mild headache. Have migraines been connected to Covid?
Thank you for the wonderful details. I am in my early 60s and have experience migraines since I was 8. They increased dramatically a few years ago for some reason. Magnesium and B2 supplements have helped along with consistent diet and hydration. An elimination diet revealed sugar and alcohol as triggers along with stress and poor sleep. Managing all of these factors along with a daily preventive med (which took multiple trials to find the right one) have helped reduce frequency and severity.
I’ve suffered migraines all my life. At 64, they’re not nearly as frequent or severe. But they are absolutely not just a headache. This is a good explanation, thank you. Staying hydrated, taking magnesium, and managing stress have helped me a great deal.
I experience my first migraine while pregnant with my first child. Then started having aura with my migraines at least 3 times a month. I'm 70 and have been dealing with migraines with aura for 40 years. I went to a new neurologist who suggested Botox injections on my neck and top of head. That was 10 weeks ago and I have not had one headache. Not one. I felt one "coming on" but it never materialized into an aura event. I'm ready for my next set of injections and I cannot say enough about them. It's been a miracle in my case. I'm not even obsessive of carrying a bottle of water with me to take Advil and Nuratec.
As a migraineur myself, it's been super helpful in relating to my patients. I went from classic migraines with vomiting that mimicked the exorcist, to perimenopausal changes that now lead to milder headaches. They run the gamut from what feels like neck muscle or tension headache, to dizziness, to profound fatigue. What always helps me identify it is that one side of my body feels normal and the other side hurts. I find that barometric pressure is a huge trigger - so I had rare migraines when living in Southern California, and frequent HA with the labile weather of DC. I have found that Riboflavin and magnesium glycinate supplements are helpful for prophylaxis without causing the GI side effects of mag oxide.
It's hard finding a neurologist, and more primary care doctors should educate themselves about migraine treatment. It is an exciting time in migraine treatment - so much more understanding of causes and so many options for treatment. They are very gratifying to treat!
Great insights ... thank you so much for sharing your history and thought, Aparna! I totally agree that we PMDs need to educate ourselves about migraines esp in the current landscape where it's nearly impossible to get into specialists (eg neuro)
Migraine syndrome is debilitating. Having survived it—choosing that term carefully—over half a century, I anger to hearing people think it is simple. It drives life. I am lucky enough to have health care allowing me medicine to address it but, in this era of stupid cuts to health investment, we need more research on this syndrome. It’s not just an occasional headache as your superb description, Lucy, provides. Thank you, as always.
Thank yo so much for this! So very helpful to understand the phases and be able to take steps beyond taking pain meds when the headache occurs. I’m 61 and have had migraines since my early 20’s. It would have helped so much to have this framework then, and I’m glad to have it now. The doctors I’ve talked to over the years have focused on the pharmaceutical interventions at first sign of headache. I’m curious about connection between fibromyalgia and headaches.
I have had migraines since my teens, but as I have aged (70 yrs now) the headache phase has gotten less severe and less frequent. I'm surprised that you didn't mention more about triggers since that has always been the approach that I have been asked to consider by health care professionals (i.e., avoiding triggers such as chocolate, wine, etc.). For me, it seems that caffeine use is correlated with the frequency of migraines. I am an intermittent caffeine (coffee or tea) user, often going long periods without caffeine and then having 1-2 cups a day for a prolonged period. In the last decade or so, my migraines are much more frequent during the periods when I am on caffeine (1-2 migranes per month) as opposed to when I am off caffeine (1x per year). I don't think caffeine is a trigger because the aura & headache phase often occur when my caffeine titer is low (middle of the night, early morning, that is, when I haven't had caffeine in a while). Perhaps caffeine increases stress which then interacts with other neurological factors to increase the probability of migraine cycle initiation.
In answer to one of your questions, I do feel differently in the 24 hours before a migraine, but I only recognize the symptoms post hoc. After reading your post, I will work harder on recognizing them in advance and recording the symptomology. One thing I remember feeling regularly is a low level of body ache during which I need to stretch regularly to relieve the low level discomfort. I suppose this can be described as stiffness, especially in the legs and shoulders and neck. In addition, I think I also feel thirsty during this period, but drinking doesn't seem to alleviate the thirst.
Several health care providers have suggested having a very strong cup of coffee at the onset of the aura (which in my case lasts 20-30 minutes). I've done that on several occasions, but cannot attest to whether it reduces the pain of the headache phase or not--sometimes it seems to be effective, other times it seems to have no effect.
At this point in my experience of migraines, the 1-2 day hangover period is often worse than the headache itself. I want to return to normal life, but my ability to get stuff done is impaired (reduced but not entirely in capacitated). In fact, I can now often do productive work through the headache.
My question for you is this: is there any evidence that migraines have a long-term negative effect on cognitive function?
Thanks for sharing this. Common triggers are barometric pressure changes, hormonal shifts, neck/jaw/muscle tension, certain foods like wine or chocolate, additives like MSG, looking into bright lights, emotional distress, emotional stress "let down," caffeine withdrawal, certain medications, and a whole host of other triggers.
No evidence that I know of that migraines negatively affect cognition - but certainly it's a great question given the acute fuzziness people often feel post-migraine
So fascinating, thank you so much for this. I experience just the aura phase, thankfully without the headache but, yet, a weird sense of not being well/fatigued for the rest of the day. It's hereditary on my mother's side, and starts with a weird blind spot in my vision, then the zig-zag crescent, which flashes and gets bigger until reaches peripheral vision and disappears. Started in my 20s, and I am sure stress and hormone-related (has also given me pause when thinking about which kind of HRT to take). The idea of the "The "Neurological Symphony of a Migraine" is amazing.
I have these, too. Mine are circular and have been diagnosed as ocular migraine.
Thanks, Jen!
An excellent cranial sacral massage therapist can resolve the migraines in 1-2 visits. I had them for years monthly or more and they were debilitating. The best neurologist in the area (Raleigh NC) gave only medication that made me feel horrible. Occasionally they come back and I head straight to her. If I could afford to go at least monthly I think they would be gone completely.
I, too, have intermittent ocular migraines. I’ve never been able to identify a trigger, but I have come up with a home remedy that helps greatly to mitigate the pain. At the first sign that an aura is developing, I take an Excedrin and drink a large glass of caffeinated Diet Coke. Simultaneously, I’m running hot water over my hands, until the aura passes. At that point my pain is minimal or non-existent. Of course, this works best when at home, but I always keep an Excedrine and caffeinated soda nearby, when on the road. Your thoughts, Dr. Lucy?
Caffeine + excedrin can be a terrific combo - I love it when people are able to find low-tech solutions for problems like this!
I have suffered migraines with aura since I was 12; and I have passed them to both of my children ( but their symptoms differ from mine ) . Mine are tied in deeply with hormones ( isn’t everything ?) but of course also sleep, hydration, weather, stress, allergens. Thank you for this article.
And I get several types; including vestibular ! And yes I have noticed clear symptoms in the cycle ; I tend to stutter or use the wrong words ( or have trouble finding a word) a day or two beforehand.
What about silent migraines?
Thanks so much Dr. Lucy talking about this. I always thought I had tension headaches, but finally found that Sumatriptan works for me, which I think is for migraines. I gave up NSAIDs and now when I get that awful pain behind my eyes, I take one Sumatriptan and feel better in 15 minutes. I usually take 1 per month. If I don't, I find the pain will last 3 or more days. Mine are definitely cycle-related. Caffeine withdrawal is a trigger for me too. "Headache Relief" by Seymour Diamond taught me so much headaches and how the menstrual cycle is involved: https://openlibrary.org/books/OL9871365M/Headache_Relief
oh, to your other question, no doctor ever told me about triptans! They said all they could give me was Naproxen, which never worked.
I am 81 and have not been a migraine sufferer. When I got covid I went to the ER. Among oter things I had a migraine with an aura. Since then I occasionally get the aura, followed by a mild headache. Have migraines been connected to Covid?
any inflammatory process can trigger a migraine, though it's less common than other causes
Thank you for the wonderful details. I am in my early 60s and have experience migraines since I was 8. They increased dramatically a few years ago for some reason. Magnesium and B2 supplements have helped along with consistent diet and hydration. An elimination diet revealed sugar and alcohol as triggers along with stress and poor sleep. Managing all of these factors along with a daily preventive med (which took multiple trials to find the right one) have helped reduce frequency and severity.
I’ve suffered migraines all my life. At 64, they’re not nearly as frequent or severe. But they are absolutely not just a headache. This is a good explanation, thank you. Staying hydrated, taking magnesium, and managing stress have helped me a great deal.
le malattie neurologichr come la fibromialgia , dolore diffuso ad ossa e muscoli
ha un origine psicosomatica , ma l'effetto e' organico e pertanto si cerca di alleviare il
dolore fisico con la somministrazione di antidolorifici ed antiinfiammatori.