How to recognize a migraine headache

As long as there have been human beings, there have been headaches. Thousands of years ago, the prescribed cure (in both Europe and the Americas) was trephination, whereby a hole was cut or scraped into the skull of the sufferer, in order to release the evil spirits causing the pain. Sometimes the patient even lived through the procedure.

In the Middle Ages, European physicians thought mercury (the element, not the planet) was an effective cure. Except for the blindness and madness it caused, maybe they were right. Some Native Americans, however, hit on a cure which did not unduly endanger their health: they chewed on willow bark, which, as it turns out, contains the chemical precursor to the first modern headache cure: aspirin.

By far the worst headaches — and usually the only type to cause their sufferers to turn to treatments as drastic as trephination and mercury — are migraines. Millions of people suffer from recurring attacks of these killer headaches, which can incapacitate the sufferer and last for days.

Each year, over a hundred million sick days are lost to migraines in the U.S. alone. Unfortunately, some of the people who suffer from migraines never realize what their problem is because they never seek medical help. Many migraineurs, as migraine sufferers are called, do not recognize their symptoms for what they are.

But why not? A headache’s a headache, right? True, but not all migraine symptoms involve headache pain, and even a crippling headache might be mistaken for one caused by stress or other illness.

This article outlines the most common symptoms of a migraine, the ones you should be on the lookout for. If you experience any of these symptoms, see a doctor — you yourself might be a migraineur. Migraines are nasty, but they’re treatable, especially with today’s new wonder drugs.

The Clues

The causes of migraine headaches are still not well understood, but it’s thought that they occur when levels of serotonin, an important neurotransmitter in the brain, become low. In response, the brain stem releases neurochemicals that act upon certain cerebral blood vessels, causing them to expand.

This is turn causes them to leak minute amounts of blood plasma, which stimulates inflammation of the brain tissue. This neural inflammation, which may persist long after the blood vessels return to their normal size, causes the actual headache pain.

Most migraines, which may take days to peak and eventually fade, have three recognizable phases: the pre-headache phase, the headache phase, and the post-headache phase. Not all migraineurs experience all three phases, but most do at one time or another.

The most critical phase to recognize is the pre-headache phase, because recognition of the associated symptoms may allow you to head off the headache altogether, or at least to dampen its worst effects.

Many migraineurs experience a pre-headache condition called prodrome, which may induce rapid mood swings and food disorders such as cravings or anorexia. A less-common condition is called an aura. Aura is characterized by odd sensory experiences and may occur with or without prodrome.

One or more of the senses may become hypersensitive, or the sufferer may experience visual symptoms such as flashes of light, strobing objects in their fields of vision, or partial loss of vision. Other symptoms of aura may include an inability to speak, partial numbness, double vision, the ringing of the ears, and temporary partial or complete paralysis.

The headache usually follows within an hour. The throbbing (and sometimes stabbing) pain of a migraine headache may occur on either or both sides of the head and is usually associated with light sensitivity. Even the dimmest light can be difficult to bear during this phase, so the migraineur often waits in darkness until the pain passes.

Nausea, sensitivity to sound, and aural symptoms are also sometimes present during the headache phase. After hours or even days, the migraine fades, and the migraineur passes into the post-headache phase. They may feel physically exhausted for 24 hours or longer, and this condition may be accompanied by irritability and an inability to concentrate.

Some migraineurs don’t experience every symptom listed here; for example, some never have aura symptoms, some have aura without significant headaches, and some feel fine once the headache has passed. A migraineur might not even experience the same symptoms from one headache to another.

What You Can Do About Migraines

If medication is taken immediately upon recognition of prodrome or aura, it’s possible to divert or dampen the oncoming migraine headache. Simply lying quietly in a dark room may even help. However, many migraineurs suffer in silence for years.

There may be many reasons for this: stubbornness, lack of funds or insurance, or simple ignorance of the disease and its symptoms. Indeed, many people who don’t know they’re migraine-prone often mistake migraine symptoms for indications of something more serious, such as a brain tumor or stroke, and are reluctant to visit a physician lest their fears be realized.

However, upon hearing of these symptoms most doctors will immediately realize that the problem is migraine, for these symptoms are well-known markers for the ailment. An attentive doctor might distinguish between migraines and other types of headaches just from a description of the aura symptoms alone.

Remember: just because you don’t experience all the symptoms listed above doesn’t mean you’re not a migraineur, and you can’t get the prescriptions you need to fight this ugly malady if you don’t go to a doctor.

The range of medications available for migraine treatment is stunning, ranging from old standbys like Tylenol-4 to morphine to a family of drugs called triptans that mimic the functions of serotonin.

The drugs that comprise the “Triptan Revolution” — compounds like naratriptan, rizatriptan, zolmitriptan, and sumatriptan — have proved amazingly effective in easing the pain of migraines and can help fight off the worst effects if taken during the pre-headache phase. Even better, some drugs can help you avoid migraines altogether if taken regularly. Among these are Elavil, Depakote, and Prozac (which keeps serotonin from being so rapidly depleted).

Migraine pain can be significantly lessened and/or avoided with the proper treatment. So, if you recognize any of the migraine symptoms listed here, don’t hesitate to consult a doctor. If it’s not a migraine, you’ve lost nothing but a few dollars — but if it is, you may lose many hours of unnecessary pain. And unless you’re a masochist, I know you’ll appreciate that.

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