Almost 40 million individuals within the U.S. endure from migraines, making the painful dysfunction one of the vital frequent that neurologists deal with. It’s additionally among the many most complicated. Due to the numerous methods it may possibly present up, it may possibly take greater than a decade to obtain an correct analysis.
“The final idea about migraine within the frequent inhabitants is that it’s a headache syndrome,” says Dr. Hamid S. Hamdi, a neurologist who leads the Headache Clinic at UTHealth Houston Neurosciences in Sugar Land, Texas. And definitely, many migraine victims—although not all—expertise a throbbing headache. Past that, nevertheless, “individuals don’t learn about all the opposite signs that migraine may cause, so that they’re very shocked to start with,” he says. “At the same time as neurologists, we don’t all the time write off all of the signs to migraine till we’ve dominated out issues like a stroke.”
We requested Hamdi and different neurologists which non-headache migraine signs they see most frequently.
Meals cravings
About two to a few days earlier than growing a headache, individuals sometimes enter the prodrome (early) part of a migraine. Signs embrace irritability and different temper adjustments, fatigue and bother sleeping, issue concentrating, neck ache, and hyperactivity. Extra surprisingly, many report meals cravings—particularly for salty meals, sweets, and chocolate.
The way in which that scientists take into consideration this type of craving has developed. Whereas some as soon as believed that meals like chocolate brought on migraines, analysis suggests that is not the case, and there’s no purpose for individuals to keep away from it. “Usually, it was believed that chocolate might set off migraine,” Hamdi says. “However what we consider now’s that it’s not chocolate that triggered it—it is that folks had been having a longing for chocolate as a prodrome of migraine.” The urge to wolf down one thing candy could also be attributable to a sudden spike or drop in glucose and different metabolic adjustments within the physique, researchers have discovered.
Imaginative and prescient adjustments
About 20% of individuals with migraines expertise a visible aura, or momentary adjustments in imaginative and prescient. These can present up as shimmering spots, zig-zag strains, blind spots, tunnel imaginative and prescient, and even momentary blindness. Visible aura is probably going attributable to a wave {of electrical} and chemical exercise that spreads throughout the mind.
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“Individuals have described all of it other ways,” says Dr. Thomas Bravo, a neurologist and director of the Headache Heart at Loma Linda College Well being in California. “It may be disturbing to a affected person if it is the primary time,” however as soon as they comprehend it’s linked to their migraine and can go inside 20 minutes to an hour, it’s not fairly so scary. Some individuals expertise imaginative and prescient adjustments with each headache, he provides, whereas others report these signs solely accompany a portion of their complications.
Speech difficulties
You would possibly recall the clip of a TV reporter that went viral greater than a decade in the past, when the journalist immediately turned incoherent—leaving many watching at house frightened she was having a stroke. It turned out she had aphasia, or momentary language impairment, attributable to a migraine.
Somebody with aphasia may need issue forming full sentences, as a substitute repeating jumbled phrases, or will begin slurring. “We see this on a regular basis within the emergency division, and we’ll undergo an analysis, ensuring it’s not one thing like a stroke,” Bravo says. Medical doctors typically do imaging exams similar to CT scans or MRIs earlier than concluding—typically by means of elimination—{that a} affected person is experiencing a migraine.
Sensory sensitivity
Migraines are sometimes accompanied by elevated sensitivity to mild, sound, and smells. The scents you’re uncovered to every single day could strike you as a lot stronger and extra putrid than standard, for instance, and you could must put on sun shades outdoors as a result of the solar’s vibrant glow irritates your eyes. “The sunshine and sound could be wherever from disagreeable to truly painful, relying on the individual,” Bravo says.
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You additionally would possibly discover that you may’t stand even the gentlest contact. Some individuals expertise tactile allodynia, which occurs when the central nervous system turns into additional delicate to issues that contact your pores and skin. “You may have a heightened sense of ache to stimuli that would not usually trigger ache, like a lightweight contact throughout your pores and skin,” says Dr. Brian Gerhardstein, a neurologist and director of headache drugs at JFK Neuroscience Institute in New Jersey. That additionally contains mild contact in your scalp from brushing your hair, the feeling of rubbing a blanket over your physique, or feeling a breeze brush in opposition to your pores and skin.
Motor adjustments
Hemiplegic migraines—that are uncommon however severe—are related to motor adjustments, like one-sided physique weak spot or paralysis. This sort of migraine has a powerful genetic element and is usually handed down from a guardian, Gerhardstein says. “Mainly, your face, arm, and leg get weak in the course of the migraine assault, after which it goes away afterward,” he says. “It could possibly look precisely like a stroke, so plenty of these sufferers find yourself within the emergency room.” Looking for pressing care is a good suggestion, Gerhardstein provides, because it’s essential for docs to rule out probably life-threatening circumstances.
Stomach ache
An “stomach migraine” may cause a horrible stomachache, nausea, vomiting, and an absence of urge for food. “Individuals vomit again and again and over, and so they don’t even essentially have complications,” Gerhardstein says. Whereas there are totally different theories why this occurs, analysis suggests it’s seemingly associated to adjustments within the gut-brain axis.
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These gastrointestinal signs are frequent amongst children and could be laborious to diagnose, particularly if younger sufferers don’t have a headache or are unable to articulate that they do. “I see pediatric docs plenty of instances scratching their heads making an attempt to determine what precisely is occurring,” Gerhardstein says. “Once they’ve dominated out all of the extra natural causes, they arrive to migraine as the ultimate analysis.”
The best way to deal with migraines
There are a selection of theories why some individuals get migraines and others don’t. Ladies are three to 4 instances extra seemingly than males to expertise them, “which makes us suppose the estrogen hormone has one thing to do with it,” Hamdi says. Genetic elements additionally play a job, as do neurochemical imbalances involving serotonin, dopamine, and glutamate. Migraines could be progressive, Hamdi provides, placing increasingly often, particularly when individuals don’t discover ways to handle them or have poor life-style habits, like inconsistent sleep or excessive stress ranges.
Happily, consultants say, there are extra choices than ever to deal with migraines, together with focused therapies and nerve-stimulation units. Individuals who solely have these assaults sometimes would possibly depend on rescue drugs they take when signs begin, whereas these with extra common migraines typically take day by day preventive remedy. “We normally say, ‘OK, if it is greater than a day per week, then we would take into consideration prevention,’” Bravo says. “It goes again to how disabling the assault is, and the way impactful it’s on an individual’s life.”
