Anatomy of a migraine
and issues in FM
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Having just had one of these monstrosities yesterday, I felt it was time to outline in detail what this means, and how it relates to FM. First off, there are many kinds of migraine. Common names are:


Paraphrased from
Migraine buddy.com
Likely causes for Migraine

* equals the most common; ( anything inside parentheses is my addition )

Migraine Without Aura *
This type of migraine causes a throbbing pain on one side of the head. The pain can be severe and is made worse with physical activity. ( So if anyone tells you, that you can exercise away the pain, feel free to smack them ) Nausea and often vomiting. Light and sound sensitivities.(Imagine the worst hangover, EVER and you might have some idea of what this is like ) "The headache can last 4 to 72 hours. A common migraine doesn't begin with an aura."

Migraine With Aura  aka classic migraine *
(All of the above, with an aura, which can happen up to 30 minutes before a migraine.) "Symptoms of the aura include:
Seeing wavy lines, flashing lights, or objects that look distorted. Other symptoms include feeling of pins-and-needles, which begins on one side in the hand and arm and spreads to the nose–mouth area on the same side. Numbness can follow."

Aura:

(What is it? Well that varies, depending on the type of migraine you have, but 99% of all migraines, have some sort of visual effects.The most common being, scintillating lights at the edge of a scotoma ( blind spot ).There are many other types, ( see stages below ) but the "visual" type, are not really in your eyes,
but they seem to be. Ocular migraines are the exception to that rule. The effect for most people is happening in the brain where the visual cortex is located,so the brain translates the effect, as sight.

It often looks like this:  see image below.  The colors, size, movement all vary but most start out as small blind spots, with an edge of zig zag lines. They can be black and white or colored. They move outward getting larger in your field of vision, until they disappear. Others report blind spots alone, snowflake white outs, flashing lights and lines.

I recall asking one eye Doctor after another what were these crazy things I kept "seeing" only to be told time and again that other than needing correction, there was nothing wrong with my eyes. I did not discover what this was until I noted an article in a magazine on migraines and bingo, there it was ... a drawing very like the one below, that finally explained what I had been seeing for years.

It still amazes me that none of my Ophthalmologists or Optometrists, knew anything about this. )

aura

Also common during the aura phase are sensory issues, " A sensory aura begins as a tingling in one limb or a feeling of numbness that travels up your arm over 10 to 20 minutes. The sensation can spread to one side of your face and tongue." other issues can be " transient speech or language problems referred to as dysphasic aura" and one of the most rare, but the main reason those of us with migraine are more prone to having a stroke* "In the rarest of auras, the limbs and possibly the face on one side of your body might become weak; this is referred to as hemiplegic migraine." Mayo

(Given I have suffered migraines since age 14, after a traffic accident, whiplash, spinal distortion etc. and have had two pin point strokes, this would seem to be born out, at least in my case. I am sure there are others. )


Hemiplegic Migraines:

"The symptoms of hemiplegic migraines are similar to those of stroke including paralysis, speech disturbances and weakness on one side of the body."

Ophthalmic/ Ocular Migraine:
"Often known as retinal migraines and include visual disturbances, blind spots and blindness in one eye. ( feels like your eye is being dug out with a spoon, or worst case, someone just shoved an ice pick in your eye or temple ) These symptoms show up for only a short time before the migraine begins."

(The visual effects can disrupt both eyes. The eyes are where the problem starts in this case. Instead of, as in the 
classic migraine where the visual cortex in the brain is being effected. Not sure which you have ? Simple test, when you see the visual effects, close your eyes. If you can still SEE the distortion, you have a classic migraine. It went away? Then you likely have an ocular migraine.)

Note: "These are more common in young children and adolescents. Causes severe pain behind the eye, double vision, droopy eye lid and often vomiting and seizures. (They are common in the young but NOT limited to them. You could have them as a child and have them follow you into adulthood. I know this from personal experience, as they were called " heat headaches" when I was a girl, as they often happened during the bright days of summer.)

Vestibular Migraines:
"Vestibular migraines, often known as migrainous vertigo, are migraines accompanied by vertigo, dizziness and imbalance. Vestibular migraine sufferers may feel the room spinning during the attack as well as feel like they are moving when they are not." (This event can happen, with or without headache pain. )

Link

Migraine with Brainstem Aura: (formerly called Basilar-Type Migraine)  mainly affects children and adolescents, this includes Migraine with Aura symptoms that originate from the brainstem, but without motor weakness.

Others: That are not "official terms", but are commonly used due to time, location and what triggers the pain.

Weather related Migraine
Hormonal Migraine
Abdominal Migraine
Complex Migraine (an outdated, very discredited term, but it will still be seen in the older texts )
Morning Migraine

Why the sub catagory names ? And why in newer literature you often do not see them? " the World Health Organization needed a common language to define  Migraine sub-types, as they are described, as well as their "official"designation, so that doctors and patients around the world could compare notes and exchange data."
Migraine again

(So, their current use or lack thereof, is just to simplify medical discussions, but this does not mean we cannot ID them this way, as we tend to ID them based on when or where they occur as well as how they happen, and this is information your Doctor needs to treat you properly.

Note: Just in case you are wondering,  you can have more than one of these types. Isn't that just a lovely thought ... NOT. Mainly due to the the long list of triggers. Example: for me this means I get, Ocular, Classic, and occasionally, since I also have inner ear issues,
Vestibular effects. Triggers for me are: Weather, biomechanics, tendon and joint damage, TMJ, arthritis, eye, sinus issues and of course ... FM.

With FM, all of this and more, becomes far more likely for a wide variety of reasons. Not the least of which is the fact most migraines can be attributed to serotonin ( sudden drops in serotonin happen during migraine )  and nerve issues, along with the afore mentioned joint and tendon problems, all of which WE have in large number. As well as, 6 of the 11 tender points in FM, are located at the back of the head, neck, and shoulders. All of which can lead to your typical tension headache. Which, if you are prone to migraine, is a starting trigger in and of itself. Therefore, migraine in FM, should not  surprise anyone.)

tender points FM and Migraine


Triggers:

Paraphrased from
Mayo clinic
( anything inside parentheses is my addition )

Hormonal changes: in women. (Fluctuations in estrogen seem to trigger headaches. Therefore, hormonal migraine, is a thing.  Pregnancy or menopause has been know to both increase or decrease attacks.Variability in estrogens are the key here.  Often the use of birth control pills, or during the phase you are NOT on the pills, can bring on migraine. For some however, there is less likely hood  during the "rest" phase, when you are not taking the pills.)

Foods: Aged cheeses, salty foods and processed foods may trigger migraines. (The culprit is Tyramine.) "Tyramine is a substance found naturally in some foods. It's especially found in aged and fermented foods." Details Web MD

Skipping meals or fasting: can trigger attacks. ( generally due to what fasting does to blood glucose levels )

Food additives: The sweetener aspartame (no surprise there, as it mimics a neurotransmitter in the brain ) and MSG, found in many foods, may trigger migraines.

Drinks: Alcohol, especially wine, ( it makes the body release histamines, creating an allergy type reaction ) and highly caffeinated beverages.


(Conversely, for some, these same things may prevent or stall a migraine, which is why caffeine is added to many headache medications. As well as the fact that many tension headaches, are due to caffeine withdrawal. It is why when you are busy, it is not just the stress or the deadline you are trying to meet, that can create the headache.

The headache can be triggered by the simple fact that you have had no time to hit the coffee maker or grab a soda as you normally would do, so you are starting
withdrawal. Not sure if that applies ? Easy test. If you have a headache, consume caffeine, if the headache eases up in a short time, you know what set it off. 

I keep caffeine pills on hand in my bag for when I am out and about, for this very reason. It is surprising how many headaches this staves off. A full 90 % of the population consumes caffeine every day. Over half of these, are considered habituated.

Now, given those numbers, do NOT let some Doctor assume that just because you are one of the 90% who consume, that that is automatically the reason for your migraines ( the same goes for that assumption of caffeine use is a reason for insomnia ( Insomnia and FM, on site link ) Because if that were always the case, over half the population would have migraines and be insomniacs.

This of course is NOT the case. However you might be one of those for whom caffeine IS an issue.  Easy test for it, go off the feen for at least 6-8 weeks. This is not even remotely fun. Been there, done that and have a whole rack of T-shirts to prove it. But you might be one of the lucky ones and find that yes ... this is your issue and it's something you can control for. This was not the case for me, but it is worth going through withdrawal, to find out. )


Stress: Stress at work or home can cause migraines. ( Tension headache, which is a trigger and the whole, fight or flight response is at play here )

Sensory stimuli: Bright lights and sun glare can induce migraines, as can loud sounds. Strong smells — can trigger migraines in some people. (Smell hypersensitivity, is also part of the effects during a migraine. It is thought that migraine suffers, often ARE hypersensitive to smells to begin with. Which triggers the migraine, which then makes the smells EVEN more notable and so on. We with FM often have this kind of  
sensitivity to start with )

Changes in wake-sleep pattern: Missing sleep or getting too much sleep may trigger migraines in some people. ( Now this is an FM hallmark moment, as sleep ? What's that ? )

Physical factors: Intense physical exertion, including sexual activity, may provoke migraines. (Post coital and after a work out in the gym migraine are commonplace )

Changes in the environment. A change of weather or barometric pressure can prompt a migraine. ( This anyone with FM, or joint issues can readily believe, as we already suffer when the weather changes )

Medications: Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines. ( Having had nitro once, due a drug induced heart issue, I can attest to this, as it feels like a sudden hammer to your head. However, migraine is a considered by most to be a combination of constriction of the blood vessels, during the prodome phase and the sudden opening of those same vessels, slamming your brain with pain in the process.  There are other theories, and studies that claim that dilation is only a part of the process, and is not in and of itself, the reason for the pain. The jury is still out on that )

Risk factors:

Several factors make you more prone to having migraines, including:

Family history: If you have a family member with migraines, there is a good chance, so will you.

Age: Migraines can begin at any age, but are common in adolescence. They tend to peak during your 30s, and gradually become less severe and less frequent in the following decades.

Gender: Women are three times more likely to have migraines. Headaches tend to affect boys more than girls during childhood, but by the time of puberty and beyond, more girls are affected.

Hormonal changes: If you are a woman who has migraines, you may find that your headaches begin just before or shortly after onset of menstruation.

They may also change during pregnancy or menopause. Migraines generally improve after menopause. ( I want to know who they asked for that one, as I have been
menopausal starting at age 20 and complete by surgery at age 25, and after all that, is when they were at their worst for almost 5 years running. Which could be due to the hormonal variablity that happens with menopause, now that I think about it ... But for some, they DO get better after menopause. )

Some women report that migraine attacks begin during pregnancy, or their attacks worsen. For many, the attacks improved or didn't occur during later stages in the pregnancy. Migraines often return during the postpartum period.

Stages: Paraphrased from Migraine.com
( anything inside parentheses is my addition )

stages

Prodrome ( meaning before, this can happen for hours or even days prior to the the event )

Aphasia: difficulty finding words and / or speaking ( since most of use are middle aged or older, this can be mistaken for age related issues. This is also an FM issue due to chemical imbalances )

Constipation or diarrhea: ( IBS, FM the guts sensitivity to Serotonin is at play here ) IBS and FM on site link

Difficulty concentrating :
(A very complex subject with far reaching effects, the page the above text is linked to, defines this in detail.)
( This sort of brain fog is a daily affair for most FMers )

Excessive yawning: ( Not due to lack of sleep. Yawning is in fact a brain cooling effect in this case. The theory is, that the brain heats up due to the blood vessel dilation, so the yawning is an attempt by the body to cool it down during a migraine)

Fatigue: ( which for those of us with FM is a daily event, so it would be very hard to say at any point, that it  was migraine related )

Food cravings: ( often carbs, which we with FM also tend to crave due to high energy issues )

Hyperactivity:

Increased frequency of urination:

Mood changes: — feeling depressed, irritable, etc. (common in FM )

Neck pain: (
common in FM )

Sleepiness : ( considering how we do not sleep, this is a given in FM )

Notice: This list and most of the others, would almost go unnoticed in someone with FM. The overlap is considerable. FM is not alone on site link


Aura ( warning phase)

Alodynia: hypersensitivity to touch, what would be “normal” touch is painful ( We with FM know this feeling, very well )

Aphasia: where you suddenly cant " find" the words you want to say, or to talk, at all. ( Also an FM thing, that happens often to us )

Auditory hallucinations
Olfactory hallucinations

Confusion:  (With this list, is this really a surprise ? )

Decrease in or loss of hearing: ( considered due to extreme ringing in your ears brought on by blood pressure changes)

Dizziness: ( the light headed, feeling like you are about pass out effect. It is due to a sudden drop in blood pressure to your head. Which again, a large number of us have, Postural orthostatic tachycardia syndrome aka 
POTS (many feel that POTS and Mitral valve pro lapse   on site link, are one in the same, 30-65% of us with FM, also have pro lapse )  In either case, it means that our heart rate and blood pressure do not behave normally and we get light headed on standing, along with a whole host of other things,  see  Link for more details.)

Parasthesia: prickling, stinging, burning, numbness, and / or tingling, usually of the extremities or face ( feels like parts of the body have been "asleep" and are waking up )

Vertigo: sensation of whirling or spinning, ( when you are not moving ) not to be confused with dizziness. ( This can be outright dangerous, as it can happen at any time, like when you are driving for example. Thankfully, for most people it is short lived, even if it seems like its lasting forever )

Hemiplegia: one-sided paralysis or  motor weakness during the Migraine.

Note: Many studies say that if you have already had a stroke, you can get hemiplegic effects with most migraine types, which makes pin pointing which type you have, problematic.

Visual:

Wavy lines 
“blank” or tiny blind spots
Blurry vision
Partial loss of sight

Phosphenes: brief flashes of light that streak across the visual field

Scotoma: an area of decreased or lost vision. Some people describe scotoma as being like having tiny blank spots in their vision. Some compare it to tiny snowflakes.

Unilateral effects: (one-sided) (occurs in retinal Migraine only)


Mayo clinic video and explanation

Headache:

Pain on one side or both sides of your head
Pain that feels throbbing or pulsing
Sensitivity to light, sounds, smells and touch
Nausea and vomiting
Blurred vision
Lightheadedness, sometimes followed by fainting


Chronic Migraine

Notes on Chronic Migraine: This is characterized by headaches occurring on 15 or more days per month for more than 3 months. ( This used to be me for many years, until I realized some of the  bio-mechanical factors (posture, movement, body kinetics, static behaviors ) that were contributing to them and corrected most of them by taking care how I move, sit, stand etc.

Big Note:( It is NOT just a matter of you have poor posture and or bad body behaviors. Now, you could have some poor body behaviors and you should identify and correct for that.  Most of us could do better in that area. ) Posture and what it means for health, work etc. is not as cut and dried as you might think. 50 to 80 % of the population has issues is this area that create pain and problems. Link

(For us, we have all of the above issues and FM. Furthermore, FM and its issues will MAKE you twist the body up like a pretzel, as it tries to avoid pain. So even with the best of intentions and body training/awareness you can still get into postures that can help start off a migraine, much less other body pain. FM can force you, literally, into some very bad positions. Correct what you can, become aware of what the body is doing, but do not let someone just blame all of this on you. Not your Doctor, your body worker or your PT and most certainly do NOT blame yourself.)


Mayo clinic


Suicide risks:

(The list above, does not even go nearly far enough to explain the kind of pain one can suffer with a migraine. These things can last from four to 72 hours or more. Note that.. that is 3 DAYS.. in the kind of pain that if someone told you that bashing your head into a brick wall would make it stop, you would seriously consider it. Suicide rates are high for migraine suffers. Most studies list at least 50% will either attempt self harm, consider suicide and/or even attempt suicide.

Many of the medications given for migraine, which happen to be some of same types of meds that they tend to give us for FM ( meds for FM on site link ) can all make the risk of suicide, up to 50% higher:

Gabapentin (Neurontin)
Oxcarbazepine (Trileptal)
Tiagabine (Gabitril)
Lamotrigine (Lamictal)
 
Which are all anticonvulsants in this case. AMA study, 300,000 people,with no prior suicide risk, treated with one of 13 anticonvulsants, for migraines, chronic pain, bipolar disorder and epilepsy. At the end of 180 days, 26 had committed suicide, 801 had attempted it. The risk factor for suicide for migraine, who use the most commonly given drug Gabapentin, is 48%.)

Migavent.com

Postdrome: ( after effects) Migraine phases

Confusion:  ( Major, it is like the past few days, other than the relentless pain, it is all a blur. Your brain struggles to get back in gear )
Moodiness:  ( Duh, after all that? Of course you are moody )
Dizziness:
Weakness: ( You just used up every erg of energy you had, to deal with pain that would register a rector scale, so weakness is a given )
Sensitivity to light and sound:

(Some of these, after effects, can be linked to the very medications you took to stave off, or ease the pain. You might have a medication hang over.

The after effects, can trigger yet another attack as it is commonplace to suffer left over neck pain, extreme tenderness in all the muscles and tendons in the area that was in pain. No surprise there, given as they were clenched like a fist for days. The after effects of sensitivity to light and sound, can also be a trigger.

Then, after all this or worse, even during this, comes an FM flare on site link, that can last for many more days. This kind of disruption makes it almost a given that you will flare. So a Migraine can mean perhaps a week or more of extra pain and debility. Treatment becomes a must for any headache, to prevent a chronic round of headache, to Migraine, to Flare, to another Migraine.)