Migraine Clues Help Patients Ward off an Attack
By Andrew Gaeddert
A migraine is among the most debilitating conditions in medicine—a blinding, throbbing pain that typically lasts between 4 and 72 hours. There is no cure. An estimated one-third of the 30 million U.S. migraine sufferers experience warning signs up to 48 hours before pain starts. Some people feel unusually fatigued, cranky or anxious. Some have yawning jags. Others have food cravings or excessive thirst. If migraine sufferers can learn to identify their particular warning signs, they may be able to head off the headache pain with medication or lifestyle changes before it begins.
Scientists have long known about this so-called prodromal phase, which occurs well before the better-known aura, the flashing lights, and wavy lines that about 30% of migraine sufferers see shortly before the headache begins.
There are Four Phases of a Migraine
- Prodrome. About two-thirds of migraine sufferers experience vague physical or emotional changes 2 to 48 hours before the headache starts. Symptoms can include fatigue, yawning, appetite changes, altered mood, muscle stiffness, or digestive changes
- Aura. About one-third of patients see flashing lights, wavy lines and other visual disturbances for a few minutes to an hour before the headache begins. Some also have temporary trouble speaking or feel tingling or numbness on one side
- Pain. Virtually all migraine sufferers have moderate to severe throbbing head pain, usually on one side, lasting from 4 to 72 hours. Many also report nausea, vomiting, sensitivity to sound, light, smells, and movement. Sufferers may be unable to work, play, or socialize during this acute phase
- Postdrome. Feeling of exhaustion, depression, malaise, and difficulty thinking can persist for days, along with residual soreness in forehead or neck. In rare cases, sufferers may feel euphoric instead
“If you ask the average migraine sufferer, ‘Do you have any symptoms a few hours before the headache starts?’ about 30% will say yes,” says Werner Becker, professor of neuroscience at the University of Calgary in Alberta. But given a list of 20 common signs, from changes in mood, appetite or energy to urinating frequently or yawning excessively, about 80% of patients will say, “Oh yes, I’ve noticed that,” he says.
Dr. Becker says one of his patients frequently feels dizzy and loses her appetite about 6 p.m. and knows that an attack is imminent. She finds that taking the migraine drug rizatriptan—usually taken only after the headache starts—can ward it off. “If she doesn’t take it, then the next morning, she wakes up with a full-blown migraine,” Dr. Becker says.
Herbal medicine can also be effective at preventing migraines. Dave, a 48-year-old executive says he knows a migraine is coming when co-workers say his neck muscles have tightened up. He rubs his neck with an essential peppermint oil and takes five capsules of Head-Q. Most of the time the migraine does not occur, saving him a trip to the emergency room for an Imitrex injection.
Doctors prescribe pain relievers, anti-inflammatories, triptans, beta-blockers, anti-seizure medications, antidepressants, and Botox, but they have significant side effects and help only about 50% of patients about 50% of the time. More drugs are in clinical trials, and non-drug treatments such as acupuncture, biofeedback, and transcranial-magnetic stimulation are also showing some promise at alleviating migraine pain.
Doctors used to tell patients to wait until their headache pain was severe to moderate before taking medication. But that’s changing. “Now we know the closer we can get to the beginning of the attack, the better the outcome will be,” says David Dodick, president of the American Headache Society and neurologist at the Mayo Clinic in Phoenix.
Changes in digestive symptoms may predict a migraine. Physiological changes in the premonitory phase may trigger sensitivity to such foods, rather than the other way around. For example, patients have craving for migraine producing foods such chocolate or pizza, before a migraine. Scientists at UCSF are conducting imaging studies to determine the brain activity that occurs during the prodrome.
Dr. Goadsby and colleagues at UCSF are conducting more imaging studies to determine what brain activity occurs during the premonitory phase. Migraine sufferers can help themselves and their health professionals by keeping a careful log of when their headaches occur, what they ate, drank and did several days in advance, as well as any early symptoms they experienced. They may notice patterns and find their own warning signs.
Although acupuncture and drugs can stave off migraines, there are herbal approaches that are less invasive or have fewer side effects. For example, Head-Q is an empirical formula used to improve blood circulation and relive inflammation. It is the best approach for treating migraines at the prodromal stage or at a higher dosage if the migraine has already flared-up. Ease Plus is an historical formula particularly useful to prevent migraines and tension headaches caused by stress. The two formulas can be combined for clients with intractable migraines. For liver fire headaches characterized by pain affecting the temples, eyes or lateral side of the head, fever, bitter taste in the mouth, insomnia, fast plus, red tongue Coptis Purge Fire™ is the recommended formula.
REV 2022