almost 40 million people People in the United States suffer from migraines, making this painful disorder one of the most common disorders treated by neurologists. It’s also among the most confusing. Because of the many ways it can appear, It could take more than a decade To get an accurate diagnosis.
“The general perception of migraine in the general public is that it is a headache syndrome,” says Dr. Hamed Hamdy, a neurologist who leads the headache clinic at UTHealth Houston Neurosciences in Sugar Land, Texas. And certainly, many migraine sufferersAlthough not everything– Experience throbbing headaches. However, beyond that, “people don’t know all the other symptoms that migraines can cause, so they are very surprised at first,” he says. “Even as neurologists, we don’t always rule out all the symptoms of a migraine until we rule out things like stroke.”
We asked Hamdi and other neurologists what non-headache migraine symptoms they see most often.
Food cravings
About two to three days before a headache, people usually enter the prodromal (early) phase of a migraine. Symptoms include Irritability and other mood changes, fatigue, difficulty sleeping, difficulty concentrating, neck pain, and hyperactivity. What’s even more surprising is that many people report cravings for food, especially salty foods, sweets and chocolate.
The way scientists think about this type of craving has evolved. While some people believe that foods like chocolate cause migraines, Research indicates This is not the case, and there is no reason for people to avoid it. “In general, it was thought that chocolate could cause migraines,” Hamdi says. “But what we now think is that it’s not the chocolate that causes it, but rather that people had cravings for chocolate as a precursor to a migraine.” The desire to eat something sweet may be due to a sudden rise or fall in glucose Other metabolic changes In the body, as researchers discovered.
Vision changes
on 20% of people With migraines experience a visual aura, or Temporary changes in vision. These can appear as shimmering spots, squiggly lines, blind spots, tunnel vision, or even temporary blindness. The visual aura is likely caused by A A wave of electrical and chemical activity Which spreads through the brain.
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“People have described it in different ways,” says Dr. Thomas Bravo, a neurologist and director of the Headache Center at Loma Linda University Health in California. “It can be upsetting for the patient if it’s the first time,” but once they know it’s related to their migraine and will pass within 20 minutes to an hour, it’s not quite as scary. He adds that some people experience vision changes with every headache, while others report that these symptoms accompany only a portion of their headaches.
Speech difficulties
You may remember Clip of a TV reporter which went viral more than a decade ago, when the journalist suddenly became incoherent, causing many viewers at home to worry she was having a stroke. It turns out she had aphasia, or temporary language impairment, due to migraines.
A person with aphasia may have difficulty forming complete sentences, instead repeat jumbled words, or begin to stutter. “We see this all the time in the emergency department, and we’ll do an evaluation to make sure it’s not something like a stroke,” Bravo says. Doctors generally perform imaging tests such as CT scans or MRI before concluding—often through a process of elimination—that a patient has a migraine.
Sensory sensitivity
It often accompanies migraines Increased sensitivity For light, sound and smells. For example, the odors you are exposed to every day may seem much stronger and more musty than usual, and you may need to wear sunglasses outside because the bright glare of the sun irritates your eyes. “Light and sound can be annoying to actually painful, depending on the person,” Bravo says.
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You may also find that you cannot tolerate even gentle touch. Some people experience dull tactile pain, which occurs when the central nervous system becomes more sensitive to things that touch your skin. “You have an increased sensation of pain to stimuli that wouldn’t normally cause pain, such as a light touch on your skin,” says Dr. Brian Gerhardstein, a neurologist and director of headache medicine at the John F. Kennedy Neuroscience Institute in New Jersey. This also includes a light touch on your scalp by combing your hair, the sensation of a blanket rubbing against your body, or the feeling of a breeze brushing against your skin.
Motor changes
Hemiplegic migraine– It is rare but serious – It is associated with motor changes, such as one-sided body weakness or paralysis. This type of migraine has a strong genetic component and is often passed down from a parent, Gerhardstein says. “Basically, your face, arm and leg become weak during a migraine attack, and then it goes away,” he says. “It can look just like a stroke, so a lot of these patients end up in the emergency room.” Gerhardstein adds that seeking urgent care is a good idea, because it’s important for doctors to rule out potentially life-threatening conditions.
Abdominal pain
An “abdominal migraine” can cause severe stomach pain, nausea, vomiting, and lack of appetite. “People vomit over and over again, and they don’t necessarily have headaches,” Gerhardstein says. While there are different theories as to why this happens, research suggests that it is likely Related to changes in the gut-brain axis.
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These gastrointestinal symptoms are common in children and can be difficult to diagnose, especially if young patients do not have headaches or are unable to verbalize what they are experiencing. “I often see pediatricians confused trying to figure out exactly what’s going on,” Gerhardstein says. “When they rule out all organic causes, they come up with migraine as the definitive diagnosis.”
How to treat migraines
There are a number of theories why some people get migraines and others don’t. Women Three to four times more likely Many men experience it, “which makes us think estrogen has something to do with it,” says Hamdi. Genetic factors It also plays a role, as it does Neurochemical imbalances Involving serotonin, dopamine and glutamate. Hamdi adds that migraines can be progressive, appearing more and more frequently, especially when people don’t learn how to manage them or have poor lifestyle habits, such as inconsistent sleep or high stress levels.
Fortunately, experts say there are more options than ever to treat migraines, including targeted therapies and nerve stimulation devices. People with these attacks may sometimes rely only on rescue medications they take when symptoms start, while people with more regular migraines often take daily preventive medication. “We usually say, ‘Well, if it’s more than one day a week, we might consider prevention,'” Bravo says. “It comes down to how disabling the attack is, how much it impacts a person’s life.”