Near 40 million people suffer from migraines in the United States, making this painful disorder one of the most common disorders treated by neurologists. This is also one of the most confusing. Due to the many ways this can manifest itself, it may take more than ten years to get an accurate diagnosis.
“The general concept of migraine in the general population is that it is a headache syndrome,” says Dr. Hamid S. Hamdi, a neurologist who directs the headache clinic at UTHealth Houston Neurosciences in Sugar Land, Texas. And, of course, many migraine sufferers…although not all– experience a throbbing headache. Beyond that, however, “people don't know about all the other symptoms that migraines can cause, so they're very surprised at first,” he says. “Even as neurologists, we don’t always attribute all symptoms to migraines 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 the onset of a headache, people typically enter the prodromal (early) phase of migraine. Symptoms include irritability and other mood changes, fatigue and trouble 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 traction has changed. Although some once believed that foods such as chocolate caused migraines, research shows it's not, and there's no reason for people to avoid it. “It was generally believed that chocolate could cause migraines,” says Hamdi. “But we now think it wasn’t chocolate that caused this phenomenon, but that people had a craving for chocolate as a prodrome of migraine.” The desire to eat something sweet can be caused by a sudden rise or fall in glucose levels and other metabolic changes in the body, the researchers found.
Changes in vision
ABOUT 20% of people migraines cause a visual aura, or temporary changes in vision. They can appear as flickering spots, zigzag lines, blind spots, tunnel vision, or even temporary blindness. The visual aura is probably caused by wave of electrical and chemical activity which spreads throughout 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 concerning for a patient if it's the first time it happens,” but once they know it's related to their migraine and will go away within 20 minutes to an hour, it's not so bad. He adds that some people experience vision changes with every headache, while others report these symptoms accompany only a portion of their headaches.
Speech difficulties
Can you remember TV journalist clip it went viral over a decade ago when the journalist suddenly became incoherent, causing many watching at home to worry she was having a stroke. It turned out that she had aphasia, a temporary speech disorder caused by migraines.
A person with aphasia may have difficulty forming complete sentences, instead repeating jumbled words or slurring their words. “We see this all the time in the emergency room and will do an evaluation to make sure it's not something like a stroke,” Bravo says. Before concluding (often by exclusion) that a patient has migraine, doctors usually perform imaging studies such as a CT scan or MRI.
Touch Sensitivity
Migraines are often accompanied increased sensitivity to light, sound and smells. For example, the odors you are exposed to every day may seem much stronger and putrid to you than usual, and you may have to wear sunglasses outside because bright sunlight irritates your eyes. “Light and sound can range from unpleasant to truly painful, depending on the person,” Bravo says.
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You may also find that you can't stand even the gentlest of touches. Some people experience tactile allodynia, which occurs when the central nervous system becomes very sensitive to things that touch your skin. “You experience increased pain when exposed to stimuli that normally do not cause pain, such as light touch on the skin,” says Dr. Brian Gerhardstein, a neurologist and director of headache medicine at the John F. Kennedy Institute of Neuroscience in New Jersey. It also includes the light touch of your scalp when combing your hair, the feeling of a blanket rubbing against your body, or the feeling of a breeze brushing your skin.
Motor changes
Hemiplegic migraine– which are rare but serious – are 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 parents, Gerhardstein said. “Essentially, your face, arm and leg become weak during a migraine attack and then go away,” he says. “It can look exactly like a stroke, which is why many of these patients end up in the emergency room.” Seeking emergency care is a good idea, Gerhardstein adds, because it's important for doctors to rule out potentially life-threatening conditions.
Abdominal pain
An “abdominal migraine” can cause terrible abdominal pain, nausea, vomiting and lack of appetite. “People vomit over and over and over again, and they don’t even necessarily have headaches,” Gerhardstein says. Although there are different theories as to why this happens, research shows that it is quite likely. associated with changes in the gut-brain axis.
Read more: Your Gut Can Affect Your Mood
These gastrointestinal symptoms are common in children and can be difficult to diagnose, especially if young patients do not have headaches or cannot articulate what is hurting them. “I often see pediatricians scratching their heads trying to figure out what exactly is going on,” says Gerhardstein. “When they rule out all the more organic causes, they come to migraine as the final diagnosis.”
How to treat migraine
There are a number of theories as to why some people get migraines and others don't. Women three to four times more likely than men experience them, “which makes us think the hormone estrogen has something to do with it,” Hamdi says. Genetic factors also play a role as neurochemical imbalance involving serotonin, dopamine and glutamate. Migraines can progress, Hamdi adds, and occur more and more often, especially when people don't learn to cope with them or have poor lifestyle habits such as inconsistent sleep or high stress levels.
Fortunately, experts say, there are more migraine treatment options than ever before, including targeted therapies and nerve stimulation devices. People who only have these attacks occasionally may rely on medications they take when symptoms appear, while people with more regular migraines often take daily preventative medication. “We usually say, 'OK, if it's more than one day a week, then we can think about prevention,'” Bravo says. “It's about how incapacitating the attack is and how much it impacts a person's life.”
