Headache experts tell us that a wave of electrical activity called cortical spreading depression occurs long before we recognize the signs of an impending migraine attack. It starts in the brainstem and spreads everywhere. The brainstem is responsible for many autonomic reflexes that are disturbed during migraine, such as balance and coordination. This process also affects speech, vision, and hearing centers of the brain. Several neurotransmitters are adversely affected, too. Serotonin, in particular, takes a nose-dive. Understanding this helps me recognize all the symptoms of migraine, not just the headache.
Before I learned this, I would blame the attack on my bad mood instead of recognizing the mood changes as part of the constellation of migraine symptoms. I would question whether all the strange symptoms were just a figment of my imagination or a sign that I truly was a hypochondriac. Now that I know migraine is a neurological disorder, the weird symptoms make sense. There are biological reasons for all of it. This knowledge is a good thing. By recognizing the symptoms I no longer question my sanity or blame myself for non-existent character flaws that are really just symptoms of the disease.
Attacks start much sooner than I once thought.
24-48 hours before I start to feel any symptoms, the prodrome kicks in with mood swings. I get irritable and impatient, feel sorry for myself, cry easily, and generally feel depressed. I crave solitude, so I tend to isolate and stop talking. Then 12-24 hours later, I get intense food cravings alternating with lack of appetite. Sometimes I will yawn uncontrollably for hours.
2-8 hours before the headache starts, my neck gets stiff and I start to feel very tired. My ears start ringing. I can’t focus or concentrate. Lights are too bright. Sounds are too loud. It’s as if the whole world has been intensified. I can sense what is coming, but can’t put it into words until it’s too late. Asking me to have a serious discussion or make important decisions at this time would be a mistake.
When the headache starts, it gradually builds a peak intensity within 4 hours. If I catch it early, I can keep the intensity low and stop it. The pain begins on the left side at the base of the neck, wrapping up and over the top of my head, stopping above my left eyebrow. Cold packs help to dull the pain. Heat feels better on my neck. Using a TENS on my neck sometimes reduces the intensity of the pain.
Nausea has been starting earlier, sometime even before the headache. I’m getting more nausea than I have ever had before. It used to take a full day of headache pain before I started to feel queasy, but now it is happening much earlier in the acute attack phase.
The migraine attacks with aura have disappeared for the moment, so I can’t rely on that early warning anymore. Most of the time, a single dose of triptan is enough to stop the pain and nausea when I take it when symptoms first start. If abortive medicine doesn’t stop the headache phase, it can last for days. I have rescue treatments to help me cope and prevent the pain from getting out of control. They help, but certainly don’t shorten the headache phase at all.
Throughout this phase, pain is only one of many disabling symptoms. My ears ring like crazy. I can only tolerate dim light and whispers. Anything more intense sends the pain spiking up. Verbal communication is difficult as I cannot find the right words or form a coherent thought. In a strange paradox, I also have a surge of creativity and rarely have trouble communicating in writing. These symptoms can linger for up to a day after the pain has stopped. The photophobia, phonophobia, and tinnitus are often untouched. Long after the pain is gone, the house remains dark and quiet. When my head clears and I crave light and sound, then I know the attack is really over.
The entire process lasts 3-4 days for a single attack. On the rare occasion that I get more than one attack per week, the postdrome and subsequent prodrome overlap.
Knowledge = Confidence
Knowing all of that doesn’t stop the symptoms. It does help to understand what is happening. I am able to recognize that mood swings are early signs that a migraine attack is coming. Knowing this prevents me from taking it so seriously when I get grouchy and impatient. I’ve stopped looking for reasons why I feel so badly because now I know it’s just because I have migraine. Since I don’t feel that way any other time, I can feel confident knowing that I am not really a moody person. My self-esteem and confidence have improved because I am better educated about migraine.