Word Picture: What’s a Migraine, a House-Fairy or a Spring Shower?

by | Aug 4, 2014 | General Health, Humor

If I ever ask a headache patient if they’ve ever had a migraine headache, the frequent answer is, “No.”

That’s because most people think “migraine” means “bad headache.” Really, really bad headache.

It doesn’t mean that, actually.

“Migraine” is actually a spectrum or sequence of neurological, musculo-skeletal, vascular, visceral, and inflammatory reactions that may be associated with a really bad headache… or no headache at all. The neurological part of the migraine may be consist of an “aura”. This aura can be a sparkling “blind spot” that moves across the visual field, often before, but sometimes during the headache. When this happens without a headache it is often called an “ocular” migraine.

An aura may also consist of unusual symptoms that may be mistaken for a stroke or TIA, like numbness or weakness of the arm, hand, or face, or brief inability to speak (aphasia), or even brief periods of amnesia. (I’m not kidding: I’ve had two patients in my career who interrupted their housework and went to bed during the day because they felt a migraine coming on, and were surprised when they woke up from their naps to find their houses clean. Of course, what actually happened was that they had gotten up, cleaned their own homes, and gone back to sleep, all with no memory of the work. To lessen my patients’ anxiety and inject a little humor I told my patients they had just been visited by the “migraine fairy.”)

There are, of course, many types of headaches, or things that contribute to headaches: muscle tension, emotional or physical stress, eye strain, medication side effects, food sensitivities, chemical or allergy reactions, hormone changes, sinus congestion, not to mention obnoxious children, barking dogs, hangovers, or a bonk on the head. But in my opinion, every headache has an element of migraine until proven otherwise. The muscular tension aspect of the migraine accounts for the spasm or tenderness of neck, jaw, or facial muscles associated with the headache. The visceral or “gut” component brings the nausea and gastrointestinal symptoms, the vascular component (due to blood vessel dilation in areas of of the brain) the throbbing, pounding, and sometimes localized headache pain element, and the inflammatory component the global, whole-head, every-movement-hurts-like-a-@$%# kind of pain.

Having had a couple of migraines like that in my lifetime I can relate to my wife’s grandma’s saying, “I felt like I’d have to get better to die.”

So, why does a migraine take so many forms? And what explains the weird neurological symptoms that may accompany them? Well, if you consider that a grand mal seizure (epilepsy) is like a giant electrical storm that erupts all over the central nervous system, a migraine consists of a much smaller area of electrical activity. The neurological symptoms (like visual changes or hand weakness) depend upon which area of the brain is affected. So if a seizure is a “hurricane on the brain”, a migraine is like a localized spring shower.

The best way to know if a headache has a migraine component is the presence or absence of associated symptoms. If you have an aura or neurological symptoms it’s most certainly a migraine. And even without that, if your headache is accompanied by nausea, that’s a strong indicator of migraine.

So, if you want to prevent and treat your headaches, it’s important to know that your “sinus” headaches or your “tension” headaches may actually be migraines. It can make all the difference.