Migraine Myth of the Month
If you experience a change in the character or frequency of your migraine headaches, seek medical attention immediately.
We have walked around this long cherished myth in previous issues of Migraineur, and perhaps now is a good time to tackle that myth head-on.
It is decidedly unusual for migraine headache to be stereotyped, with the individual migraineur experiencing precisely the same type and degree of symptoms with each migraine episode. Just as a migraineur evolves in so many other ways biologically as the years progress, so does his/her migraine. Even discounting the influence of aging or of the given individual’s genetic blueprint, internal and external events occurring along the way may result in a reduction or increase in migraine burden. The change in sex hormone receptor sensitivity that occurs during the first trimester of pregnancy is a frequent (but not invariable) aggravator of migraine, and in women menopause frequently (but not always) results in a reduction in headache burden. From nation to nation, race to race, and culture to culture, migraineurs invariably rank stress at the top of those factors which aggravate their migraine.
Patients often report that along with migraine they experience “eight other types of headache”. Most often, what they are confirming is that the clinical manifestations of migraine range along a spectrum that varies from episodes involving no associated headache whatsoever (aura only) to episodes of “classic” migraine characterized by pounding, incapacitating head pain with associated nausea, vomiting and light/sound sensitivity…and everything in between, including headaches that sound identical to those experienced by individuals with “pure” tension type headache.
Rarely does a change in headache character or frequency indicate the existence or development of a more ominous neurologic disorder such as brain tumor, brain aneurysm or meningitis. This is not to say that migraineurs are immune these and other disorders which may produce headache, but it’s true that the migraineur‘s experience of change in headache character or frequency most often results from a change in his/her migraine itself. If that change is for the worse, by all means seek medical attention. But do so more for assistance in treating your headache disorder than for embarking upon an extensive diagnostic evaluation typically destined to achieve nothing of value.