Migraine Myth of the Month
If you have a history of migraine and experience a change in the character or frequency of your headaches, you should be concerned that you have developed a brain tumor or another serious neurologic disorder.
Not true. Migraine is a highly variable headache disorder, and even in a given individual, the character of the migraine episodes one experiences, and the character of the headache, in particular, typically do change over time … and even from episode to episode. The headache associated with acute migraine ranges from no headache whatsoever (migraine aura without associated head pain) to severe and functionally incapacitating headache, with every level of headache intensity in between those two extremes.
Your migraine headache may be throbbing one time but not the next. It may be invariably lateralized to one side of the head, shift from one side to the other, or involve both sides. There may or may not be nausea, light sensitivity, sound sensitivity, sensitivity to odors, sensitivity to motion, or aura. At times your migraine symptomatically may be indistinguishable from an acute tension-type headache, with an annoying (but not severe) pressure-like band of discomfort encircling the head and no associated nausea, light sensitivity, or sound sensitivity.
Migraine is divided into two large subgroups: episodic and chronic. Patients with episodic migraine experience fewer than 15 days of headache per month, whereas patients with chronic migraine experience 15 or more days of headache per month.
Each year, 2% of the many millions of Americans who have episodic migraine will experience “transformation” of their headache disorder into chronic migraine. As they do, the frequency of their severe headache episodes may decrease in parallel with the increasing pervasiveness of their head pain. This is not episodic migraine co-existing with chronic tension-type headache; this is chronic migraine. More to the point of debunking this month’s myth, the most common cause of a change in a migraineur’s headache frequency/severity is not a brain tumor or other serious neurologic disorder but rather this transformation of episodic migraine to its chronic form.
Very, very little about migraine can be said to be “always”. Migraine often improves during the latter portion of pregnancy or following menopause, …but not always. In those migraineurs who are susceptible, drinking red wine often may trigger an acute migraine headache…but not always. Episodic migraine often remains episodic throughout a migraineur’s lifetime…but not always. And so it goes.
Caveat: 12% of the American population has active migraine, and nothing about migraine makes those millions of citizens immune to brain tumors or other serious neurologic disorders, which may produce headache. If your headache disorder is changing in a manner you find concerning, tell your provider. If this change represents episodic migraine transforming into chronic migraine, then early treatment intervention may help you avoid a lot of pain and inconvenience down the line. If the change appears to your provider to potentially reflect something other than migraine changing its spots, then further diagnostic testing may be indicated.