Diagnosing Migraine With Brainstem Aura
Migraine with brainstem aura should be distinguished from hemiplegic migraine. Hemiplegic migraine causes temporary weakness on one side of the body, usually in the face and arms but may also affect the legs.
People experiencing migraine with brainstem aura attacks may be considered and investigated for some other conditions such as Menieres disease, ischaemic stroke, epilepsy or vestibular disorders affecting the ear causing vertigo. Other conditions will need to be ruled out to receive the appropriate diagnosis and treatment.
Migraine with aura has a slightly higher risk of stroke than migraine without aura however, there is no evidence that migraine with brainstem aura has a higher risk of stroke than migraine with typical aura.
What Are The Four Stages Or Phases Of A Migraine Whats The Timeline
The four stages in chronological order are the prodrome , aura, headache and postdrome. About 30% of people experience symptoms before their headache starts.
The phases are:
It can take about eight to 72 hours to go through the four stages.
What Causes Hemiplegic Migraine
The brain and nervous system depend on a combination of electrical and chemical signals to function. When a nerve impulse of sufficient strength passes down from one nerve cell towards another, it opens a so-called channel which acts like a gate. This process releases neurotransmitters which contact the neighbouring cells and tell them how to respond.
When a channel in the brain is not working properly, neurotransmitters, such as serotonin, may be released in an abnormal way. In hemiplegic migraine, the way some channels dysfunction, results in these symptoms.
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What Questions Should I Ask My Healthcare Provider
- Will my child grow out of their migraines?
- What medications do you recommend for me?
- What should I change about my lifestyle to prevent my migraine headaches?
- Should I get tested?
- What type of migraine do I have?
- What can my friends and family do to help?
- Are my migraines considered chronic?
A note from Cleveland Clinic
Migraine headaches can be devastating and make it impossible to go to work, school or experience other daily activities. Fortunately, there are some ways to possibly prevent a migraine and other ways to help you manage and endure the symptoms. Work with your healthcare provider to keep migraines from ruling your life.
Last reviewed by a Cleveland Clinic medical professional on 03/03/2021.
References
Migraine And Headache Causes
Migraine and tension headaches usually have a genetic link just as some inherit asthma or another illness, you likely inherited a tendency to get these headaches from your family. Once inherited, several factors can trigger an attack.
The top FOUR migraine triggers are:
Less common migraine triggers are alcohol and MSG.
Tension Headache Common Triggers
- tiredness
Cluster Headache Common Triggers
Unlike migraine and tension headaches, cluster headaches tend to occur because of abnormalities in a region of the brain that connects the nervous system to the endocrine system . Once a person has clusters, alcohol or MSG may trigger an attack.
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What Is Alice In Wonderland Syndrome
This is a rare form of migraine aura that causes distortions in perception. Someone with this condition might feel as if her body is getting smaller, then larger, or might find that time seems to speed up or slow down. Children experience this syndrome more than adults, but it can occur in people of any age.
The Different Types Of Migraines
A migraine is not just a really bad headache, as some people believe. Instead, it is an illness with a constellation of neurological symptoms that may include really bad headaches. There are several types of migraines, and many share some of the same symptoms, which typically include nausea, vomiting, dizziness, sensitivity to touch, smells, and light, andin a few peoplenumbness and difficulties with speech.
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Migraine Causes And Symptoms
A migraine has a usual cause of environmental and genetic factors. About two-third of migraineurs have a Migraine in their genetics. The nerve and blood vessels of the brain are believed to be involved in migraine.
A migraine headache is a result of unusual changes within the brain. It causes severe head pain that is often accompanied by sensitivity to light, sound, or smells.
Common Symptoms Include
- Sensitivity to light or sound
- Nausea
- Vomiting
- When usually severe pain happens on one side of the head that some individuals described as pounding
Most typical migraines are distinguished by the fact that whether its accompanied by the aura or not.
What Causes Migraine With Brainstem Aura
Cortical spreading depression is believed to be the brain mechanism that generates migraine with brainstem aura, similar to typical visual aura in migraine. However, the current understanding is that CSD occurs either in the brainstem or additionally on the surface of the brain .
Like other forms of migraine with aura these attacks can be triggered by certain things.
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What Causes A Migraine
The cause of migraine headaches is complicated and not fully understood. When you have a headache its because specific nerves in your blood vessels send pain signals to your brain. This releases inflammatory substances into the nerves and blood vessels of your head. Its unclear why your nerves do that.
What Triggers A Migraine
Migraines can be triggered by a wide variety of factors that will vary from person to person. These triggers can generally be categorised into types, which can often overlap and interact with one another. Different types of migraines can generally have similar triggers.
Hormonal triggers include the menstrual cycle and the menopause.
Emotional triggers can centre around distressing or destabilising feelings and moods, such as:
- Alcohol and caffeine consumption
- Foods and drinks containing nitrates or tyramine
With such a range of possible triggers, you might find it useful to keep a migraine diary. Migraine diaries note the symptoms and duration of your attacks, but also any potential triggers and different types of migraines. For example, you might note down what you had to eat or drink that day, how many hours of sleep you had, whether or not you were exposed to bright lights, etc. Over time, youll be able to develop a personalised profile of your triggers, which can help you to avoid the offending stimuli and prepare appropriately.
Of course, its not just the causes that can vary. In addition to types of triggers, there are types of migraine, each with different symptoms, frequencies, and rarity.
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A Guide To Managing Different Types Of Migraine
Most of us have to suffer through mild headaches now and again, but thats nothing much compared to a migraine. Those familiar with the condition know that migraines can be genuinely debilitating sometimes for hours at a time. Frequent sufferers can find their quality of life seriously dampened by the attacks, which can be triggered by everyday stimuli.
There isnt a definitive cure for migraines , but thats no reason to despair. Nowadays, migraines can be effectively managed with a little know-how and with the right treatments to hand. So lets examine the condition, and find out how we can handle these headaches in the most pain-free way possible.
When To Call The Doctor
- A change in migraine features, how often a migraine happens, or how severe it is
- A headache that lasts days, getting worse as it goes
- A headache brought on by coughing, sneezing, bearing down, or straining while on the toilet
- The worst headache youâve ever had, especially if it started very quickly
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The Empowered Patient’s Guide To Migraine And Headache
Knowing what type of headache you are experiencingwhether from stress, cluster attacks, or inherited migraineis the first step in finding relief. Here’s a look at the symptoms, triggers, and treatments.
Migraine headaches are like the bully who won’t leave you alone. But here’s the thing you should knowregardless of your headache triggeryou are in control so it’s important to seek treatment. Many people don’t and suffer needlessly.
All headaches are bullies. But while some are short-lived hindrances , others are relentless and soul-crushing in their taunts .
In fact, if we put together a lineup of these bullies, it would be half-a-dozen-headaches long. Heres the thing, though: No matter what kind you get, you are in control. Many people dont realize this and never seek diagnosis or treatment. In fact, many headache attacks can be prevented with a few simple changes. But since youre here, we realize youre not one of those people, so lets get you some relief.
What Else To Expect When Living With Headaches And Migraine
If you are diagnosed with migraine, you may experience symptoms BEFORE and AFTER the attack. But there are warning signs that can clue you in when a bad headache is on the way.
According to the American Migraine Foundation, this time before the onset of a headache is referred to as the prodrome period, preheadache or premonitory phase.8 Not everyone who experiences migraine will have these warning signs, but knowing what these signs are if you do experience them is important so you can seek out treatments to help prevent the attack. These early warning signs can occur between several hours to up to several days before an attack and include:
- subtle changes to your day-to-day life, including constipation, mood swings, food cravings, neck stiffness, increased thirst and urination, and frequent yawning
- difficulties concentrating
In addition, some people with migraine may be more likely to have chronic dry eye disease.9
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Two Main Types Of Migraine
The International Headache Society names 2 main types of migraine, and each has several subtypes. Migraine types are diagnosed based on the symptoms a person has. For example, a migraine that only causes stomach pain is called abdominal migraine. A migraine that causes head pain plus visual or auditory hallucinations is called a migraine with aura. The 2 main types are:1
People living with migraine can have both main migraine types and different subtypes over the years. Any type of migraine can be chronic, meaning the person has 15 or more of any type of headache per month for 3 months, with at least 8 of those being migraine attacks.1
How Prevalent Are Migraines
Migraines are about three times more common in women than men, and may affect more than 12 percent of the U.S. adult population. Migraines often run in families, and can start as early as elementary school but most often in early adulthood. They often fade away later in life, but can strike at any time. The most common cause of recurring, disabling headache pain, migraines are also the most common underlying cause of disabling chronic, daily headache pain. While migraines are the No. 1 reason that patients see a neurologist, most cases are handled by primary care physicians.
Things that can make the headaches more likely to occur include:
Alcohol
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How Is A Migraine Different From A Regular Headache
Headache is an all-encompassing term that includes a wide variety of nervous system conditions that cause painful symptoms in the head, including migraine. Migraines differ from typical headaches in that the pain is usually more intense and severe, and presents with a number of other symptoms in addition to head pain.
These additional symptoms can include nausea, seeing spots or flashing lights, sensitivity to light and sound, temporary visions loss, and vomiting. Migraines also typically affect only one side of the head, though its possible to have a migraine that affects both sides of the head. The pain quality of a migraine is also different from a regular headache in that it is usually described as throbbing.
How Are Migraines Treated
Migraine headaches are chronic. They cant be cured, but they can be managed and possibly improved. There are two main treatment approaches that use medications: abortive and preventive.
- Abortive medications are most effective when you use them at the first sign of a migraine. Take them while the pain is mild. By possibly stopping the headache process, abortive medications help stop or decrease your migraine symptoms, including pain, nausea, light sensitivity, etc. Some abortive medications work by constricting your blood vessels, bringing them back to normal and relieving the throbbing pain.
- Preventive medications may be prescribed when your headaches are severe, occur more than four times a month and are significantly interfering with your normal activities. Preventive medications reduce the frequency and severity of the headaches. Medications are generally taken on a regular, daily basis to help prevent migraines.
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What Are Other Types Of Migraines
The other types of migraines include:
- Migraine with aura : Aura is a neurological symptom of migraine, which is most commonly visual disturbances along with the normal symptoms of migraine. It commonly affects 10-30% of people. The frequency of this type of migraine may range from once a year to several times per year. In this, a person might observe below symptoms 10-30 minutes before an attack:
- Seeing flashing lights, zigzag lines, or blind spots
- Numbness or tingling in the face or hands
- Altered sense of smell, taste, or touch
- Feeling mentally fuzzy
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So What Are The Types Of Migraine And Chronic Headache Disorders
When seeking a diagnosis, your doctor will first try to determine if the type of headache you are experiencing is itself a disease or a symptom of another disease .
A primary headache is caused by overactivity of or structural issues with the brains processing and sensitivity centers. Various structures may play a role including your brains chemical activity, the nerves or blood vessels around your skull, your head and neck muscles, or a combination of all of these. Genetics can also play a role.3
Common primary headaches include:4
- Tension/stress headache: occurs in 75% of the US population. Also known as muscle contraction headache, psychomyogenic headache, ordinary headache, essential headache, idiopathic headache, and psychogenic headache
- Migraine with aura: occurs in 25% of people who experience migraine
- Traditional migraine: occurs in 12% of US population
- Cluster headache: occurs in 0.1% of the US population.
If you are told you have a secondary headache, that means there is an underlying condition that may be causing your headaches. Several conditions may be responsible for secondary headaches as described below.
Read more about what each headache type feels like below.
Whats A Migraine Journal
- Keeping a migraine journal is not only beneficial to you, but it helps your healthcare provider with the diagnosis process. Your journal should be detailed and updated as much as possible before, during and after a migraine attack. Consider keeping track of the following:
- The date and time of when the migraine began specifically when the prodrome started, if youre able to tell its happening. Track time passing. When did the aura phase begin? The headache? The postdrome? Do your best to tell what stage youre in and how long it lasts. If theres a pattern, that may help you anticipate what will happen in the future.
- What are your symptoms? Be specific.
- Note how many hours of sleep you got the night before it happened and your stress level. Whats causing your stress?
- Note the weather.
- Log your food and water intake. Did you eat something that triggered the migraine? Did you miss a meal?
- Describe the type of pain and rate it on a one to 10 scale with 10 being the worst pain youve ever experienced.
- Where is the pain located? One side of your head? Your jaw? Your eye?
- List all of the medications you took. This includes any daily prescriptions, any supplements and any pain medication you took.
- How did you try to treat your migraine, and did it work? What medicine did you take, at what dosage, at what time?
- Consider other triggers. Maybe you played basketball in the sunlight? Maybe you watched a movie that had flashing lights? If youre a woman, are you on your period?
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