Is Your Brain “Slower” During A Migraine Attack?

It’s well known that many migraine patients claim to have trouble thinking during a migraine attack.  But is it just a perception, or is it a measurable reality?

Researchers in Portugal and Brazil wanted to see some better research to answer the question.  So, they recruited 39 people with episodic migraine, mostly women, and did some careful study to see if their thinking was impacted by an untreated migraine attack.  (That doesn’t mean that the same wouldn’t happen if the attack was “treated”, it just gets rid of a few more variables and makes the study more reliable.  In fact, some medications can make the problem worse.)

Can't think during a Migraine Attack?

The results?  Yes, we do have trouble thinking during migraine attacks, and the change is significant enough to measure.

In a brief discussion in the study abstract, the authors concluded:

Cognitive performance decreases during migraine attacks, especially in reading and processing speed, verbal memory and learning, supporting patients’ subjective complaints.  These findings suggest the existence of a reversible brain dysfunction during attacks of migraine without aura, which can relate specifically to migraine or be a consequence of acute pain processing by the brain.

So, we were right.  Trouble reading, processing, remembering . . . it’s all very common during a migraine attack.

We know that even some severe forms of temporary memory loss are connected to migraine attacks.  The symptoms can be quite serious, and sometimes will show up in very noticeable ways, such as difficulty recognizing faces, or slurred speech.

The question remains whether or not there is permanent brain damage from migraine.  Although there does seem to be some cumulative damage from migraine, study after study seems to confirm that permanent cognitive problems are rare.  In fact, one study even suggested that migraine brains stay sharper than other brains in the long run!

Still, it’s helpful to be aware that these cognitive difficulties during an attack are very common.  Make note of them, and do mention them to your doctor at your next visit.

Study abstract from the journal Cephalalgia:  Cognitive dysfunction during migraine attacks: A study on migraine without aura.

Also see Trouble remembering words during migraine?

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Describe Your Pain. Better?

Pain Scale

A few days ago, Christine Miserandino of ButYouDontLookSick.com posted (reposted?) some thoughts about the ways we describe our pain.  Or I should say, the ways we are asked to describe our pain.

If you’ve had cancer pain or arthritis pain or lupus pain or migraine pain or any of a number of different kinds of pain, you know what we’re talking about.  Often it’s a scale of 1 to 10.

And various commenters have expressed their frustration with this scale.  For example, what if you put a 10 one day, and then find that the pain has gone right off the scale the next day?

1 to 10

I avoided this problem early on by saying that 10 was a “theoretical impossibility” – that I would actually pass out if I were in that much pain.  But that didn’t keep me from pushing the scale and adding a 9.5 more than once!

Then there’s the almost useless Headache (Yes) (No), or do you feel (GOOD) or (BAD) . . . which I’m afraid makes my life look worse than it is!

Most doctors should be well aware of the limitations of these scales.  It’s mostly just a way to see if things are improving or getting worse.  And numbers are of course the easy way to measure over time, with all their limitations.

But don’t forget that there are various ways of measuring.  As you fill in your headache diary, or prepare to visit the doctor, here are some things to think about.

The Number Scale

This is the most common, usually 1 to 5 or 1 to 10.  Also, especially in the case of children, this scale may be translated into faces that look very happy or very sad.

Remember, the most important thing is to compare your pain this time to your pain at other times.

Also, it’s important to know what exactly you’re measuring.  For example, you might measure just pain, but that would by no means tell the whole story if you’re having a migraine attack.  You could say you’re measuring overall “discomfort” from all your symptoms, or disability.

Mild, Moderate, Severe

Mild, Moderate, Severe

This is another one that can easily be translated into numbers (1, 2, 3).  Again, be aware what you’re measuring.  Symptoms overall?  Just pain?  Disability?

Adjectives

Using adjectives to describe headache is very important, because different types of pain can indicate different types of headache and causes as well.  Here are a few to get you thinking…


Achy       Burning
Cutting       Dull
Gnawing       Inflamed
Pounding       Pressing
Pulsating       Sharp
Shooting       Squeezing
Stabbing       Stinging
Tearing Vice-like


Remember, you can use adjectives to describe other symptoms as well.

Symptoms

Some headache diaries specifically mention major symptoms.  The most common would be nausea.  Do you feel nauseous?  Did you vomit?

I’d rather not even answer that question in the middle of an attack, but it is very important to be aware of the symptoms that you have that aren’t headache.

For example, nausea, sensitivity to light, noise, smells.  A feeling of heaviness.  Fatigue.  Stiffness.  Weakness.  Numbness.

To think this through, check out What is Migraine? (the Story of Symptoms)

Location(s) of Pain

It’s very common for migraine diaries to include questions about the location of the pain.  One sided?  Behind the eyes?  Back of the head?

This is another very important clue about where the headache is coming from and how to treat it.

But something that is often overlooked is pain in other parts of the body.  Neck, feet, stomach – make a note, even if it doesn’t seem to be related to the headache.

How it Affects Your Life (Disability)

More and more, researchers and doctors are looking into the actual disability that is a result of headache conditions.  They may use fancy tests to measure disability over time, or just ask you how often you’ve missed work or school.

Of course the more specific you can be, the better.  You may go to work to make an important presentation, when you otherwise would have stayed home.  You may work every day, even though some days your productivity is half of what it is other days.

Jotting down the decrease in productivity on a diary, even using yet another 1 to 10 scale, may help you have a better idea what your symptoms are doing to your life.

“Type” of Headache

When I was younger, I noticed that my attacks seemed to fall into various categories.  These were a mix of symptoms.  For example, maybe a throbbing, inflamed headache where I became very irritable, as opposed to a piercing headache where I was nauseous and very sensitive to light.

Some people do have attacks that are very similar, for example a menstrual-related headache versus a headache other times of the month.  If your attacks don’t seem to regularly fall into “types”, this will be too simplistic for you.

Other ideas?

What other ways have you measured your pain/symptoms/disability for yourself and/or your doctors?  We would love to hear your tips.  Remember, the better we can record and communicate these things, the better we can help ourselves and others with similar symptoms.

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10 Highlights from the past 3 Months (October 2014 edition)

Neck pain, Topamax, Stevia, surgery, and much more!  These are the most-visited posts from the last three months.  Join the conversation!

  1. Neck Pain: A Missing Piece of the Migraine Puzzle?
  2. Topamax not working? Here’s a Possible Alternative
  3. Is it Migraine or Lupus?
  4. Complex Confusional Migraines
  5. Using Migraine as an Excuse
  6. Having Trouble Seeing “Up Close”? Just can’t focus?
  7. Standard Blood Tests for Migraine – are they on the way?
  8. Vasculitis: When Your Body Attacks Your Blood Cells
  9. Migraine Surgery – Should it be Banned?
  10. Is Stevia giving me a Migraine Attack?
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Should We Be Talking About Stem Cells as a Migraine Treatment?

Reports are beginning to emerge of patients who are seeing a major decrease in migraine symptoms from stem cell treatment.  Might this be another new frontier in migraine treatment?  And might it help with other headache disorders?

Stem cells for Migraine and Headache
Photo courtesy of Jacopo Werther

Stem cells are remarkable partly because they can become many different types of cell.  Stem cell treatment is the result of over a hundred years of research, which has become much more intense over the past thirty years.

A lot of the controversy over stem cells has come from the field of embryonic stem cell research – stem cells that come from aborted “test tube babies”.  However, the controversy has calmed down a little because there are many different stem cells that can come from other sources, and that’s where most of the medical breakthroughs are coming from.

Researchers have found that stem cells can repair the body in remarkable ways.  They can also help repair problems with immunity.  Stem cells can be introduced into a new area without a fight from the body – and yet without impairing immune responses.

And so stem cells are being researched and used for many conditions, including arthritis, colitis, and lupus.

And what about migraine?  The New York Headache Blog reports that cases are showing up where migraine is being treated with stem cells, often unintentionally (see Stem cells for headaches).  For example, a study in Australia treated women for osteoarthritis using stromal vascular fraction, a type of tissue taken from the patient’s own fat which contains stem cells.  The women found that both migraine symptoms and tension-type headaches decreased after the treatment.

Another case study found that four women with chronic headache conditions saw significant improvement with similar treatment.

What about other headache conditions?  Another study out this year showed the promise of stem cell treatment for patients with neuropathic trigeminal pain, once again using a similar type of treatment.  Another study last year looked into stem cell research for traumatic brain injury.

How exactly stem cell treatment may fight these conditions is a complex question that will take time to answer.  We do know that stem cells can repair damage to the body, help with immune responses and fight inflammation.  This type of treatment could go a long way in helping patients with chronic headache conditions of various kinds.

Because stem cell treatment is already common for many conditions, the field is wide open for serious research into how migraine patients and patients with various headache disorders could benefit.  This may be another way to actually heal the body instead of just coping with other ongoing treatments.

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Sumatriptan and Cluster Headaches

Sumaptriptan has been used for cluster headache for many years, but it may not be used in the way you think.

Cluster headaches are not only known for the very severe pain which is the most well known symptom, but also for their predictable cycle.  Lasting from a few minutes to a few hours, they come during a “cluster period” lasting weeks or months, most often followed by a remission of months or even years.  Some patients, however, do not experience remission, but continue to have attacks up to eight times a day.

Sumatriptan Cluster Headache treatment

One of the most common abortive treatments is a sumatriptan injection.  Cluster patients often have injection kits, so that they can inject themselves right when an attack hits.  It is usually effective within a few minutes, and can be repeated once in the day if the pain continues or returns.

But here are a few other facts you might not have known about sumatriptan and cluster headaches:

  • A sumaptriptan injection does not always involve a needle.  For example, Sumaval DosePro pushes the sumatriptan through the skin in a tenth of a second without a needle.
  • Sumatriptan works better for men than women.  Women with cluster respond better to inhaled lidocaine.
  • Some cluster patients take a sumatriptan nasal spray, or even oral sumatriptan.  These approaches work, but take longer, which limits their usefulness in a headache like cluster which doesn’t usually last long to start with.
  • Usually patients experience very few side effects, and they don’t last long.  Typical temporary side effects include nausea, fatigue, and dizziness.  However, if you get hives or experience chest pain or pressure, you should call your doctor immediately.
  • Because cluster is rare and studies are limited, there have been very few studies into various other triptans.  Zolmitriptan is most commonly used next to sumatriptan, but it does not tend to be as effective.  However, for some patients it may have fewer side effects.
  • Dosages vary depending on how you’re taking sumatriptan, from a small dose of 6mg for an injection to a large dose of 100mg when taken orally.

Have you used sumatriptan for cluster headache?  How well did it work for you?

Also see:  Cluster vs. Migraine (Infographic)

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