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Do You *Hear Voices* during a Migraine Attack?

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It’s rare, but it is occasionally reported in medical literature. Hearing auditory hallucinations, most often “hearing voices”, associated with a migraine attack.

Visual hallucinations are actually much more common, and can be something simple (such as seeing a flashing light) to something very complex (seeing people). But hearing things is so rare that it’s not usually considered a symptom or trigger of migraine.Hearing things during a Migraine Attack?

Researchers in the USA decided to do a little more research into this phenomenon. They confirmed that of all types of auditory hallucinations, hearing voices was the most common (but still only 58%). But the question remains, is this actually a symptom of migraine?

Most often the patients had the auditory hallucinations during the headache phase of the attack (75%), and it usually lasted less than an hour (67%). This seems to be something more common in patients who had at some time been diagnosed with depression, although many of the patients wouldn’t fit in that category.

In fact, it was difficult to say why these patients experienced this symptom, when the vast majority do not. We do know that in the case of these patients (12 of them – remember, this is very rare), the symptoms did always come with the migraine attack and disappeared afterwards.

So here definitions become important. Is this a migraine aura? A migraine symptom? Or could it be that auditory hallucinations are something caused by another factor, but triggered in some way by the migraine attack?

We do know that there are other physical problems that could lead to hallucinations such as hearing voices, such as blood flow to the brain or issues with the messages sent through the nervous system. But for now, although some patients may need special treatment just for the hallucinations, the answer seems to be the usual – treat the migraine attacks, and these strange symptoms should disappear as well.

Have you experienced anything like this during a migraine attack? We would love to hear from you!

Study abstract: Auditory hallucinations associated with migraine: Case series and literature review.

Topiramate + Nortriptyline (and another reason why treatment is not simple)

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We’ve talked about nortriptyline, an antidepressant commonly prescribed for chronic pain, and topiramate, an anticonvulsant often used for migraine in particular, in the past. As you can see from the comments people leave here, both have been a wonderful help – or haven’t been so great – depending on the patient.

It’s not unusual for someone to try one or the other, discover that they’re still having migraine attacks, and drop the medication permanently. But that may not always be the best option.

A study published in the Journal of Headache and Pain in 2010 tested both of these medications together as a migraine treatment.

Researchers started with patients that had experienced less than 50% reduction in symptoms with either topiramate (Topamax) or nortriptyline after trying either one for eight weeks. 78.3% of the patients improved more when taking both together than when taking just one.

It is not unusual for a combination of treatments to be better – sometimes drastically better – than one or the other. This is just another example.

When your doctor suggests you retry something you’ve already tried – but this time with something else, whether it be a supplement or drug or other type of treatment, don’t brush the idea aside quickly (even if the drug didn’t work in the past at all).

On the other hand, be very cautious if you have experienced significant side effects in the past. For example, when it comes to topiramate watch out for heart palpitations or chest pain, visual changes, weakness, confusion, or a loss of appetite. For nortriptyline, common things to watch for are depression, trouble breathing, seizures, fever, fatigue or weakness.

And remember, never change your dosage without checking with your doctor.

Thanks to:

Abdominal Migraine in Adults

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Abdominal pain – likely a nauseous feeling – recurring again and again.  It can be very hard to get a diagnosis, but it could be abdominal migraine.

Abdominal Migraine in Adults

Abdominal migraine in adults is not often recognized, even though the medical community has been talking about it for almost a hundred years.  Abdominal migraine is well recognized in children, all the more reason why it’s overlooked in adults.  And to be fair, it probably is a rare condition.

As with most types of migraine, abdominal migraine brings on recurring symptoms.  It usually lasts from a couple of hours to three days.

Unlike migraine headache, the pain in the abdomen isn’t one-sided.  It could be very severe, or just a dull ache.  During an attack, there is usually nausea and/or vomiting, or you may become pale and lose your appetite.

To be technically diagnosed with abdominal migraine, there should be no headache associated with the attack.  In other words, instead of headache you have abdominal pain.  However, it’s true that other types of migraine may include abdominal pain as well.

Other characteristics of migraine may be present, such as an aura before an attack.

Abdominal migraine usually starts in childhood and disappears in adulthood (or “changes” into other types of migraine).  But there have been cases of abdominal pain from migraine appearing in adolescence and early adulthood for the first time.

Diagnosis of Abdominal Migraine in Adults

If the above description sounds like you, you’ve taken the first step.  But your doctor will still want to run some tests and rule out other possibilities.

Be sure to tell your doctor how many attacks you’ve had, and what the symptoms were.  She’ll want to rule out various other conditions, such as gallstones, irritable bowel syndrome, infections, and even abdominal epilepsy, which can be quite similar.

A common feature of abdominal migraine in adults seems to be a family history of migraine.  If you know anyone in your family who may have had migraine, be sure to mention that.  Also, your doctor will want to know if you had migraine symptoms when you were younger, or possibly cyclic vomiting syndrome.

Treatment of Adult Abdominal Migraine

Because it is so rarely diagnosed, there’s no standard treatment.  However, there are some treatments which have been used successfully.

Triptans, a common migraine abortive, such as sumatriptan, may be tried.  Pizotifen (pizotyline, Sandomigran, Sanomigran), a serotonin antagonist, has been used for abdominal migraine in adults.  Other migraine treatments such as topiramate (Topamax), calcium channel blockers, beta blockers, and valproic acid (Depakote) may be tried, depending on the patient.  Antihistamines have also been used.

For more information:

TRPV4 and “Switching Off” Headache Pain

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Imagine an old-fashioned but complex machine, based on switches.  When you turn on switch A, for example, it supplies power to switches AA, AB, and AC.  If you want power to go through these switches, you must turn them on.  And so there is a complicated interaction of hundreds of switches.

Don’t worry, that’s about as complicated as this article is going to get.  If you grasp the idea of the interaction of switches, that’s enough to understand the analogy.

Switch off MIGRAINE!

So what would happen if a switch got stuck?  Well, if it were stuck in the “on” position, you wouldn’t be able to stop the power flow through that switch.  If it were stuck in the “off” position, neither that switch nor any down the line would ever get power.

This is an over-simplified way to understand the way that some messages are sent through the body.  Each cell, for example, relies on something called “ion channels”, proteins which allow a flow of information through the wall of the cell.  Imagine it as a switch.

But what would happen if the protein wasn’t properly “programmed”?  It might let too much information through, or not enough.  It could get “stuck”.

Migraine research is focusing more and more on specific types of ion channels.  Consider this statement from a 2011 article in BMC Medicine:

We could now be at a watershed moment in this respect, as the genetic loci associated with typical forms of migraine are being revealed.  The genetic discoveries are the latest step in the evolution of our understanding of migraine, which was initially considered a cerebrovascular condition, then a neuroinflammatory process and now primarily a neurogenic disorder.  Indeed, the genetic findings, which have revealed ion channels and transporter mutations as causative of migraine, are a powerful argument for the neurogenic basis of migraine.

Many common migraine medications affect ion channels, such as verapamil and topiramate (Topamax).

But researchers are continually looking to new frontiers.  And one of these is the investigation into TRPV4, (a nice name for Transient receptor potential cation channel subfamily V member 4).  We know that TRPV4 is related to the sending of pain messages in the body.  Might it be involved in headache pain?

One of the interesting discoveries that researchers made was the link between TRPV4 and sunburn.  When TRPV4 is blocked, so is the sunburn pain (see Could discovery lead to end of sunburn pain?).

Trigeminal pain, often manifesting in face pain or headache, also seems to be closely related to TRPV4 (see TRPV4 is necessary for trigeminal irritant pain and functions as a cellular formalin receptor.).

A study published last year in Cephalalgia specifically looked at headache, and found that TRPV4 working in the tissue around the central nervous system (meninges) could actually contribute to migraine pain.

Is it possible that the hot pain of many headache conditions could be stopped with the flick of the TRPV4 switch?

Of course, it’s not that easy in real life to find the right switch and turn off pain without causing other problems.  And TRPV4 is one of only 30 channels in only on category.

We do know that various factors, such as environment (for example being exposed to chemicals in the air) can turn switches like TRPV4 on and off.  In other words, we’re not talking about flipping a switch that was never meant to be switched.  It could, for example, be that certain factors, in people with migraine, are flipping switches too often.  Perhaps a certain medication could put it back to normal.

This is a huge area of research, but we’re already using medications that involve ion channel “switching”.  Better understanding the switches helps us better understand headache and pain disorders, and directs us to the most likely methods of treatment.

If you want to dive even deeper into this topic, check out:

A Migraine Mystery (You’ll never guess this one…)

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You’ve heard it before.  And intuitively, it seems true.

Something starts the migraine chain-reaction.  Ok, maybe we’re not sure exactly how that works.  But then the blood vessels expand and constrict, the inflammation starts.  And as your heart beats and the blood forces its way through your body, it brings on the POUND POUND POUNDING pain of a migraine headache.

But, have you ever really thought about whether that’s actually true?

Throbbing pain is, of course, a typical characteristic of migraine.  It’s one of the ways that we recognize migraine as opposed to other types of headache.  In fact, in the most recent headache classifications from the International Headache Society, in order to be diagnosed as migraine the pain must have at least two of these characteristics:  one-sided pain, pulsating, moderate or severe pain, and aggravated by activity.

But as with so many realities of headache disorders, when researchers actually investigate, they find that the mystery deepens.

For one thing, we have discovered that the constriction and dilation of blood vessels is not always a clear process when it comes to migraine.  Advanced imaging studies are discovering that vasodilation, formerly the cornerstone of migraine research, is not a necessary part of migraine after all.  (See also this study and Vasodilation and Migraine – The fall of a theory)

Although blood vessels are clearly and necessarily a part of our study of migraine, they may not be related in the way we formerly believed.

And that brings us back to that pulsating pain.

What would happen if we did the obvious, and compared the movement of blood through the body, the heart beat, the pulse, with the throbbing?  Well, now we know.  It looks something like this…

Throbbing Pain vs Pulse

Notice anything odd?  That’s right, the pulse and the pulsating pain don’t match.  In this case, the throbbing pain was slower than the pulse.  This was typical.  But even in patients where the rate of the throbbing and the pulse were similar, they went in and out of sync.

This study (On the temporal relationship between throbbing migraine pain and arterial pulse.) and others are sending researchers scrambling to figure out what is actually causing the pulsating pain sensation.  One theory is that it’s something neurological, not directly related to blood flow at all.

Sometimes the most obvious things about migraine are not so clear once we actually check them out.  As you can imagine, the re-thinking of something simple like pulsating pain could have (and is having) huge repercussions when it comes to migraine treatment.

And in this case it’s not just migraine.  The same phenomenon has been found in other pain conditions, including other headache related conditions.

Not knowing something can actually be a benefit – as long as you know that you don’t know.

If you want to investigate this fascinating line of research further, check out:

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