Detecting migraine in children is a challenge, and there is a lot that we simply do not understand about how migraine attacks affect this population. A new study out of France is answering a question many did not even think to ask – what are some of the symptoms that children and adolescents experience after the main attack (which usually features a headache)?
100 children and adolescents with migraine were interviewed by phone. They were asked specifically about symptoms that began after the headache phase of the attack, as well as symptoms that simply continued afterwards. (See study abstract: Postdrome symptoms in pediatric migraine)
91% reported symptoms that persisted after the attack. Here are the ones that were the most common:
Asthenia (weakness and/or a lack of energy)
Cognitive difficulties (trouble thinking)
Pallor (paleness)
Cognitive slowing (slow/foggy thinking)
Loss of appetite
Sleepiness/drowsiness
Nausea
“True postdrome” refers to symptoms that actually start after the headache phase. The most common symptoms in this category, reported by 82% of patients, were:
Thirst
Sleepiness/drowsiness
Visual disturbances
Food cravings
Paraesthesias (sensations such as “pins and needles”)
Eye pain
For most patients these symptoms lasted less than 12 hours.
This is an absolutely fascinating study that will help both adults and children understand migraine symptoms better. The postdrome is very common. There is so much focus on the headache that we often miss the other symptoms, some of which are quite debilitating. Recognizing these symptoms in children (and adults) will not only help us recognize migraine, but also treat it in a more understanding way.
If you have a child with migraine, have you noticed any of these? Adults, have you noticed any of these symptoms in yourself? Leave a comment and let’s talk about it.
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.
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!
Her doctor had told her that this day might come – would probably come. But knowing is not the same as being prepared. It’s not the same as knowing what is really coming.
As the symptoms began to show themselves, she wanted to go to the hospital. To take some medication, have some surgery – anything that would alleviate the symptoms or cure her. But she was tired. And she knew that there would be no easy way out.
Why don’t diseases strike at a convenient time? Then again, what would a convenient time be? When I didn’t have that deadline at work? When I wasn’t planning to go out with friends? When I hadn’t planned that precious time with my family?
There’s no reason to think about that now. Even if there was a “good” time, even if I could choose – but I can’t. It’s now. And now always seems like the worst possible time.
I’m still with it enough to call and explain that I won’t be able to make it. No, I’m so tired. I’ll email.
They’re trying to be understanding. “Don’t worry about it!” They’re right – there will be other days. Not this day. But other days. If . . .
But how can they brush it off like it’s nothing? It’s a crisis.
I need help. Who can help? I can’t see. I can’t think.
Time goes by. My body shuts down. Everybody’s body shuts down over time, as they get old – but I’m not old. I’m young. I wish I had a wheelchair. It’s so hard to walk.
There’s a sound coming from outside. What is it? I wish it would stop. I have to get to bed. Where was I going?
Pain! Oh yes, my doctor told me there would be pain. I wish I could take something to stop it. Oh yes, he gave me something – it won’t stop the pain, but maybe it will be a little less.
No. I can’t even take the medication – I’m going to throw up. Was that the phone? Turn it off – someone turn it off!
Pain! So much pain!
When did I go to bed today? I don’t remember. I don’t care. It’s still light. I must make it. I can’t, but I must.
I should have undressed. Who cares? Pain! I wish I had undressed. So uncomfortable.
My mouth is dry. Pain! Why can’t I stop thinking about the pain? Think about something else. Ok – no – regrets – where I would have been in life if I hadn’t – no – can’t think about that – PAIN – can’t think – what is happening?
Need to go to the bathroom. No, I can wait. I can’t get up. Can’t even reach the light switch. If only I could turn over. Wish I had a glass of water. Would I be able to drink it?
There’s that noise outside again – why now? Did I fall asleep? Pain! I’m going to throw up. I know it.
I should call the doctor. But I can’t get to the phone. What was I supposed to do today? What day is it?
I must have slept. Nightmares. Always in every dream the PAIN. Sometimes it’s a person, sometimes an animal, or a fire or a bullet wound . . .
It’s morning. Less pain now. Maybe I can get up. I was supposed to work this afternoon.
Wait – how long has it been? Have I been sick weeks? Months? Why has no one called?
No – now I remember. It was a day and a night. I’m getting a shower. Just a day and a night.
How did I handle so much pain? I didn’t know I could.
I’m showered, dressed. I’m shaking. Still in a cold sweat. I need to eat something.
But I did it. Somehow. I can’t stand up. But I got something to eat. It’s a great victory.
It will take time to recover. A few days. Can I go to work? Should I call in sick?
So silly. Anyone who had lived through that would call in sick for a week. Why wouldn’t I call in sick? Why wouldn’t I tell all my friends – they will be amazed that I survived! Why wouldn’t I?
Most people would enjoy complaining about an experience like this for months – chatting about it in the lunch room while their friends listen with amazement and admiration. Why can’t I?
Because it’s just a migraine. I thought it was a battle with dragons, I thought I survived a medieval battle against incredible odds. I thought a sword had struck me in the head and I just barely made it through, by sheer willpower.
But they say it’s just a migraine. Just a migraine. One of many. Nothing to write about or talk about. Just another one. Is that what it was?
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…
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.
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:
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.)
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.