FitSugar

Sorry I haven't updated in months and months

wackdoodle — Wed, 06 Jan 2010 22:23:10 -0800

Dear Migraine Sugars,
I'm sorry I haven't updated this page at all in months. I was living my life and dealing with financial and family issues.

I think I may have said in my last post that I went to my follow up appointment for the ONS clinical study in May 2009. At that time, I found out that my ONS device was never turned on and that I was part of the "sugar pill" placebo portion of the study. They needed to see if the knowledge that I merely had the device implanted was enough to trigger my brain to overwhelm the impulse to have an attack.

Uh no it wasn't. Intially, because of the anesthesia and the fact that there was an electrode resting on my occipital nerve in my brain I had minimal migraine attacks but then by March and April I was back to having nearly constant attacks of varying severity.

When I went to the clinical study office I was mortified when I found out that the device was not on because I was sure that I felt some shocks going through my head. Nope, it was my imagination but the clinical study people assured me that my reaction to getting the implant was the norm. The placebo people were so hopeful that our minds did attempt to mentally stop the migraines in order to be free of the symptoms of this disease but eventually the pain from the attacks would kick back up.

I also think that I mentioned that when they did turn the device on I received a horribly strong jolt a shock that went through my entire body and was extremely unpleasant. This happened whenever they would change from one setting to another. The study people couldn't figure it out and chalked it up to my body being slightly overly sensitive.

So from the moment they turned the ONS device on until late July or August my migraine attacks were lessening and becoming more infrequent. They ( the study folks) asked that I leave it turned on all the time, so long as I can stand it. When the device is on depending on the setting that I have it on I can feel a strong tingling under my scalp to feeling a strong rhythmic throbbing sensation to feeling a very strong constant stabbing sensation. I started on the mildest setting the tingling and found that my brain and my overactive nervous system rapidly adjusted to the impulses so I would have to up the Amps or change the setting. Eventually by the end of July 2009 my brain had adapted to the initial low settings on ONS device and I had to have the settings and Amps increased.

Let me tell you I went to the clinical study office a bit pissed that my brain was overwhelming the device and that I was failing the study and failing the potential other migrainuers who could benefit from his device. Once at the office the representative of the company that made the device met with me and I gave her an update on how things were going with the implant. At that point I realized that even though I had had migraine attacks after the device was turned on that they had not been as bad as they were before and weren't as frequent. I fact I was feeling pretty good and very energetic. I hadn't felt that energetic since before I turned 28 and the migraine attacks became increasingly more frequent.

So the representative from the ONS device company set about changing the settings for me and increasing the amplitude of the impulses to my brain. And surprise when she went to change the setting, which I had not done in over a month, I got a huge shock. I mean I jumped high off the chair and she could see my whole body tense up. She couldn't figure out why this kept happening as she changed the settings. Every time I got a jolt. It got to the point where I would brace myself before she changed the setting. Eventually we came to the consensus that I am just a circus freak - far to sensitive the electric impulse that when there is a change in the impulse my nervous system lets my entire body know. It isn't much different from what happened with my brother-in-law and his MS. If you pinched his leg he didn't immediately feel it but later on his leg would jump and kick then his entire body would spasm and he'd yelp in pain. I remember read about his form of MS and that his spinal cord wasn't transmitting messages in a proper manner if at all and when it did that it could and would misread the message and overreact. Well that was my response to the change in electric impulses directly into my occipital nerve - my body would overreact. I'm not even gonna mention what happened when I went into the SF Main Library through the metal detectors - I'll just say never again will I try to go through them or do I want to - I'd rather be strip searched or hand patted down.

OK so the representative from the ONS company changed the settings to stronger less rhythmic settings then she really upped the amps that the impulses could deliver and wow what a difference. I left the office with a bag full of relpax just in case the new setting weren't enough but surprise they were terrific. I actually would go days and weeks without having a migraine attack. I had one level 5-6 migraine attack and rather than taking the migraine abortive (relpax and diazepam) I took two Tylenol and the attack was ended. Then I realized that for the first time in almost two years I had just had a normal run of the mill mild headache. It was incredible. The device was working. I found the perfect setting to keep the attacks at bay and left it there. Instead of using the controller pad they gave me to change the settings or up the amps or turn the device off and on I used the strong magnet that they give me and I didn't get shocked by the device at all.

So things went swimmingly from the end of July to late September. Rare headaches, even rarer migraine attacks and I felt fabulous, free of pain and full of energy. I mean I was starting tasks and finishing them and exercising lilke a madwomen because I felt so great. I was actually even going out in social situations in because my inhibition problem was under control as was my extreme pain. I could focus and concentrate again.

I am not sure if I mentioned that I did have to give up my job as a bus driver for the city of SF. I even with the device I couldn't guarantee that my disease wouldn't take a turn in a different direction and endanger the safety of the citizens of SF as well as my own safety. So I was amicably separated from the city without prejudice due to a medical condition, meaning that should I desire to try to become a bus driver again the city will not hold my previous situation against me or my disease. And way back in April I decided after applying for many and failing to get a new job I decided to try to apply for Social Security Disability. I applied without the real hope that they'd recognize Chronic Intractable Migraine Disease as a real neurological disease, since most layman and general practitioners aren't even aware that migraine disease is a progressive neurological disease. Anyway, after filling out the initial paperwork, the subsequent medical release papers and medical questionnaires I was approved for full Social Security Disability. I was expecting them the want to examine me or to just flat out say "NO. It's just a headache" but there was no inquisition. The medical review personnel a SSA was shocked that I had been able to work as long as I had given what my neurologist and gp had said as well as what the numerous ER reports had said about my all to frequent trips to the ER for treatment for attacks that had lasted a week straight or longer. They rule that I am full disabled, possibly permenantly.

Being approved for SSDI was bitter sweet. Yes, the monthly payment would insure that I could have a roof over my head but not much else. And it meant that others were recognizing that I have a disease that is so bad and so unpredictable that it made working without any severe restrictions and exceptions being made by my employer impossible. Regardless of being approved and receiving SSDI I told myself that I would only stay on it for 6 months before I resumed looking for and pursuing a new job. So I'm back to looking for job that I can do, where I can be allowed to be a handicapped person with an odd often unrecognized disease and still thrive.

Anyway, let's finally cut to the chase. As I said everything was peaches and cream until the end of September when I started to again wake up with fairly severe migraine attacks. I would realize that my ONS device was off for some reason and I'd turn it back on and get relief but I had to resume taking the relpax in the mean time. Then I went to my first live NASCAR race in Southern California. I drove to my sister's house then from my sister's house in Ventura to the race track in Fontana which was 111 miles away. Everything was great at the track. The extreme noise and vibrations from the powerful cars didn't bother me in the least. The fumes for the cars caused no headache or migraine attack while I sat on the first day watching the Sprint Cup drivers practice. Nothing not a peep from my head but I was having gut problems but that is another story for some other time. Then on the first day of practice as I was driving home in the horrible Friday evening L.A. rush hour traffic I was struck with a thunderbolt migraine attack. I had to pull off the freeway and take my emergency Relpax from my bag and sit and wait out the pain.

I made it back to my sister's house and grabbed my controller console for my ONS device and upped the Amps. Better but the next morning, race day for the Nationwide drivers, I was woken up at 4 am with an intense attack. Again, as a precaution I carry all my medications with me so I took the relpax and diazepam and waited. The attack receded and I dragged my nephews and their friends out of bed at 6am so we could head to the track for practice and the race. At the track I was terrific. No migraine attack, no headache, no nausea, no vertigo just my normal stomach ache. We stood for hours out on Pit Road where the stock cars were revving up and rumbling just feet away from us with no reaction except excitement.

Then after the race shock of shocks. The group that I had bought with me (willing) was munching down on our tailgating fare in the parking lot and suddenly my youngest nephew who had previous been migraine disease free at 19 started to say that he felt weird. He was covering his eyes. He was nauseated and dizzy. He was very agitated. He was confused. I watched him for about 10 minutes and though maybe he had heat stroke from standing on the hot asphalt of Pit Road then sitting in the sun-drenched bleachers for hours. Then my older nephew who has migraine disease too, said "I think Jeff is having a migraine attack. Look at his face. It looks like your face or my face when we get an attack." Sure enough he was right. But I hesitated to give Jeff my relpax because he's never been prescribed it and he's never had a migraine attack but he has had heat stroke before. I didn't want him having some drug in his body that could possibly worsen his condition if he had heat stroke. Luckily Tylenol is a major sponsor of NASCAR and while in were inside the track I had my nephew visit the booth for Tylenol and get handfuls of free samples. So we gave Jeff Tylenol and had him slowly but steady drink plenty of cool water and strip down to to his t-shirt and underwear and sit inside my car with the air conditioning on low. After 30 minutes he started to feel better and he ate and we drove home.

By the time we got home Jeff was not feeling good at all. He was very dizzy, confused, nauseated and that his head was throbbing worse like it never had before. He said his spine was even throbbing. He was sensitive to light and sound, he was intermittently angry and then elated. By that time I had taken his temperature and for him it was one degree higher but normal and I was sure it was a migraine attack. Of course my sister is a RN and she refuses to believe that not everyone has migraine attacks like she does (she actually has tension headaches - we know this because the migraine preventatives don't work on her but the tension headache medications do-still she wants to be part of my horrible crew of migraineurs do she insists that she "KNOWS" what migraines are like cause she's had them and treated patients in the hospital who've had them). Anyway, my sister insisted that because Jeff has never had a migraine attack in his head that this couldn't be a migraine attack and must be heat stroke. So she proceeded to try to treat him at home as if he had heat stroke - putting a cold wet blanket on him and making him drink ice water etc. This only made him feel worse until he was vomiting. So I asked Jeff quietly is he thought he could be having a migraine attack, being that over the years he had witnessed my attacks and his brothers attacks. Jeff answered "Yes. I think this is a migraine attack and it hurts so bad." I asked him if he wanted a relpax or if he wanted to go to the ER and let them examine him and treat him. He said he wanted the relpax, that he had wanted it in the car but couldn't remember the name of the medication. So then I asked him if he was having any other symptoms. He responded that the room was spinning violently, that he needed to vomit and even after he did he still felt nauseated and that his neck was so stiff he couldn't turn his head . Full on attack. Poor thing. I then told him that since he'd been dealing with the migraine attack for a while that it would be best if he took the pill the way that I do - crushed and mixed with a bit of water. So I crushed the relpax mixed it with water when my sister wasn't looking and Jeff drunk it down. I should have warned him that it tastes horrid. He kept it down. His older brother knelt next to him and told him that shortly he was gonna feel really weird and that it would be the relpax starting to work. Sure enough Jeff suddenly said he felt flushed then his arms were so heavy then he was tired, that he could hear his heart beating in his ears. I also gave him 1/2 a diazepam and he willingly used a compazine suppository for the nausea and vomiting. After an hour Jeff said the pain, dizziness and nausea were gone but that he felt so sleepy. Yup migraine attack. First one,very severe. His brother said that he felt horrible about Jeff getting an attack because he had hoped that this disease had skipped his brother.

Anyway, Jeff was relieved from his attack and within three hours I was having an attack myself. Boo! I took my medications and went to bed. Fast forwarding now. I ended up stuck in Southern California longer than I wanted or planned to be because I kept having more and more and stronger and stronger migraines. I couldn't understand it.

About two weeks after the race I had to go Arizona with my older nephew to an ice skating competition that he was competing. It was either sectionals or regionals (cannot remember) and my nephew was going to try to earn a position for the next up competition to go to Nationals. However, my nephew had like two days before the start of the competition caught the Flu. But he still wanted to go compete and he believed that if he just rested in between practices he'd be fine. He was partly right. We were in Arizona for 5 or 6 days and he was sick until the day we left but still he practiced his ass off at each scheduled competition practice then after practice we'd go back to the hotel and I'd take care of him trying to help him get through the flu and recover from his difficult practices. However, I started to notice while we were in Arizona that my patience with people was growing shorter and shorter and that I was having more sensitivity to the weather and to light and noise and the migraines were back with a vegeance. But I didn't focus on it because I was focused on my nephew.

Anyway, at the competitions he went out and skated with a fever and very runny nose as well as being dizzy but he gave it his all. He didn't qualify for the next competition but at he got some high scores and let the skating world that he was back competing (coaches and other skaters had thought that he retired because his firs coach quit).

As we were leaving I my nephew finally felt well enough to drive and I kicked back in the passenger seat for the 700+ miles drive back to his house. However again I ended up trapped at my sisters house because one my stomach problem had gotten really bad and unpredictable and two I was having uncontrollable migraine attacks again.

One night I woke up and it dawned on me that I couldn't feel the sensation of the implant in my head anymore. I couldn't think of when the last time I had felt the thumping sensation in my brain from the implant. I pulled out the magnet and ran it over the battery pack in my chest expecting the device to suddenly turn on but it didn't. I kept running the magnet back and forth over my chest - no reaction from the device. So I pulled out the controller console and tried that. For about 20 minutes the thing looked for a signal and waited for a response from the implant in my body and it got nothing.

What the hell? Here I am standing in my pjs at 3am in the dark placing this round paddle over the battery pack and nothing was happening. No huge shock, no little shock in fact the controller is saying that something is wrong it cannot find the unit. WTF? I stumbled into my sister's room and found some new batteries for the controller thinking that the controller was the problem. Nope. Suddenly I remembered that when we left the hotel the bellhop had failed to show up with a luggage cart so we had carried all of our heavy luggage down to the parking garage alone. I had overloaded my bag so it weighed like 25 pounds and I had to place it over my left shoulder and the strap had pressed hard against the battery pack and wires in my chest. I suddenly thought "oh my gosh I disconnected those wires that run from my head to the battery pack in my chest when we left the hotel." I panicked. Finally I remembered to take my medications but then I thought "okay the device is off and my migraine attacks are back and as bad as they were before the implant".

The next morning I called the clinical study people and told them what I thought had happened they scheduled me for an immediate appointment for an x-ray - to see if the leads were indeed disconnected or damaged. Then I called the representative from the ONS device company and told her what I thought had happened and asked if she knew anyway that I could fix it myself. She calmed me down and said there wasn't anything I could do short of self-surgery. She told me that when I got back the SF that she'd meet me at the hospital for the x-rays to see if the leads had been disconnected or shifted.

So I got back to SF driving 476 miles with a intense migraine attack and two crazy cats in tow. I got home the next day off to St Francis for a chest and head x-ray. True to her word the rep met me at the hospital and stayed with me through the x-rays. I didn't realize but she's actually a nurse practitioner or some such but that she's certified to read x-rays. So she and the x-ray tech immediately read the x-rays. She looked at the implants position on my occipital nerve. It hadn't moved and the wires (leads) were intact. She then followed the path of the wires down my neck looking for damage to the wires leading to the battery pack. No damage. Then she looked at the chest x-ray. The leads were still connected and intact. The battery in the experimental ONS device that I had gotten had died. Terrific news in a way.

So since late September when the attacks were increasing the battery in the ONS device was dying until it finally gave up. The rep assured me that the company would replace the ONS device for free and they would put in a rechargeable unit with a lifespan of 5 to 7 years on high amps rather than the experimental battery pack that was meant to last one year or so on moderate impulse. She said she was glad that I realized there was a problem and called her because now she knew to contact any other study members that were set on high amps and alert them and prep them for replacement of the battery pack. Also, that the company now would know definitively that that battery should be rechargeable when first implanted and that the higher the amps and shocks the sooner the faster the battery dies.

Okay that was late October, early November I had to suffer through crippling attacks again. Suffered through being bed-ridden from the extreme pain and going through expensive medication like it was water. I still am incapicated til the battery pack is replaced.

The thing I do know is once the device was set to the right levels, I was nearly migraine attack free. I was feeling great physically and emotionally. And that this ONS device actually worked! That was the most surprising thing. After the adjustments I hadn't really thought about the device at all, I was just out living my life again. I wasn't having to alter my behaviour or actions to avoid having an attack. I was my old self again, I was nice and in control of my impulses and feelings. As soon as the ONS device battery started to die the disease reared its head with a vengeance, making my life miserable and isolating me again.

So all I can say is I am glad I volunteered and was accepted for this clinical study. I'm glad that I had this experimental device implanted in my brain and chest and I cannot wait to get the battery pack replaced in 8 days. I'm ready to get back to living normally again.

My advice for other chronic migraineurs is that if the disease continues to worsen like mine did there are new treatments on the way! I believe that the ONS implant will be approved by the FDA early this year as this was the last study they needed to prove that the device worked for mild case as well as for extreme cases.

I advise all migraineurs to stay on top of the disease and the attacks. If you have medications to prevent the attacks take it as prescribed and if you have an abortive medication take it as soon as you feel a headache coming on. If the medications aren't working or are creating side-effects that are as bad as the migraine attacks then insist that your neurologist change the medication. If you don't have a neurologist who is up to date on the latest information regarding migraine disease then find one who is. Give serious consideration to the new long term treatments that are coming out now. And even if you have a neurologist that you trust in, you still need to do your own homework and research. Papers on new studies and courses of treatment are being published all the time.

If you don't already get the National Headache Foundation (NHF) newsletter then subscribe and read it. Neurologists and researchers are finding all sorts of new and interesting data about migraine disease and approaches to treatment. In the latest newsletter they have devoted considerable space to discussing what happens or what you should do (with your neurologist) if treatments fail to work for you. It's really useful information to have available. There are also testimonials from other migraineurs about how the disease is adversely effecting their lives and how they are dealing with the "invisible disease".

There is one other thing I wanted to say - after I got the implant but before it was turned on (when I was still a placebo patient) I had my normal quarterly appointment with my regular neurologist. I told her that I had gotten the implant (I had mentioned the study before I got approved for it as well). She was extremely skeptical and asked me if it was working for me. I told her that I didn't think it was working for me but that I was scheduled to go back the see the study people in a week to find out if the device was on or not and to have it adjusted if indeed it was on. She poo-pooed the entire thing saying that she thinks that I was proof that the ONS device didn't work for people with Chronic Intractable Migraine Disease and that for people with lesser forms of the disease it might work but it was too extreme and radical a prospect to be reasonable used. I left her office feeling like I had seriously f*cked up since my neurologist is a top-rated specialist in the treatment of migraine disease. However, as I said my unit wasn't turned on and when it was I started to and continued to get relief from it (until the damn battery died). In August 2009, when the device was still working I had another quarterly follow-up with my neurologist and she was shocked. To her I looked totally different, I told her that the last time I saw her the device wasn't on and since then it had been turned on and adjusted to suit me and that I hadn't had the chronic constant migraine attacks and that my other symptoms were under control and that when I did get an attack that two Tylenol or if it was a little worse 1 vicodan worked to end the attack. She was speechless. We talked in her office for nearly an hour (my appointments are usually a fast 15 minutes). She wanted to see where the battery pack was and feel were the leads went into my neck up to my brain. She asked me tons of questions about what it felt like, how I thought it was resolving my migraines and whether I would recommend it to other Chronic Migraineurs. I told her that she should ask her office mate and fellow neruosurgeon because he did the surgery and is getting the results of the study now. I told her that I cannot and will not tell other chronic migrainuers to do what I did but that it was worth investigating whether the treatment was right for them. That there are criteria that I was not fully aware of in to be of the study or to get the implant - I just knew that I met the health and mental capacity criteria of the study to be accepted. She was very pleased that despite her negation that I had been proactive to pursue treatments that could help get the disease under control.

I have seen this same neurologist since the battery died and she now believes completely that this ONS device is a valid and rational method of treatment for my level of disease. She was pretty disappointed that the battery had died so soon but was glad to hear that it would be replaced with a rechargeable unit and that future implantees would automatically get rechargeable long term units.

I am sorry that this post is so long and I am sorry that there are questions that people have asked that I haven't answered but I was trying to get my life back. But that's no excuse, so if youhave questions that I haven't addressed or there is information you want from me just post your question or if you want email through this site.

Migraines

Monique Marie — Wed, 27 May 2009 13:20:08 -0700

A migraine is a severe, debilitating form of headache that typically appears as a throbbing ache near the side of the forehead. Over time, the ache often intensifies to a disabling pain. Migraines are usually a chronic condition, occurring repeatedly throughout a person’s life.

Migraines are considered a type of vascular headache because they involve blood vessels, nerves and chemicals in the brain. Although the exact cause of this type of headache is not fully understood, a number of factors that can trigger the condition have been identified. These include sensory stimulus (e.g., bright lights, loud noises, certain odors), stress and certain foods, such as chocolate or nuts.

A migraine differs from other types of headaches because it is usually more severe and often accompanied by a number of other symptoms, such as nausea or vomiting. In some people, temporary visual changes such as hallucinations or blind spots may occur before the headache appears. Known as aura, these warning symptoms occur in only about one–fifth of migraine suffers. Migraine with aura (classic migraine) and migraine without aura (common migraine) are the two most common types of migraine.

A number of serious conditions, including stroke, blood clot, and brain tumor, can cause severe headaches that may be mistaken for migraines. To rule out these conditions, a physician evaluates the patient by taking a medical history and performing a physical examination. Diagnostic tests such as MRI, CAT scan or electroencephalogram (EEG) may also be performed.

There is no known cure for migraines. However, there are a number of methods used to control symptoms and prevent future episodes. These include headache medications, biofeedback and self–hypnosis. Patients may help prevent migraines by avoiding factors that trigger the headaches.

The National Headache Foundation (NHF) estimates that more than 28 million Americans experience migraine. The disease is more common in women, people between the ages of 15 and 55, and those with a family history of the condition.

People with other conditions are sometimes incorrectly diagnosed with migraines, but because symptoms and onset vary, some migraine sufferers go undiagnosed. The NHF estimates that even among people with complaints of severe disability from the condition, a large percentage do not receive a diagnosis of migraine.

Although they can be debilitating, migraines pose little risk of severe damage to a person’s overall health. However, patients should seek emergency medical treatment when a headache is accompanied by a symptom not experienced with previous migraines, such as speech problems or a loss of balance, as it may indicate a more serious medical condition.

Migraines are a type of vascular headache. They involve blood vessels, as well as nerves and chemicals in the brain. They are most likely caused by an abnormal trigger of chemicals that cause the blood vessels to swell. Migraines differ from other types of headaches because they often are more severe and are accompanied by other symptoms. In patients with aura, they can have unusual symptoms such as nausea or fatigue even two days before the onset of full-blown migraine.

Often described as a throbbing headache, migraines are usually felt on only one side of the head. They typically begin as a dull ache near the side of the forehead. Over a period of several minutes to hours, the ache intensifies to a disabling pain. The pain is often so severe that people may be sensitive to anything touching their head.

Without treatment, the headache may last anywhere from four to more than 72 hours. During this time, a person may experience a number of additional symptoms including nausea, vomiting and sensitivity to light. The pain associated with a migraine is referred pain, meaning it is usually felt around the eye or temple area, but it may develop in the face, sinus, jaw or neck.

According to National Headache Foundation (NHF), more than 28 million Americans experience migraines. The frequencies in which migraines are experienced vary from person to person. Some people experience migraines once or twice a year, whereas others will experience them several times a month.

Migraine symptoms appear differently among individuals. None of the symptoms develop in all individuals, making the diagnosis of the condition more difficult. In a large study conducted by the NHF in 1999, 48 percent of the individuals with migraines reported that they had received a medical diagnosis. Even today, the NHF estimates that less than half of the people who suffer with migraines receive a medical diagnosis.

Although migraines pose little risk of long-term damage to a person’s overall health, the debilitating pain can interfere with daily life. In addition, there is a very low risk of stroke associated with severe migraines. This may result from a narrowing of the blood vessels, which reduces blood flow to parts of the brain. Permanent neurological changes, such as muscle weakness, may also occur as the result of complicated migraines.

Severe headaches from a number of serious conditions may be mistaken for migraines. These headaches may be caused by:
-Stroke or intracerebral hemorrhage (bleeding in the brain resulting from the rupture of a blood vessel within the head)
-Blood clot or aneurysm (an abnormal expansion or ballooning of a section of an artery)
-Brain tumor
-Concussion
-Lyme disease

As a result, patients should discuss all serious or recurring headaches with their physician and seek medical attention when a headache:
-Starts suddenly
-Is severe or persistent
-Disturbs sleep
-Occurs during activity
-Changes in pattern or intensity
-Intensifies after lying down
-Is accompanied by other symptoms, such as drowsiness or vision changes

Emergency medical treatment should be sought when:
-A headache is accompanied by unusual symptoms not experienced with previous migraines, including:
-Speech problems
-Vision abnormalities
-Numbness, weakness or loss of balance
-Difficulty moving a limb
-Fever
-Stiff neck
-Rash
-Seizures or mental confusion
-A headache occurs soon after a sore throat or respiratory infection
-A headache occurs after a head injury
-A chronic headache intensifies with coughing, exertion, straining or sudden movement
-A new type of headache pain occurs (in those over age 50 or younger than
-A new type of headache pain occurs that is severe and not contained to just one side of the head
-There is loss of consciousness

The two major classifications for migraines are:

1. Migraine without aura. Also known as common migraine, this type of migraine is characterized by a severe throbbing headache felt usually on only one side of the head. Additional symptoms may include nausea, vomiting, allodynia and sensitivity to light, sound and odors. It is the most common form of migraine.

2. Migraine with aura. Also known as classic migraine, this type of migraine is similar to the common migraine except it is preceded by warning symptoms (aura) before the headache occurs. The aura usually presents as a visual disturbance that begins 20 to 60 minutes before the onset of the migraine, but can start up to 48 hours before.
Additional classifications include:

Complicated migraine (the one that I suffer from) In some cases, warning symptoms (aura) are prolonged, or continue into or through the headache period. This type of migraine is known as a complicated migraine. Forms of complicated migraine include:

Ophthalmoplegic migraine. During this migraine, patients develop a partial or complete paralysis of the nerves needed for eye movement. The pain typically surrounds the eye. Triggered by weakness of the muscles encasing the eyes, the pain can last anywhere from a few days to a few months. This is a rare form of migraine that most often occurs in children and young adults. I feel like my eyes are going to pop out of their sockets and it is painful.

Retinal migraine. Also known as an ocular or ophthalmic migraine, this type of migraine is characterized by multiple episodes of blind spots or blindness related to a headache. It differs from other forms of headache because the retina (light-sensitive tissue in the back of the eye) is responsible for the visual disturbances, not the brain.

Hemiplegic migraine. This form of migraine is characterized by numbness or tingling and temporary paralysis on one side of the body. Because of its similarity in symptoms to a stroke, individuals should seek immediate medical attention if they experience these symptoms. I also have parts of my body going numb, usually my left side.

Although they occur rarely, hemiplegic migraines are considered one of the most severe forms of migraine. In some cases, it may take several weeks for a patient to recover completely. In addition, patients may suffer permanent weakness after multiple episodes. In 2004, I had one of these and it took a year to be able to move my left side normally.

A rare type of hemiplegic migraine can be inherited. Known as familial hemiplegic migraine, this condition has been connected to mutations in genes on several chromosomes. Familial hemiplegic migraine is autosomal dominant, meaning it can be passed on to a child if only one parent has the abnormal gene.

Basilar migraine. Also known as Bickerstaff’s syndrome, this type of migraine is characterized by neurological symptoms related to the brainstem. It occurs as the result of a migraine affecting circulation in back of the neck or brain. Patients may experience headaches located at the back of the head, accompanied by numbness on both sides of the body and severe vomiting. Additional symptoms may also occur, including dizziness, double vision, loss of balance, confusion, slurred speech, disorientation, fainting and loss of consciousness. This condition occurs most often in children and young women.

Migraine equivalents. Also known as migraine variants, acephalgic migraine or simply migraine aura without headache, this rare type of migraine presents in a form other than head pain. A patient with a previous history of migraines may be diagnosed with this condition when the headaches have been replaced by an equivalent set of symptoms. A migraine equivalent may present in the form of visual abnormalities (e.g., blind spots), neurologic deficits or psychic disturbances without headache.

A common form of migraine equivalent is the abdominal migraine. Also known as periodic syndrome, this form of migraine most often occurs in children. Patients usually have a family history of migraines, and they often develop typical migraines later on in adulthood. The condition is characterized by recurrent bouts of abdominal pain without headache. These episodes can last for a number of hours. The condition is often accompanied by nausea, vomiting, flushing and pallor (paleness).

Additional terms used to describe migraines include:

Coexisting migraine and tension headache. Also known as transformed migraine, chronic migraine and chronic daily headache, this condition is characterized by the combination of a chronic tension–type headache and recurrent migraine headaches. In most cases, patients with this condition have a personal history of migraine headaches that can be traced back to adolescence or young adulthood.

Cyclic migraine syndrome. Patients with this syndrome usually have 10 or more migraines a month, which are accompanied by typical migraine symptoms. These headaches are not classified as cluster headaches because they are long-lasting and do not have symptoms typically associated with cluster headaches.

Menstrual migraine. This term may be used to describe migraines that occur during ovulation or before, during or immediately after a woman’s menstrual period.

Nocturnal migraine. This term may be used to describe migraines that occur during the middle of the night or in the early morning. Patients experiencing nocturnal migraines are often awakened by them. They may be caused by changes in the brain’s neurotransmitters that occur during sleep.

Status migraines. This term may be used to describe a migraine that continues for more than 72 hours.

Migraine with acute-onset aura. This term may be used to describe aura that fully develops in less than five minutes.

Migraines are caused by abnormal brain activity. This abnormal activity may be triggered by a number of factors. Although the exact process in which this occurs is unknown, the disorder appears to involve blood vessels, nerve pathways and chemicals in the brain.

Some researchers believe migraines are caused by imbalances in brain chemicals such as serotonin (a neurotransmitter that controls pain signals traveling through the trigeminal nerve) or changes in the trigeminal nerve, which carries sensory stimuli to the brain from the face, teeth and tongue. Others believe that migraines are due to central sensitization, which means that pain centers feel pain without any painful stimulus.

Serotonin levels drop during a migraine. Many researchers think this triggers the trigeminal nerve to release substances known as neuropeptides. Once released, the neuropeptides travel to the brain’s surface, where they cause swelling and inflammation of blood vessels. This results in head pain. Low levels of magnesium, a mineral involved in nerve cell function, may also play a role.

Factors that may trigger a migraine include:
-Sensory stimulus, such as bright lights, loud noises or certain odors
-Stress (physical or emotional)
-Depression
-Changes in sleep patterns, including too little or too much sleep
-Smoking or exposure to secondhand smoke
-Skipping or delaying meals
-Alcohol or caffeine
-Intense physical activity
-Tension headaches
-Medications that cause the blood vessels to swell (vasodilators), including some blood pressure medications
-Frequent use of pain medication (rebound withdrawal headaches)
-Allergic reactions
-Environmental changes, such as changes in weather, altitude level, barometric pressure or time zone
-Hormonal changes, including those caused by menstruation, pregnancy, menopause, birth control pills or hormone replacement therapy

A number of factors appear to make a person more likely to develop migraines. These risk factors include:
-Age. According to the National Headache Foundation (NHF), migraines occur most often between the ages of 15 and 55.
-Sex. The NHF estimates that women are affected with migraines three times as often as men.
-Family history. Migraines are more likely to occur in people with migraine sufferers in their immediate family, such as a parent or sibling. According to the NHF, between 70 and 80 percent of migraine sufferers have a family history of migraines.
Some studies have found increased prevalence of migraines in people with certain conditions, including epilepsy, insulin resistance, obesity, fibromyalgia and certain cardiovascular conditions

The main symptom of a migraine is a throbbing, pounding or pulsating headache. The pain, which may be dull or severe, is typically worse on the sides of the forehead. It starts on one side of the head and typically remains contained there. However, it may spread to the other side. For many migraine sufferers, the headaches start on the same side each time.

Exertion often intensifies the pain. In addition, many patients experience pain behind the eye or in the back of the head or neck.

Migraines may be accompanied by a number of other symptoms including:
-Nausea or vomiting
-Sensitivity to light or sound
-Loss of appetite
-Fatigue
-Numbness, weakness or tingling
-Dizziness or vertigo (feeling that the room is spinning)
-Chills
-Increased urination
-Increased sweating
-Swelling of the face
-Irritability

Some people who experience migraines have warning symptoms before the headache appears. Known as aura, these temporary visual disturbances are caused by transient changes in the activity of certain nerve cells. The changes may occur in one eye or in both. Aura most often occurs 20 minutes to one hour before a migraine. However, it can develop anywhere from a few minutes to 24 hours before the headache appears. Warning symptoms may include:
-Visual hallucinations (e.g., flashing lights, zigzag lines, dots)
-Blind spots
-Tunnel vision
-Sensitivity to bright light
-Blurred vision
-Eye pain
Most people, however, do not experience aura. According to the National Headache Foundation (NHF), only around one–fifth of migraine suffers experience aura. Some people also experience difficulty speaking, or a tingling sensation in their arm, leg or face.

Regardless of whether or not a patient has aura, there are a number of symptoms that may appear several hours to a day before a migraine occurs. Known as prodrome symptoms, these include:
-Feelings of elation or extreme energy
-Cravings for sweets
-Increased thirst
-Drowsiness
-Irritability
-Depression

There are also a number of symptoms that may remain after a migraine has disappeared. These include:
-Mental dullness (unclear or slowed thinking)
-Fatigue
-Increased need for sleep
-Neck pain

During an evaluation for migraines, physicians take the patient’s medical history and perform a physical examination. While collecting a patient’s medical history, physicians may ask the patient about their symptoms. They will ask if there is a family history of migraines. Typically, physical examinations performed on patients with migraines yield no findings.

The patient may be asked to complete a pain assessment form, such as the Migraine Disability Assessment (MIDAS) Questionnaire, which was developed to help physicians identify sufferers most in need of care.

Information provided during the evaluation can help physicians determine whether a patient’s symptoms are the result of an underlying medical condition, such as a brain tumor or aneurysm.

A number of diagnostic tests may be ordered to rule out other potential causes. These may include:
MRI (magnetic resonance imaging). MRIs use a powerful magnetic field to create images of structures and organs within the body, allowing a computer to produce clear cross-sectional or three-dimensional images. This test may be ordered to rule out sinus inflammation, brain masses and a number of other causes.

CAT scan (computed axial tomography). This test allows for multiple x-rays to be taken from different angles around the patient. A computer analyzes the "slices" or cross-sectional images. Frequently after the first set of images is taken, the patient receives an intravenous (I.V.) injection of a contrast agent (dye) to better outline the body parts. Then a second set of images is taken. This test may be ordered to rule out sinus inflammation, brain masses and a number of other causes.

Electroencephalogram (EEG). Electrodes are placed on the head to measure the brain’s electrical activity. This test may be performed to exclude seizures.

Spinal tap (lumbar puncture). This procedure uses a needle to remove a sample of cerebrospinal fluid (CSF) from between vertebrae in the lower spine. Although this test is rarely performed, it may be ordered to rule out encephalitis, meningitis, subarachnoid hemorrhage or other possible underlying conditions that can cause severe headaches.

No tests are available yet to confirm the diagnosis of a migraine. As a result, migraines are often misdiagnosed as sinus headaches or tension headaches.

There are a number of treatment options available for migraines. Although migraines cannot be cured, treatments aim to control the symptoms and prevent future episodes. Patients may benefit from immediately treating their migraine as soon as symptoms appear. This may lessen the severity of the headache.

Simple treatment methods for migraines include:
-Resting in a quiet and darkened room. During a migraine, patients are often sensitive to noise and light. Silence and darkness may lessen the severity of migraine symptoms.
-Drinking fluids. This prevents dehydration, especially after vomiting.
-Placing a cool cloth on the head.
-Prescription and over–the–counter medications may also be used to prevent migraines, stop the progression of a migraine and relieve symptoms.
-Beta blockers. These drugs decrease the workload of the heart and lower blood pressure.
-Calcium channel blockers. These drugs increase the flow of oxygen-rich blood to the heart, lower blood pressure and reduce the workload of the heart.
-Selective serotonin reuptake inhibitors (SSRIs). This class of antidepressants is most commonly used to treat depression. Antidepressants, however, may increase the risk of suicidal thinking and behavior in children and adolescents. As a result, the U.S. Food and Drug Administration recommends that people being treated with these drugs be closely monitored for unusual changes in behavior.
-Antihistamines. These drugs are commonly used to treat allergic reactions.
To be effective, these medications must be taken every day. They are frequently recommended for patients who experience three or more migraines a month. Although they may be recommended for some patients, they are less helpful and tolerable in patients with only occasional migraines.

A variety of drugs may be recommended to reduce pain, nausea or emotional stress related to migraines. Medications given to treat these symptoms include:
-Anti-emetics to relieve nausea
-Sedatives to reduce anxiety
-Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen to reduce pain and inflammation
-Acetaminophen to relieve pain and reduce fever
-Narcotic analgesics (opioids) to relieve pain or inflammation

Medications used to treat migraines have variable effectiveness in different people. In many cases, a number of medications may be tried before an effective drug, or combination of drugs, is found.

As an alternative to drug therapy, patients may choose to take feverfew, MIG-99 (an extract of feverfew) or butterbur. These are herbs commonly used to treat migraines. Although their effectiveness has not been proven, some studies support their use. Riboflavin (vitamin B–2) and magnesium sulfate may also be helpful. Patients should receive their physician’s approval before taking herbs, supplements or other complementary and alternative treatments for their migraines.

Additional treatment methods include:
-Biofeedback. This method uses electronic monitoring devices to teach people how to consciously regulate their bodily functions through relaxation or imagery. Migraine suffers may use this technique to stop an attack or reduce its symptoms.
-Self-hypnosis exercises. This method requires a patient to self-induce a state of hypnosis (an altered state of consciousness). It may be used to control muscle contraction and the swelling of blood vessels in patients with migraines.
-Cognitive behavioral therapy. This technique, in which patients identify negative thought patterns and replace them with positive ones, may benefit people with chronic pain.
-Cryotherapy. Application of cold, such as compresses or an ice pack, can numb nerves and increase the patient’s pain threshold.
-Electrical therapy. Techniques such as occipital neurostimulation (ONS), in which electrodes are placed near the base of the skull in minimally invasive surgery, have been used to ease severe migraines.
-Acupuncture or acupressure. Some people have found these Eastern treatments helpful.
People respond differently to treatment. Some may require little or no treatment and others may require the use of several medications or techniques, or in some cases, occasional hospitalization. Patients are encouraged to contact their physician when treatments that were previously effective are no longer helpful.

In addition to taking medications, patients may reduce the frequency of migraines by avoiding factors that trigger the headaches. Patients may identify these triggers by keeping a headache diary. To compile this journal, patients should record certain information after each migraine occurs, including:
-When the migraine occurred
-How severe the migraine was
-Additional symptoms experienced with the migraine
-What was eaten before the migraine occurred
-Sleep patterns
-Menstrual cycles

Other common prevention methods include:
-Avoiding cigarette smoking
-Avoiding caffeine and alcohol
-Avoiding or reducing medications containing estrogen
-Exercising regularly
-Maintaining a regular diet and sleep pattern
-Using relaxation techniques, such as progressive muscle relaxation or meditation

There is a great deal of research being conducted on migraines, including clinical trials and scientific studies. Many studies are focused on developing more effective treatment methods. Areas of research include:

Botulinum toxin type A (Botox). This drug is commonly used to reduce the appearance of wrinkles. In clinical studies, however, this form of injection therapy has reduced the frequency and the intensity of migraines in some people. More research is needed to verify the connection.

Other medications. Many combinations, new drugs and new formulations of older drugs are under study.

Nerve blocks. Performing an occipital nerve block may abort an attack, but more research is needed.

Genetics. Because migraines appear to be linked to family history, researchers are studying the possibility of a “migraine gene.”

Links to other conditions. Scientists are investigating the relationship of migraines to conditions including epilepsy, insulin resistance, obesity, irritable bowel syndrome, fibromyalgia, depression, and cardiovascular disorders such as heart attack, high blood pressure and a fairly common heart defect called patent foramen ovale (PFO).

Surgery. Nasal surgery to keep surfaces inside sinuses from touching has brought relief to some migraine sufferers. Recent research has found that some migraine patients improved after surgical removal of muscle or a minor nerve to reduce nerve compression and inflammation. Surgical treatment of PFO is being investigated as a way of controlling migraines associated with this heart defect.

Personal:
I can always tell when i am going to have a migraine because the back of my head will start to hurt a little. Within an hour the whole head hurts and within a few more hours it is a full blown migraine. When I get a migraine, I am unable to do anything, and it usually lasts 24 hours even with medications. I know I get migraines from having tight neck muscles and those are caused from stress. Also, another point I want to make about Complicated Migraines, is that you do not always have to have a migraine to experince the other symptoms.

Best thing to do in my mind is to find out what your triggers are and try to prevent the migraine and talk to a neurologist about what medications to take instead of your regular doctor. Yes, neurologists are more expensive but they specialists. Another good idea is to get a CAT scan and an MRI done to rule out other possibilities.

Sources: NHF and NIN