Spotting Often-Overlooked Clues Like Nausea, Fatigue, Even Yawns May Help Patients Stave Off Attack

This article appeared on the front page of the Wall Street Journal today 7th June 2011.

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A migraine is among the most debilitating conditions in medicine—a blinding, throbbing pain that typically lasts between four and 72 hours. There is no cure.


An estimated one-third of the 30 million U.S. migraine sufferers experience warning signs up to 48 hours before the dreaded pain starts. Melinda Beck discusses how patients can learn to recognize their personal warning signs. Illustration by Bernard Maisner.

Yet, a few hours or days before the dreaded headache sets in, subtle symptoms emerge: Some people feel unusually fatigued, cranky or anxious. Some have yawning jags. Others have food cravings or excessive thirst.

If migraine sufferers can learn to identify their particular warning signs, they may be able to head off the headache pain with medication or lifestyle changes before it begins, experts say.

"The holy grail of migraine treatment would be to have something you could take tonight to ward off an attack tomorrow," says neurologist Peter Goadsby, director of the headache program at the University of California-San Francisco. At a conference of the American Headache Society last week, he and other experts said these early symptoms may hold clues to what causes migraines in the first place.

Scientists have long known about this so-called premonitory phase, which occurs well before the better-known aura, the flashing lights and wavy lines that about 30% of migraine sufferers see shortly before the headache begins. Yet there have been only a handful of clinical trials treating patients in the premonitory stage—in part because the symptoms are so vague. Still, once patients know what to look for, many can identify some early warning signs.

The Four Phases of a Migraine

1) Premonitory, or prodrome. About two-thirds of migraine sufferers experience vague physical or emotional changes two to 48 hours before the headache starts. Symptoms can include fatigue, yawning, appetite changes, altered mood, muscle stiffness, digestive changes.

2) Aura. About one-third of patients see flashing lights, wavy lines and other visual disturbances for a few minutes to an hour before the headache begins. Some also have temporary trouble speaking or feel tingling or numbness on one side.

3) Pain. Virtually all migraine sufferers have moderate to severe throbbing head pain, usually on one side, lasting from four to 72 hours. Many also report nausea, vomiting, sensitivity to sound, light, smells and movement. Sufferers may be unable to work, play or socialize during this acute phase.

4) Postdrome. Feelings of exhaustion, depression, malaise and difficulty thinking can persist for days, along with residual soreness in forehead or neck. In rare cases, sufferers may feel euphoric instead.

Source: WSJ reporting

"If you ask the average migraine sufferer, 'Do you have any symptoms a few hours before the headache starts?' about 30% will say yes," says Werner Becker, professor of neuroscience at the University of Calgary in Alberta. But given a list of 20 common signs, from changes in mood, appetite or energy to urinating frequently or yawning excessively, about 80% of patients will say, "Oh yes, I've noticed that," he says.

Dr. Becker says one of his patients frequently feels dizzy and loses her appetite about 6 p.m. and knows that an attack is imminent. She finds that taking the migraine drug rizatriptan—usually taken only after the headache starts—can ward it off. "If she doesn't take it, then the next morning, she wakes up with a full-blown migraine," Dr. Becker says.

Sheena Selvey, a 28-year old special-education teacher in Northbrook, Ill., says she knows a migraine is coming when co-workers say her neck muscles have tightened up. She rubs her neck with an essential peppermint oil until she can inject herself with Imitrex, another medication usually used to stop rather than prevent headache pain. She says such steps have helped reduce attacks to two or three times a month from three or four times a week.


http://online.wsj.com/article/SB10001424052702304906004576369431835920332.html

I have to say yawning is a big one for me, I yawn so much and so often that my face hurts!

I get really stressy and snappy, I yawn but I didn't realise about the weeing thingy...I never knew that was a symptom..I must pay more attention...and the neck is a deffo for me.

Another good article Tee..xxxx