Many people have experienced a migraine attack and don’t know it – probably because the signs aren’t always so obvious.
“Only half of the 40 million people in the US who have migraines are actually diagnosed,” said Dr. Andreas Blumenfelda dual board-certified neurologist and psychiatrist in San Diego.
Some symptoms are obvious, like blurred vision, sensitivity to light, and of course, the all-consuming headache. But during a migraine attack—even before the pain sets in—parts of the brain lose function, which can affect other areas of your body. Symptoms can appear disjointed. And when you suffer from chronic migraines (more than half the days of the month), symptoms persist well beyond the course of the incident.
Below are some sneaky signs to look out for, as well as some other important migraine warnings to keep in mind.
Confusion, brain fog, or loss of speech
If you’ve ever been unable to find the right words, suddenly lost the ability to express yourself, or completely forgot what you were talking about mid-sentence, this could be a scary (but common) migraine symptom.
“Difficulty speaking, memory loss, confusion [are some of the most] surprising migraine symptoms,” said Dr. Medhat Mikhael, pain management specialist and medical director of the nonsurgical program at Spine Health Center at MemorialCare Orange Coast Medical Center in California.
Migraines can cause dysfunction in the brain’s language centers, resulting in a loss of the ability to express yourself, Blumenfeld said.
“In the cortex — where language and vocabulary are stored — this part of the brain shuts down during this phase of the migraine,” Blumenfeld said.
dizziness or disorientation
Many patients with dizziness tend to also have migraines, Blumenfeld said. “There are a lot of patients in this particular population who end up being migraine sufferers as well,” he explained.
In particular, they could have what is known as a “vestibular migraine”. A vestibular migraine does not always involve a painful headache, which means that dizziness can be a symptom on its own or be associated with regular migraine attacks.
If you have a history of migraines and have occasional dizzy spells — even if some of those dizzy spells aren’t accompanied by migraine pain — it may still be a migraine attack, especially if there “is no other medical condition that explains dizziness,” Blumenfeld explains.
Tired all the time? Migraines can be to blame. Chronic fatigue is a symptom of chronic migraines both before and during an attack, as well as between attacks.
“The fatigue can be physical, mental, or both,” Blumenfeld said. “You can experience cognitive slowdown — slow thinking — as well as lethargy. When your brain is working slowly and you are trying to be productive, you will tire more easily. It all comes from the cortex in the brain.”
If fatigue is a major symptom for you, Blumenfeld says treating migraines right can help you regain some of your energy. Bring this symptom up with your doctor when discussing a medication plan.
“Certain medications used to treat migraines can increase fatigue, including some of the older medications used to prevent migraines,” he explained. “You could get rid of the headache, but the patient is [wiped] out.”
numbness or sensitivity
“I think the most surprising migraine symptom — the one that people don’t recognize as such — is something called allodynia,” said Dr. Huma U. Sheikh, a board-certified neurologist with a specialty in headache medicine from Harvard-Brigham and Women’s Hospital. “This is a symptom where ordinary touch can feel irritating or painful.”
She said if you’ve ever felt like your “hair hurts” or suddenly become sensitized to a necklace or glasses you wear regularly, it “could be due to hypersensitization of the nerves starting to feel normal sensations.” so painful to portray.”
anxiety and depression
Anxiety and depression are “very common in migraines and are genetically linked — these disorders run in families,” Blumenfeld said. “In the time between the attacks [many people with migraines] tend to get very anxious – you may be afraid of the next attack, but you may have anxiety and panic attacks independent of worrying about the headache.
“If you look at the cases of anxiety and depression, the more common the migraine, the stronger the connection,” he continued. “In chronic migraineurs, you see anxiety and depression in more than a third of the cases.”
indigestion and nausea
Nausea, vomiting and diarrhea can be associated both as symptoms themselves and in the form of migraines comorbid conditionsaid Blumenfeld.
“In migraine attacks, it has been shown that gastric emptying is delayed, [known as] gastric stasis“ he continued. This can lead to nausea and stomach problems.
Cravings for chocolate
Before pain occurs, there is an initial phase of a migraine attack, called a migraine attack pre-warning phasesaid Blumenfeld.
This typically consists of fatigue, neck discomfort, yawning, and thirst cravingsincluding craving for chocolate, he added, carefully pointing out that the chocolate in this case “a desire and no trigger.”
So if you’re suddenly craving a brownie or ready to inhale a bag of M&Ms, this might be a warning. Cravings, along with the other symptoms of this phase, can help you with this recognize an imminent attack before the blinding pain sets in, giving you a chance to find medication.
Many migraine attacks start with a stuffy nose, said Maureen A. Moriarty, a headache specialist and current fellow at the American Headache Society. Stimulating pain pathways in the trigeminal nerve — which is part of your nervous system — creates the congestion, she explained.
“Unfortunately, many people often become dependent on decongestants to relieve this symptom,” Moriarty said. “Not recognizing this as part of the migraine, they neglect to mention the symptom to their doctor. It’s important to let your doctor know if nasal congestion precedes a headache. Controlling migraine attacks can control this symptom.”
Ideally, you should see a neurologist as soon as possible, but Blumenfeld recognizes that it can be an arduous process. Not many specialists are available, and the symptoms can often act as a distraction to other conditions.
There are many cases where it It can be difficult to determine which experience is a symptom caused by a migraine attack and which are simply co-existing (known as comorbidities). For exampleThere may be an overlap between symptoms and comorbidities such as anxiety and depression. Migraines can cause depression, and depression can contribute to a risk of having a migraine attack.
This can mean that doctors may need to treat you for multiple medical conditions, which is why it’s important to find someone you trust and who is willing to provide you with an appropriate plan that is tailored to your situation and needs. Whatever you do, don’t stay with a doctor who makes you feel like you’re just “dealing with a headache.”
“It’s not your fault; it’s a genetic condition,” Blumenfeld said. “Tell your doctor you think you have migraines.”