There’s a distinct migraine phase with its own symptoms that begins when your head pain ends
For people who do not have migraine, the worst “headache” they ever experience may be the one that accompanies their hangover after a night of heavy drinking. A migraine hangover is much more complicated—it is a distinct phase in a migraine attack that begins once peak head pain dissipates. It symptoms can closely resemble the hallmarks of a typical “hangover,” like fatigue, dehydration, body aches and mental “fogginess.” For many, the effects of a migraine hangover may be just as debilitating as the period of head pain that precedes it.
The Migraine Hangover
The entire body can be affected during a migraine attack, not just the head. From abdominal issues to cognitive impairment to sensitivity to touch, the malfunctioning of several bodily functions can wreak havoc on your entire system. The medical term for a migraine hangover is postdrome, which is the fourth and final phase of a migraine attack. It can take days or even weeks to transition through all four phases.
For those having a severe migraine episode, the shift from headache to postdrome can be difficult to identify. The pain can manifest itself into areas of the body not previously affected: stiffness in the neck and shoulders, tenderness in the scalp and dizziness are common “migraine hangover” symptoms.
Everyone experiences the postdrome phase differently: it does not necessarily occur in everyone with migraine, nor does it happen after every attack. These inconsistencies can be confusing, and often cause “migraine hangover” to be mistaken for a different medical condition.
Reducing the Risk of Migraine Hangover
Migraine hangovers can be reduced, or better managed, by maintaining good headache hygiene. When consistently practiced, these preventative measures can reduce the severity and length of a migraine hangover.
Stay well hydrated throughout all four phases of a migraine. While it can seem daunting, getting out of bed, stretching or very light activities can help the healing process. Avoiding factors which exacerbate the symptoms is important, and avoiding overstimulation may hasten the pace of recovery.
Caffeine during the prodrome phase can have a positive effect for some people, but others find it makes their symptoms worse. Many find comfort food, ice packs, heating pads, massages and additional rest helps to soothe their migraine hangover. Ignoring or pushing through the effects of the postdrome phase doesn’t give the body necessary time to recover, and can increase the risk of having another attack. Take it easy and rest during this time.
Prevention is the key to avoiding a prolonged migraine hangover, and in managing your migraine health on a daily basis. Maintaining a headache diary will help you track your symptoms and their changes during the prodrome, aura, headache and postdrome phases, which can help you identify patterns, like behaviors or foods correspond with your attacks, helping you reduce your exposure to triggers. Working with a headache specialist will help you better understand your migraine, find medications that may relieve some symptoms and obtain a better understanding of your unique headache disorder and how best to treat it.
You can find a headache specialist using the American Migraine Foundation’s Find a Doctor tool. AMF also maintains a comprehensive resource library full of fact sheets, toolkits and advice sourced directly from the nation’s leading migraine specialists to help you take control of your migraine.
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The Comorbidities of Migraine – Facebook Live Recap
Understanding why diseases can occur in association with migraine
Other illnesses that can appear alongside migraine, called comorbidities, can affect any number of body systems, and often require more complex treatment plans. According to Dr. Nate Bennett, Director of the Preferred Headache Center in Pittsburgh, PA, comorbid diseases are more common in people with migraine, because the hyperactive pain receptors in their brain have difficulty filtering out unnecessary signals from both the body and the outside world.
In a recent Facebook live chat hosted by the American Migraine Foundation, Bennett discussed the more common comorbidities of migraine, why they occur, and offered insights on their respective treatment options.
Depression and anxiety
Patients with migraine are 25% more likely to have depression and 50% more likely to have anxiety. These diseases are commonly classified as mental health disorders, but Bennett prefers to use the term “limbic dysfunction,” in reference to the area of the brain that controls emotions and memory.
“Patients with migraine often have imbalanced limbic systems as well, so the emotional part of their brain will misinterpret environmental stimuli or stressors,” Bennett said. “Logically, they may know something should only cause a bit of anxiety, when it’s really causing them much more.”
This signal mix-up works similarly with depression and bipolar disorder. All three diseases can increase a person’s likelihood of having migraine, and vice versa, because the diseases are heavily influenced by stress. Stress can worsen the limbic dysfunction, which in turn puts strain on the pain pathways involved in migraine.
“You’ve probably heard the commercial where they say ‘depression hurts,’” Bennet said. “Well, it really does. It lowers the pain threshold, making patients more likely to get more migraines, which can cause heightened depression and anxiety. It creates a vicious cycle.”
Bennett recommended using medications that treat both diseases. Some antidepressants, like Cymbalta or Effexor, can help manage both migraine and depression/anxiety symptoms. Stress management techniques like meditation have also shown to be helpful as well.
A large number of people living with migraine also have fibromyalgia, a chronic pain disorder that affects specific muscles. Like migraine, it’s an invisible illness that can’t be diagnosed with a blood test or an X-ray. As a result, even some physicians question the validity of this disorder.
“Whether it’s due to the brain misperceiving signals or receiving pain signals at the wrong time, the bottom line is, there is pain,” Bennett said. “One of the reasons some physicians don’t believe it exists is because there’s nothing to measure. It’s quite similar to migraine in that way.”
Comorbid fibromyalgia can be treated similarly to comorbid anxiety and depression. Some antidepressants have shown to be helpful in managing pain, but Bennett believes that exercise, although difficult, may help the most.
“Yoga has proven to be very helpful for people with fibromyalgia,” Bennett said. “The hard part is, sometimes exercise can initially cause more pain, so it can be be very difficult for people to go out and get started. It’s easy for physicians to say to say ‘go out and exercise’ because they’re not in pain. I still try to get my patients to push themselves, because the more they do it, the lower the pain should go, hopefully.”
Managing migraine to manage comorbidities
Many people with migraine try to plan their life around their disease to avoid triggers and sudden attacks. Unfortunately, the pressure of that kind of self-monitoring can heighten anxiety, triggering migraine and other associated comorbidities. According to Bennett, getting your migraine under control is the best way to avoid this cycle.
“There are many lifestyle changes that can be made to help manage migraine,” Bennett said. “Drink plenty of water, avoid foods that trigger your migraine, get plenty of sleep, exercise. All these little changes can help get your headache under control.”
Knowledge is a powerful tool for migraine management, which is why it’s important to stay up to date on news and the latest research. The American Migraine Foundation maintains a comprehensive resource library full of fact sheets, toolkits and advice sourced directly from the nation’s leading migraine specialists, and distributes a monthly newsletter with the latest migraine news you need to know. Visit AMF’s website to learn more and to find a headache doctor near you.
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Migraine in Transgender People
Understanding the unique needs of transgender people with migraine to provide better treatment
Over 36 million Americans live with migraine, and different populations have different treatment needs and experiences. For transgender people living with migraine, less is known about migraine’s effects and potential obstacles to finding effective treatment. Headache specialists like Barbara Nye, MD, Co-Director of the Headache Center at Dartmouth, are working to improve the field’s understanding of migraine in transgender people and provide more comprehensive treatment options that reflect the unique needs of this community.
Migraine Treatment for Transgender Patients
Migraine treatment for transgender patients closely mirrors treatment best practices for cisgender patients. In all cases, doctors will work to identify individual symptoms, triggers and lifestyle habits to find the best solution for every unique patient. It’s important for transgender migraine patients to know that they don’t have to choose between persistent, debilitating head pain and hormone therapy. Many preventative treatments won’t interfere with hormone therapy. But because certain migraine treatments may be contraindicated for patients taking hormone medications, it’s important to be honest with your headache specialist about any medications you may be taking. Doctors can factor in hormone levels when working with patients to find treatment plans.
Gender, Hormones and Migraine
Much of the conversation about migraine and gender stems from the influence of hormones. Migraine incidence in children is similar in boys and girls, but after puberty, women are three times more likely to have migraine than men. Fluctuating hormones are thought to be the reason for this difference. Dr. Nye says patients undergoing hormone therapy often maintain more consistent estrogen levels than women not undergoing hormone therapy, which can reduce migraine symptoms and attacks. The more information you can provide your doctor, the better he or she can devise a custom treatment plan that meets your needs and helps improve your migraine.
Tips for Seeking Treatment
The first step to finding the treatment and care you deserve is to use our Find a Doctor tool to locate a headache specialist near you. A headache specialist is a critical part of your migraine support team, and finding a compassionate, LGBTQ-friendly provider you feel comfortable with is a huge step forward. It’s up to the patient to take initiative in connecting different providers and granting permission for them to share information, Nye said, which is important so that your medical team is on the same page and can synchronize your treatments.
Once you’ve found a headache specialist, communication is the key to finding the right treatment plan. Your doctor will ask open-ended questions and listen to your circumstances, needs and concerns. To get the best treatment, be honest with your providers, and disclose facts about your transition when necessary. Nye notes that for transgender patients, sensitivity surrounding their transition can impede an open discussion about possible side effects of hormone therapy. Hormones may affect the way transgender patients experience migraine, so it’s important to work with your doctor to understand potential medical risks and find alternatives if needed. No one will make you stop hormone treatments: what they can do is prescribe a migraine treatment plan that accommodates your existing medication regimen.
Migraine is different for every patient, and finding the right doctor is essential to getting a proper diagnosis and a treatment plan that works for you. Search our online doctor database to find a headache specialist near you, and read more about living with migraine in our resource library.