Migraine

It's seems like every weekend I get a mirgaine on Friday night, then Saturday night and usually Sunday night too.

I take 50mg Imitrex to abort and then feel better and usually feel like the migraine is gone, until it comes back the next evening. Usually about 24 hours in between.

Just wondering how to tell if this is the same migraine that the Imitrex only sends into "remission", or 3 different migraines? How does one tell the difference?

Claudine,
I don't usually answer questions with another question, but if you could tell that it was 3 separate migraines how would it make a difference in the way you handle them? I often get migraines back to back and I had the same question you do. Then I realized that it didn't really matter if it was 1 recurring migraine or 3 different one. I treated them the same way. Now, my dr may want to know if it was one or the other, but it makes no difference to me.

Claudine,

I honestly don't know the answer to your question, although I think it is a great question for an Ask The Clinician submission.

However, I recalled reading this article Teri wrote about weekend migraines:

Weekends, Sleep and Migraines

I hope this helps!

Okay. There actually is a general rule of thumb for deciding whether a migraine is either a reflare of an existing one or whether it's a separate, new migraine. I like to call it the four hour rule.

The idea is that you must have a continuous four hours or more with complete relief of migraine symptoms. Complete is the key word. If you have residual symptoms, then you wouldn't count it as being gone.

So...if you do have the complete four-hour break, then you can generally assume the following migraine is a separate one. If you don't have the four hours of complete relief, then you can generally assume that it's a reflare of the migraine you had.

Of course, you have to keep in mind that this is a generalization, and that some migraine episodes are going to be close to call, especially around that four-hour mark. Instinct plays a role, too to some extent.

Hope that helps some.

thanks for the info! they must be sep migraines then. Except the one today is still pain from last night. only felt better for about an hour. ugh.

The reason I was curious was I am still trying to figure out the triggers, so trying to see if new triggers start a new one each day on the weekends or if it's just a 3 day migraine. But overall as far as treatment it doesn't change anything.

I sleep the same on weekends as I do during the week because I work from home so weekends are the same to me as the week because I work every single day! Just visit family more on the weekends so maybe they are my trigger. HA! LOL! Will check out that article though!

Hi Claudine,

Are you by chance keeping a Migraine diary to track your triggers? That is a very helpful way to see what is going on. You can find that HERE

Another important thing about the "just a 3 day migraine" is that it really may not be. It could be a condition called Status Migrainous. This type of Migraine needs medical attention because it can increase our risk of stroke.

Thanks for the question and the info on this- I always wondered about this since I seem to get a number of back-to-back migraines after my period. Thanks again!

Valerie

I also usually have migraines that would be 3 day migraines if I didn't abort them with Zomig NS or treat them otherwise. I can abort and the headache completely disappears and I feel fine, usually for around 24 hours, but slowly comes back. I can abort again, and am fine for another 24 hours. The third 24 hours always becomes the issue, since I don't want to use the Zomig more than twice a week, but depending on how bad it comes back, I am actually allowed to use 3/week when necessary.

If I don't treat, or I get another migraine within 7 days, I can be in trouble, since it WILL probably last 48-72 hours, so I have to have an alternate plan for that.

tracie -- yes that's exactly what happens to me. I abort, then feel better then about 24 hours or sometimes less it comes back. or maybe it's a new one. then sometimes I get a third. Today I had it all day. finally getting better but now at my imitrex limit for the week! eek!

Nancy -- yup keeping the old diary! I can't find anything about weekends except I run more errands which def give me migraines!

You run errands? Could it be something in the stores where you run the errands, such as fluorescent lights?

Yeah i find it tricky to figure out if some of migraines are continuous or separate.

For example:

Last Wednesday was a really good day at work (but bittersweet because the class I'm teaching is ending & I'm not ready for it to end). After work, I started to feel worse again. (From Sunday evening to Tuesday, I had a migraine & bad cramps due to my period, kept taking Tylonal which wasn't doing a thing & finally took Alleve & started getting chest pain & bad heartburn the following day).

Wednesday night, I woke up soaked in sweat, out of breath & ripped of my nasal mask (just started auto CPAP therapy). Felt ill & fell back asleep w/o mask. Kept waking up throughout the night because I kept punching myself in the face (w/visual hallucinations), wake up started & then fell back asleep & this kept repeating. Weird.

Anyway, woke up with a raging migraine, incredibly groggy & out of it, major tinnitus & paresthesia. Didn't take meds because I had to go to work. Came home extremely cranky & very overtired. Tried to nap several times, but I was so out of it, I couldn't sleep but could stay alert. Eventually fell asleep (with my CPAP). Had several nightmares, woke up ill, again took off mask. Very broken sleep, slept for a long time. Woke up Friday with pain even worse. Friday night I took 1 midrin (generic substitute that is new to me), didn't work, then took 2 more. By Sat, pain a bit better, but still bad. Didn't take more Midrin, because I was concerned about rebound. By Sunday morning, pain still around a 5-6. By early evening, the pain went down to maybe a 2- not too bad- I can deal with that, but just about an hour ago, my tinnitus started again.

Since I haven't been totally symptom-free since Wednesday, I guess it's the same migraine? But at least I haven't had severe pain for over 72 hours, so I'm still safe from the danger zone.

I think it's good to know if it's the same Mig vs diff migraines to know if you're a risk for migrainous stroke.

Alexandra

wow! I hope you are OK! And I thought my weekend was bad!

So you're only at risk for migraine related stroke if it' been SEVERE pain for 72+ hours right? Not migraine then goes away for 10 hours then comes back etc?

the stroke thing freaks me out!!

Hey there,

The 72 hour rule seems so cut and dry when typing it and reading about it, but when it comes to enforcing it, for some reason it becomes a different story.

So, as Teri has drilled into my head- the pain has to be totally GONE for four hours or more - then that Migraine is over. Let's say this Migraine, we'll call it Migraine A, completely goes away, I mean pain-free, feeling good, doing work, cleaing the house (whatever!) and then in six hours you get another, we'll call this new one Migraine B.

Ok, now we have Migraine B which we treat with our triptan, rescue medications but can't get rid of it. It continues almost 68 hours, without any pain-free time. suddenly, at 70 hours, or so, the pain subsides to a tolerable level, 1 or 2. This is where a lot of us get into trouble. The pain is not completely gone, but tolerable.

Now 5 hours later we have a Migraine. Is it still Migraine B? I believe it is, and now we may be into Status. This is when we need to break it and seek medical attention to do so.

Does this help a bit? Let us know, because this world of Migraines and headache disorders can be very confusing.

Claudine,

thanks for asking. I think the pain has finally disappated by late morning (Monday) today. I just have tinnitus & some paresthesia, so I'm better.

Last night, I vaguely remember my S/O shouting, "What's going on? How are you feeling?" but I don't know what happened. I think I put my mask back on. When I woke up midmorning my mask was off, but I don't remember taking it off. I'll have to ask him what happened.

So I guess according to what Nancy was saying, I guess I had one migraine from Wednesday evening to Monday morning. So I guess on Sunday morning, I hit the 72 hr mark for the pain. I had to go to work yesterday (the most important day of the year). I've been trying to avoid ER because I've had such bad experiences & gotten no help.
I don't necessarily recommend dealing with things like I did, but last year when I had the worst migraine pain ever for over 3 weeks, no one took me seriously...and things have just gotten plain weird since & none of my doctors can figure what's going on with me.

I've also had worries about stroke (even when people say even when you are "high risk" it's still not that bad of a risk, when you've actually experienced paralysis and weakness, it seems pretty real), but honestly,I would try to not work yourself up in a worry.

Do you have a migraine specialist or someone who is closely monitoring you? My main issue is that I have so many specialists I don't know who to call when I have weird stuff happen because I don't know if it's a seizure, migraine or apnea episode or something else.

Severity isn't the issue for deciding status migrainous. Continuity is. It's all about time without a break, regardless of the severity. You can be in status with mild to moderate pain. The length of time is the thing to watch, because allowing the blood vessels to remain dilated is where trouble lies.

That said, while it's imperative to be aware of status, and to be watchful for it, so that you can be treated as early as possible if you do enter status migrainous territory, the risk of migranous stroke is fairly rare. As long as you remain aware and watchful, and make sure you're taken care of, you don't need to "freak" at the thought. You can be assured that you're informed and ready to adequately deal with status situations.

quote:

Originally posted by claudine:
Alexandra

wow! I hope you are OK! And I thought my weekend was bad!

So you're only at risk for migraine related stroke if it' been SEVERE pain for 72+ hours right? Not migraine then goes away for 10 hours then comes back etc?

the stroke thing freaks me out!!