So, to recap what was said in Migraine Basics, Part 1 and 2:
- Migraines happen in normal brains
- Migraines are the result of a malfunction in pain processing, or specifically pain processing in reverse
- Migraines are weird
- A classic, fully expressed migraine consists of four phases: prodrome, aura, pain, and postdrome
To sum up, a fully realized migraine attack is a complex process with many moving parts, each involving different brain circuitry, neurochemistry, and so forth. And when all these parts are firing on all cylinders, we end up with a full blown, classic migraine attack.
But that’s not always what happens.
In many, perhaps even most, instances of migraine not all of these parts are activated, and only bits and pieces of the migraine process are experienced. And many times, the resulting symptoms aren’t recognized as migraine. Some examples:
- A migraine that consists primarily of pain in the face and congestion in the sinuses (a well documented migraine phenomenon) often gets labeled as a “sinus headache” (even though sinus headache isn’t a recognized diagnosis). Studies show that about 9 out of 10 of sinus headaches are actually misdiagnosed migraines (1, 2).
- A migraine that results in lower-grade, diffuse, aching pain in the cranium (many migraines begin this way, and many migraineurs experience these type of headaches in between major attacks) will get labeled as “tension headaches.” According to this dubious line of reasoning, chronic “tension” in the muscles of the scalp is purported to lead to head pain, a notion that has never been supported by scientific evidence.
- Recurrent migraine auras involving temporary alterations in vision, sensation, or speech without a subsequent headaches many times are labeled as a TIA or “mini stroke” (another non-existent diagnostic term!), often leading to thousands of dollars of superfluous diagnostic testing.
- Recurrent, isolated prodromal symptoms of fatigue may lead to an erroneous diagnosis of and treatments for depression, diagnostic testing for exotic infections and so on.
You get the picture.
This is why so many patients I see for the first time will tell me they have a “migraine” every so often, but they also have lots of other headache types (which they may attribute to “sinuses”, “tension”, “hunger”, etc.) much more frequently, in addition to various types of non-specific symptoms. Yet, as you now know, these other headaches are almost always just pieces of the migraine process getting switched on, and are therefore triggered by the same exact factors that caused their full-on migraine attacks.
When the entire 4 staged migraine mechanism unfolds, the diagnosis should be straightforward.
When only parts of the migraine mechanism are set in motion, however, people (including healthcare professionals) are often led astray. This can result in a substantial loss of time and money costs, as well as potential harm from unnecessary testing and treatments. Moreover, it also takes our eye off the real problem. And without knowing the real problem, there’s no way we can devise a proper solution.