reader mail You ask . We answer .
Tired of searching the Internet for answers ? It ’ s time to learn from those in the know . In every issue of Head Wise , our experts respond to reader-submitted questions about migraine and headache disorders .
SENSE AND SENSITIVITY
Many of my migraines will last days , even with medication . After the pain has subsided , I will have soreness all the way down the side of my face , neck and back . Does that mean I ’ m really having tension-type headaches ? What can I do to stop the soreness ? — Lori N .
It sounds like you are probably experiencing what is called “ allodynia .” Cutaneous allodynia is hypersensitivity to touch or temperature , a common condition that may feel like skin , scalp or muscle soreness . Given the muscle factor , I understand why you would think it ’ s due to tension-type headache ; but this soreness is more often the result , not the cause , of a headache attack . This sensitivity is seen in some patients with a chronic tension-type headache but is more frequently a component of migraine . Following a severe migraine , many patients will often report discomfort from pressure applied to the head and neck , and some even complain of their hair or teeth hurting .
I look at migraine as a three-stage process : Stage 1 of migraine responds nicely and completely to medication ; Stage 2 is more severe , with medication providing significant relief of the headache without clearing it completely ; and Stage 3 is when nothing you do will turn off the migraine and it just needs to run its course and burn out . Once the migraine has hit Stage 3 , as you mentioned , it will go on for days and you may be left with soreness . The longer the headache lasts and the more intense it is , the more soreness you will experience . Instead of your muscles being sore from running , a brain workout generally manifests as hypersensitivity of the nerves and soreness of skin and muscles connected to those nerves . This most often happens in the face and neck , but can sometimes extend down into the limbs .
You want to be aggressive with treatment if you ’ re a person who can get an attack lasting several days . It ’ s imperative that you catch your migraine within one or two hours with fast-acting , strong migraine medication . If you can , go with migraine-specific medication like injectable triptans . In such situations , a combination of a migraine medication and a nonsteroidal anti-inflammatory drug ( NSAID ) can often be helpful in aborting the migraine .
— Robert G . Kaniecki , MD , University of Pittsburgh , Pittsburgh
SEEING RED
My boyfriend has been having migraines for the past three years and finally went to the emergency room ( ER ). The ER physicians did a computed tomography ( CT ) scan and found a cyst on his brain . After many visits to all kinds of physicians , they told him it wasn ’ t the cyst that was causing the migraines — but it ’ s funny that he never had migraines until that cyst popped up . His headaches
The National Headache Foundation has a list of headache specialists who may be of help . See www . headaches . org or call 888-NHF-5552 .
6 HEAD WISE | Volume 2 , Issue 4 • 2012