Migraine, childbirth, and a kidney stone are the most painful medical conditions and there are certain conditions that make for THE WORST MIGRAINE.

This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.

Read my eBook on Migraine. Click Here

The worst migraine is the one you didn’t expect, the one that got away from you and became “one of those,” the one that came at the exact worse time in your life when you didn’t need to have a migraine, the one that came after you ran out of your medicine, the one that woke you up at 4 AM that you should have treated, but didn’t treat, or the one that came just on the first day of that holiday to Italy you had been planning so long, but now you’re in misery in your hotel throwing up with your “let down headache.”

 Further discussion

 It seems Migraines can come out of the blue, unless you really study it.

 Depend upon a migraine coming for no known reason. It’s just the way migraine is.

 How about a list of when migraines usually come? I’m talking about migraine triggers:

Read my article on “Migraine Triggers,” on my website, www.doctormigraine.com.

 Stress or freedom from stress-always the most common migraine trigger. Forty percent of migraine patients have either generalized anxiety or panic disorder. They are comorbid, which means that medically migraine and anxiety and panic conditions are related and come together.

Premenstrually 1 or 2 days-For women menstrual headaches, defined as a migraine like headache occurring the day of menstruation onset or 2 days before or after, is their most intense and longest lasting migraine. 25% of women have migraine, which is their most common medical problem.

Menstruation with fluctuating estrogen levels

Elevated estrogen level from birth control pill or treatment of postmenopausal women-Migraine headaches may be driven by estrogen if it is at a higher than normal level or is pulsed, like with the monthly menstrual cycle.

Read my article on “Menstrual Migraine” on my website at www.doctormigraine.com,

Intractable migraine starter, or just any type of alcohol that sets you off your hangover migraine.

Hypoglycemia from fasting-normal, non migraine persons may get a “hungry headache” which I tell patients may be treated by feeding it, but migraineurs are especially prone to migraine onset with fasting or missed meals. Persons with migraine need to eat three regular meals every day.

Barometric weather change-this has a big connection with causing the onset of migraine headaches. It is very common and most all migraine patients have this relationship. I personally do not think that the site in the brain that reacts to barometric pressure is known-some say it is in baroreceptors in the carotid arteries, but the headaches still come with pressure drop. I tell patients that weather reports on a cell phone report barometric pressure change and they can follow or plot this daily if they have a strong reaction of migraine onset and pressure drop.

Motion sickness-this is an associated migraine inherited condition. Something like 40% of patients with migraine have motion sickness. I used to joke with headache patients that God marked their foreheads with a big M, meaning migraine and motion sickness.

Mountain sickness/decompression illness

Insomnia-relates to anxiety conditions and depression which are treatable medical problems. See your doctor for this and get treatment.

Over-sleeping or napping-sleep and migraine just relate to each other and migraine patients may have a late morning attack following oversleeping or a long nap.

Nocturnal end of a dream headache-Nighttime migraines, especially late morning like 4 AM are classical and some patients will relate remembering a significant dream which ended with start of a migraine. Dreaming is associated with cerebral vasoconstriction which is reversed to vasodilation on awakening. Migraine relates to trigeminal activation and cerebral arterial vasodilation.

Fragrances-fragrance sensitivity is prominent with migraineurs. In my office my nurse put out a sign warning visitors to not wear prominent perfume which might likely aggravate some one else visiting the office. We tried to keep a fragrance free environment.

Flashing/flickering/fluorescent light-Many persons with migraine with aura may have the aura part of their migraine set off by flashing lights, from computer and tv screens. Glancing sunlight off a hood medallion of a car or flickering light of the sun as viewed while travelling in a car and looking at the sun through trees are both common triggers for migraine. Migraine patients should not look at bright, flashing light and wear good dark glasses.

Dietary factors-still a relatively under researched subject, but very popular on the internet (It’s got to be true I read it in the newspaper.) Specific dietary factors may trigger a migraine in some persons.

Heat/sun/workout headache

Intercourse/Orgasm-many persons with intense migraines starting at orgasm worry about “Thunderclap Headache” which requires an ER doctor visit and screening CT or MRI brain scan. If the tests are negative the patient has a benign type of orgasm headache.

Overuse of analgesics-Caffeine is the most common here, next over the counter analgesics like Excedrin, Tylenol, Advil, naproxen, all triptans, worst are hydrocodone and butalbital.

Read my article on “Medication Overuse Headache” on my website, www.doctormigraine.com.

Head injury/concussion/post-concussion-I’ve seen many persons with prolonged 6 months of daily headache with migraine features from taking hydrocodone or tramadol after a concussion. The doctor said to take it and even wrote a prescription, but he never said stop.

Fever-the red victim’s face represents facial vasodilation. Migraine causes cerebral arteries to vasodilate.

Caffeine withdrawal-caffeine taken too much can cause medication overuse headache and chronic migraine. The Mayo Clinic says that normal non-migraine persons may take as much as 400 mg of caffeine a day without problems, but migraineurs can’t do this. Caffeine should be limited to only 2 days a week like other pain killers or triptans used for migraine acute therapy.

Read my article on “Caffeine Withdrawal” on my website, www.doctormigraine.com.

Brain freeze/ice cream headache-this has been thought of as a feature of migraine but some think that it is just a universal feature of all persons.

Toothache/grinding with TMJ syndrome-this relates to anxiety and can be treated with dental consultation and a bite guard.

Prolonged overexertion-the Mayo Clinic states that the reason for exertion to relate to migraine attacks is somewhat uncertain but may relate to cerebral vasoconstriction which changes to vasodilation with cessation of exercise.

Read my big book on Migraine. Click Here

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Although this site provides information about various medical conditions, the reader is directed to his own treating physician for medical treatment.

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All the best.

Britt Talley Daniel MD 523