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THE SEARCHLIGHT MESSENGER

Is My Headache a Migraine?

I have to tell you, one of the occupational hazards of being a physician, is the formal dinner table. This is the traditional “non-doctor place” where doctors are hit-up by guests for medical advice. I'm not sure how conversations drift to "headaches". I mean, a lot of people get them. So when you're a doctor, people are going to ask.

So, one question will lead to another because somebody had a stressful day, and they're glad to be winding the day down with a pleasant dinner, and wondering, "Why am I getting a headache now?"

I am often asked by family, and friends, “What is a migraine headache, and are my headaches migraines?” This is sometimes difficult to answer when brought up as dinner conversation. So you ask why? Because we're talking about pain. Yeah, food and pain are just not good partners. I've been to a lot of dinners.

Understand, many things can cause headaches. From brain tumors to eye fatigue, many conditions can present with severe to mild headaches. Besides, this subject gets so deep, unless you’re ready for a long conversation, you don’t dare get started. But that's not going to happen. Many questions come up. So, this is the discussion which usually ensues, and it always gets interesting.
 
Barring serious conditions such as brain tumors, severe head and neck pathology, trauma, eye and vision disorders, serious metabolic conditions and infectious diseases, this article is meant to discuss non-pathogenic and non traumatic induced headaches, moreover, the difference between muscle tension headaches and migraines.

Yeah the ones we all get. It can't be helped. It's where we are at the paces we run. We process more information in a day, most of which is negative, than my Grandparents did in their entire lifetime. And you wonder why we get headaches.
 
Generally, the "regular joe" thinks of a migraine as a very severe headache. So, when they get a “bad” headache, they usually refer to it as a “migraine”, but this is not the case at all. There are many types of benign headaches which are severe enough to ruin one’s day or even their week. The classification of headaches, and more importantly, migraines, has been written and rewritten by doctors for centuries.

Although doctors have been practicing neurology since there were doctors, It wasn’t until the twentieth century that the specialty of neurology was well etched in stone, which gave way to modern clinical research protocols, and methods to evaluate headaches scientifically. Interestingly, even during the  twentieth century, the classification of different types of migraines has changed substantially.
 
We live in a fast paced society. We run around dehydrated, drinking coffee, stare at LCD screens whether tiny or large. Drive to work or school, drive back, go do things, watch the news, most of it bad, and don't forget this is the stuff that didn't happen at work. Yeah, we worked today too.

Most of us manifest our stress physically, so we either get upset stomachs, aching necks, or we get headaches, and for some, all three. In America, particularly, two types of headaches are generally seen in this regard, muscle tension types, and vascular migraine types. Here’s “the quick and dirty” on both. and keep in mind that there is no purity in these classifications, and that most headaches are mixed.
 
Muscle tension headaches tend to come on as the day progresses, while the stressors one is dealing with are ongoing and building. So by the end of the day, your headache progressively worsens, your neck and scalp muscles increase their tone and now you have a full blown “head-knocker” at the end of the day.

Migraines on the other hand are vascular in nature, are brought on by chemical changes reacting to stress loads and dietary triggers. You generally awaken with the headache as they come on after the stress is gone. You guessed it, the following day, after the stressful event or events are over, you’re in pain.

It is the classic euphoric phase of “the general alarm reaction to stress”. So you wake up with a “banger” which is hugely painful and stays with you all day. This is also why a migraineur (pronounced, “mi-gren-yurr”) tends to have his headache on Saturday mornings, or say, the day after that big speech he had been preparing for weeks.
 
Muscle tension headaches, also known as “tension” headaches or “contraction” headaches, are direct results of increased tone and muscular irritation in the back, shoulders, neck, and scalp. As a result, they usually respond to anti-inflammatory drugs like ibuprofen or aspirin; massage; muscle relaxants; or just lying down for a while.

Migraines are more brittle. Since they involve vascular changes in the coverings and meningeal septa of the brain, anti-inflammatory drugs and muscle relaxation are usually ineffective treatments, moreover, they can even make a headache worse. Increased blood vessel caliber is the problem and needs to be turned off and re-set. This is why caffeine, decongestants, and other vasoconstricting agents help.
 
A test I have many patients, as well as friends and family try, is the “Beer Test”. It’s not one hundred percent, but fairly reliable, and if you want to know if that headache you have had all day is a migraine or tension headache, when you get home, drink a beer, preferably "a dark".

If the headache goes away, it’s a tension headache, if it gets worse, it’s a migraine. The practice of medicine, as cutting edge as it is, we seasoned craftsmen, can still shoot from the hip.
 
So, tension headaches are a direct result of stress insult, like someone turning up the volume on your neck muscles throughout the day.  This type of headache is obviously exacerbated by posture, compensatory changes after an injury, arthritis, chronic musculoskeletal conditions, and of course,  stress load. 
 
Migraineurs suffer as they do because the headache waits, then sneaks up on them when they’re resting. The other important thing to remember is that in all these headache types, physical examination, metabolic workups, and imaging, are always negative for “lesion” or organic pathology. What I’m saying is that, “migraine”, is a diagnosis of exclusion. Other organic conditions must be ruled out first.
 
“Migraine” is a very old term derived from the Greek, meaning “semi-cranium” or “half skull”. Yes, generally a migraine headache is usually, but not always, unilateral, affecting one side of the head. The problem is they come in so many different manifestations that it has been difficult to classify them, even in modern medicine.

Several versions have been published since the early 1920s, however, after World War II, neurologists in America started to find some consistencies which allowed at least for neurologists, an ability to observe, diagnose, and treat with a standard of care. It also allowed doctors to communicate the type of headache a patient was experiencing.
 
This so-called classification remained in place for nearly sixty years, but in 1995, The National Headache Foundation along with The American Academy of Neurology, published straight forward guidelines that have allowed all physicians to more easily navigate the presentation of headache patients, diagnosis them accurately, and treat them appropriately and effectively.

Stratified Visual Scotoma of MigraineThe older “traditional classification” which is still used by many older doctors, uses excellent descriptors and relies on 5 major presentations, and thus, the patient is labeled as such.

They are: Classical Migraine; Common Migraine; Complex Migraine; Mixed Headache; and Migraine Equivalent (also known as Retinal Migraine). I don’t need to remind you that there are many variations on each one of these.
 
Classical Migraines are the brittle ones you hear about, and the type that causes a great many to present to the emergency department of their local hospital.

Here’s a typical presentation. Usually a woman, as 75% of migraineurs are women; she awoke with a one sided throbbing headache that wouldn’t respond to any medication. It started with a visual aura of sparkles in the upper left visual field (what we call a stratified visual scotoma). She can’t stand to have any light in the room, noises make the pain worse, and she’s nauseous and vomiting, in addition, just moving around makes it much worse.

It should be noted that auras can present in many fashions, including ringing in the ears, a tingling sensation anywhere, a deja vu, or a lot of yawning during the day. Yeah! I know!

The patient generally requires narcotic pain management, and neurovascular control with a triptan drug (see below) and an-anti emetic like phenergan.

It is this sufferer, the U.S. Department of Labor has stated, “costs our nation nearly 33 billion dollars in lost man hours a year"! That’s not including the tab to her health insurance company. Oh, and don't forget, if she’s on Medicaid insurance, your tax dollars.
 
Common Migraines, are much less intense and disabling, they still throb, are usually one sided, the patient can have nausea, but generally no vomiting. The lights and sounds are still bothersome but not as overwhelming. Most apparent in their history, is no aura or scotoma. These are self limited, usually responding to aspirin, Tylenol and caffeine in combination, and of course, rest.
 
Complex Migraines can be terrifying. Also referred to as Hemiplegic Migraines, they will generally have features of either a classical or common type, but in addition, present with neurologic deficit. Many are mistaken for Cerebral Vascular Accidents (stroke), or Transient Ischemic Attack, and require hospital observation and treatment. Ancillary studies are usually negative, and the event resolves spontaneously. Obviously, this patient requires an exhaustive evaluation before being given this diagnosis.
 
Mixed Type are just that. They are also the most common headache generally seen. They are more migraine than muscle tension, however, they are usually a common migraine with muscle tension overlay or muscle tension headache with migraine overlay. Again, aspirin, Tylenol, and caffeine are helpful; also mild muscle relaxants are effective. Usually if one component is treated, the other falls away. Interestingly, these respond very nicely to Botox injection which can keep the patient headache free for months.
 
Stratified Visual Scotoma. This is a Left Superior Quadrantanopsia.Migraine Equivalent types are very interesting. Generally seen in college aged “type A” personalities, their hallmark is the scintillating visual scotoma, but there is no pain. That’s right! There is no headache. These patients are obviously afraid they have something serious when they first see their doctors, but after a negative work up and reassurance they do fine.

Also interesting is the phenomenon of "dissipation" with this migraine. The scotoma starts generally as a “dot”, slowly enlarges, becomes a "crescent" with a large visual field cut known as a bilateral superior, left or right, lateral homonymous quadrantanopsia, (say that 3 times, real fast),  sweeps laterally, then vanishes.
These types of migraine usually resolve as a condition by the time the individual reaches their thirties.
 
The newer guidelines have made diagnosis more accurate and streamlined for therapy using two sets: “Migraine with Aura”, and “Migraine without Aura”. Both have their specific subsets, criteria, and recommended therapies for each. Understand that The National Headache Foundation also endorses guidelines for other types of headaches that are not classified as “migraine”.
 
What we really know about migraines now, started in the 1980s, subsequently producing new knowledge and new therapies. When sumatriptan hit the medicine cabinet as migraine weaponry in 1991, much changed in the approach to headaches, including migraine classing. Since its introduction, our understanding of the migraine condition and the migraineur’s display of symptoms has been revolutionary, and produced a paradigm shift in treatment. We now know that the “migraine” is actually a cascade of events.
 
We always knew that there was an underlying driver and that migraines were vascular, hence, the pre-triptan therapies, which were designed to do two things; lyse an acute headache with narcotics and get the patient to sleep so as to break the vascular pain cycle and throbbing. The other, was to approach chronically, preventing the migraine from evolving.

We assumed that migraine headaches were vascular from the beginning, as our known therapies, mostly vaso-constricting agents, were very efficacious, right out of the bucket.

Subsequent research revealed that these headaches occurred in 2 phases. First the blood vessels of the brain would constrict during stress or dietary trigger. Then, rather than come back to their original caliber, the vessels would overshoot, engorge, ultimately causing the painful phase.
 
So, our therapies in the 1980s and 1990s were designed to keep the constricting phase from manifesting, and therefore there would be no overshoot and no pain.

This is why to this day, we continue to see migraineurs treated with blood pressure lowering medications like verapamil and propranolol, which prevent tightening of vessels. In addition to these agents, antidepressants with chronic neurovascular threshold activity like amitriptyline are added which help control chronic pain. For many patients these drugs work. That’s why they are still used in many migraineurs who suffer severe and ongoing disabling attacks.
 
Sumatriptan led to more compounds in the “triptan class”, and a host of “me too drugs” which are the mainstay for acute therapy today. This is because the research which produced these drugs revealed that deep inside the brain of a migraineur is a “migraine motor”. It is tied to an area in the midbrain called the Trigeminal Nucleus Caudalis.

When stimulated by neurotransmitters from stress loads, lack of sleep, too much sleep, medications, or food triggers, it sends pain signals along the Trigeminal Nerve (The Fifth Cranial Nerve), and the vascular bed which surrounds it.
 
The two Trigeminal Nerves (left and right) are sensory nerves innervating the scalp, forehead, face and periosteal bone of the skull. When the migraine motor is stimulated, blood vessels along these nerves are irritated, inflamed, and dilate, causing severe painful migraines.

This should not be confused with its very famous cousin, Trigeminal Neuralgia which is also extremely painful and responds to similar medical treatments.

Sumatriptan is structurally similar to serotonin (5HT), and is a 5-HT_agonist. The specific receptor subtypes it activates are present on the cranial arteries and veins. Acting as an agonist at these receptors, sumatriptan reduces the vascular inflammation and dilatation associated with migraine, countering this cascade at its source.

Even in a disabling attack, sumatriptan injection can lyse the pain of migraine within minutes, without the side effects and sedation of narcotics and anti-emetics.
 
Now we know more about migraines and tension headaches. We know what causes them, how they are different, and how we can treat them. But you’ve probably been asking yourself, what are these food triggers and how do they stimulate the “migraine motor”? Migraine triggers are all over the web. A good place to start for a thorough list is at The National Headache Foundation .
 
The real mechanism of migraine motor stimulation is not fully understood, but may involve the neurotransmitter levels of dopamine, serotonin, and nor-epinephrine, in addition, the hormones 2-hydroxy-estradiol, progesterone, and thyroxin, as well as IgG  antibodies from different food antigens. However, the triggers are well known and they themselves give us a clue.
 
Certainly there are known direct vasodilator foods such as Monosodium Glutamate (MSG), caffeine, kava based, and ephedra based herbs, and chocolate. Of course MSG is in all of our salted snacks and most of our “prepared” foods in the freezer section.

Not surprisingly, many of my migraine patients when asked to keep a food diary, find they consumed large amounts of MSG the night before an attack, usually a potato chip, Doritos, or Frito binge. Citrus such as orange juice; wine, particularly the reds; hard aged cheeses; meats cured in nitrates; pickles; peanuts; and mint, to name only a few, are well known culprits. Don't forget about the beer, partcularly, "the darks".
 
The non-food triggers are classic: too much or not enough sleep; the computer screen you’re looking at right now; stressful life styles, including the classic "workaholic"; drugs of all kinds, including aspirin and acetaminophen; and lastly, medicinal hormones such as progesterone, yeah, your birth control pills. This is one of the reasons why women are more prone to migraine.

Yes, a huge connection with progesterones and vascular engorgement in the turbinates of the nose as well as migraine is well documented. This is also why many women suffer during their menstrual cycles, and even pregnancy.
 
Because headaches are so prevalent, they can become a huge topic in any casual conversation with any doctor. Perhaps one needs to write a book on the subject to produce a concise literary treatment which the chronic headache sufferer can utilize. But there have been so many. All written by doctors and non-doctors alike. All that folk medicine and traditional medicine out there, it can become easily confusing.

Especially with all those quacks out there with their, "infomercials" and "snake oil" they try to sell you. What does the headache sufferer do? Hopefully this article will help you choose the right book.

In the mean time, watch those foods, try some way to lower your stress, (excuse me, "get off your ass, and find a sport you like to do, and do it"), don’t forget to drink plenty of water. Throw away all of your MSG. Oh, and throw out anything with high fructose corn syrup in it. Do it right now.

If you are a true migraineur, or a chronic headache sufferer, you should see your doctor right away, and don’t forget to check out The National Headache Foundation
 
 




Dr. Counce






 

55 Comments to Is My Headache a Migraine?:

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Prafull More on Monday, December 05, 2011 11:14 PM
Really a painful disorder!I myself have experienced this disorder.But the article here is so informative that the guys who are suffering from it will definately get idea what exactly this disorder is and how they can get rid off this kind of painful disorder.So thanks for sharing this information. migraine diet list
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Dr. Counce on Tuesday, December 06, 2011 12:42 AM
You are welcome, Sir. Always a pleasure to be of service.
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Phenocal on Sunday, April 15, 2012 11:38 PM
I am doing yoga, workouts, exercise still not loosing my weight.Tell amyone what can I do now???
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Dr. Counce on Monday, April 16, 2012 9:12 AM
Sometimes we need to augment our diets to burn fat. There are foods which help with this. A good place to start is the recently published diet book, "The Digest Diet", by Liz Vicarriello. I have read this book cover to cover and find it medically sound in its advise and techniques. It is very easy to follow and inexpensive.


Melissa C. on Monday, December 10, 2012 9:42 PM
Thank you for introducing me to this website and the information. I have level 10 migraines, that get worse each time, so my research isn't just for a class project. Thanks again, very informative and easy to read.
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Dr. Counce on Tuesday, December 11, 2012 11:48 AM
Glad I was able to help, Melissa. Stop me in the halls next time you see me. I am always available to help students. I can explain more about how this website can help you, and at no cost. I am also available to my campus students when they need medical advice. Happy Holidays


CPR Training Sydney on Thursday, February 14, 2013 4:08 AM
I am really surprised by some of the points about the headache and migraine. You have cleared my several doubts regarding this topic.
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Dr. Counce on Monday, February 18, 2013 9:40 PM
My pleasure. More articles coming.


what is laser eye surgery on Thursday, April 04, 2013 5:02 AM
We must clear difference between migraine and headache so that we can prevent its upcoming negative results. The article was just amazing.
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chiropractic emr software on Tuesday, June 11, 2013 1:00 AM
Migraine is a complex neurological disorder. It generally includes headaches, but not always.Thanks a lot and keep sharing such useful information.
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Replica Watches on Tuesday, July 09, 2013 1:06 AM
I do think that one could employ several pics drive an automobile what it's all about house a little bit, but other than that, this really is great weblog. An excellent examine. Let me easily be back.
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IPL Newmarket on Monday, July 15, 2013 3:12 AM
The information you shared through your post is really useful for migraine patients. I admire your work. Wish you all the luck for all your blogging efforts.
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Dr. Counce on Friday, July 19, 2013 5:05 PM
Thank you.


Diploma of Beauty on Tuesday, August 20, 2013 12:47 AM
Wow! I am really impressed by the way you detailed out everything regarding the headache and the migraine. Both are absolutely different. It is really going to help me a lot. Thanks for sharing your thoughts so clearly.
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Dr. Counce on Sunday, September 01, 2013 9:45 PM
Thank you very much. I am so glad you found it immediately useful.


kylievault on Wednesday, August 28, 2013 5:41 AM
Its like you read my mind! You seem to know a lot about this, like you wrote the book in it or something. I think that you could do with some pics to drive the message home a bit, but other than that, this is wonderful blog. A fantastic read. I'll certainly be back.
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Pharmacy Dropshipping on Wednesday, October 02, 2013 2:34 AM
Thank you so much for writing such a nice article. Please share more and more information...
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Dr. Counce on Friday, October 04, 2013 3:49 PM
You are very welcome. Thank you for your readership.


permanent hair removal melbourne on Wednesday, October 16, 2013 4:15 AM
Migraine is painful headache that is often preceded by sensory warning signs such as flashes of light, blind spots, and increased sensitivity to light and sound.
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Dr. Counce on Monday, October 28, 2013 2:58 PM
Yes, I agree. Thank you for your comment.


Body Contouring Sydney on Tuesday, December 17, 2013 3:11 AM
One of my friend have this migraine problem and I can say it's really painful. Some time I also suffer from a high headache and have confusion that is this the same problem but on reading your post I have more clear points for it.
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Dr. Counce on Saturday, December 21, 2013 12:01 PM
I'm glad this article was helpful. Thank you for your readership.


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Hi there,Hi! This is my first visit to your blog! We are a team of volunteers and new initiatives in the same niche. Blog gave us useful information to work. You have done an amazing job!
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Dr. Counce on Wednesday, February 05, 2014 9:29 AM
Thank you. We are pleased you found the article useful.


Jenny Holmes on Monday, February 10, 2014 1:39 PM
I myself have headache problems I believe that most of my headaches are stress related reading your article opens my eyes to what my headaches could be coming from that they aren't migraines just simple bad headaches thank you Dr.Counce your always very knowledgeable !!
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Jessica Beelow on Monday, February 10, 2014 1:44 PM
My best friend has been getting migraines for years. It has gotten so bad that she has to be in a dark enclosed room, with no noise, and she finds herself in a fetal position. She has tried several techniques and medicines but nothing has helped. I'm going to pass this article onto her because I know she will find it informative and helpful. Thank you.
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jessica bellew on Monday, February 10, 2014 4:47 PM
I actually tried the beer test Friday not even knowing that. I had a Heineken and I actually got extremely sick to my stomach with my head pounding even more.
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Tracey Skrzypek on Monday, February 10, 2014 4:54 PM
My younger sister has been suffering for over a year now with a nightly headache, which she is always stating is a "migraine" even though she has not seen a physician. This article was quite interesting on the differences of tension headaches and migraines. I will definitely pass on the information and encourage her to avoid those food and stress triggers that might be contributing to her headaches. Thanks you for the helpful information.
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Nicole on Monday, February 10, 2014 6:11 PM
Very informative information on the difference of headaches. I now understand that the headaches I have started having are definitely tension, stress headaches . Especially since starting school. I will definitely pass this information on. And I will also try the beer test.!!!! Thanks Dr. COUNCE you are so full of knowledge.
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Kayla Lever on Tuesday, February 11, 2014 7:03 PM
I loved this article! I never actually knew the difference between a headache and a migraine until mow! I will definitely pass this on to friends and family! Thank you, Dr. Counce!
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Morgan Frazier on Tuesday, February 11, 2014 8:45 PM
I am very lucky to not suffer from headaches. My Mother has suffered from debilitating headaches from ever since I can remember. She would loose her eye sight and balance and then have to be closed off in the dark room for hours on a heavy sedative to try and find some relief. She just recently suffered a TIA and is no longer allowed to continue with those types of medications. Hopefully she can find some relief with this article you have shared. Thank you for your time and effort in my education and future.
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Leah Ricoangeles on Tuesday, February 11, 2014 8:45 PM
I had a bad car accident back in January 2010 and ever since I frequently get bad migraines. Before the accident I would get the occasional "tension headache" and would take some Ibuprofen or Excedrin and would get rid of it, but now I get both and when I get a migraine it is so bad I can hardly function. I loved the article though it was very informative and I will definitely be passing it on to family and friends. Thank you Dr. Counce!
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Nikki Spencer-Ashley on Tuesday, February 11, 2014 9:11 PM
A good read, I suffered a lot from migraines when I was younger. And in reading this article I realize that I may still be suffering from them. I don't like going to the doctor unless it is serious so I found things that help me when I get the symptoms of a migraine that I have been ignoring to see my doctor about. But glad I kno....knowlege is power!!!!!
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Mary on Wednesday, February 12, 2014 12:01 AM
This article has a lot of useful information. Although I don't often get headaches or migraines, (besides, once in a while, random throbbing for about 2-3 minutes on only one side of my head), I do know quite a few people that do suffer from them. I'll feel good being able to give them some advice now and being able to refer them back to this article. It's interesting how some foods and drinks can cause those headaches. I knew alcohol, and caffeine play a huge part in it sometimes, but I would have never thought something like orange juice would, so that was awesome information. Thank you Dr. Counce, great article!
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Nichole on Wednesday, February 12, 2014 12:29 AM
Ive suffered migraines for years, I believe from a terrible car accident, all your information is incredible! Alot of which I knew but so much more to add to the pot. I for sure will try the beer thing but not much for darks! I currently take relpax it helps with the light and the nausea but not much for the pain, it also stops the aura, but i'm pretty much down for about 2 days! A great read, gonna check out more of your website, Thanx Doc!
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Lynnette on Wednesday, February 12, 2014 8:20 AM
I've suffered migraines from the changes of the climates. I was born in a tropical island where the climate is always sunny or rainy. But as we started to move around to new places, i began to feel different. My sinuses would act up and I would be extremely sensitive to light when i wake up. But wow this article was indeed a good read and it had a lot of good information on some ways to help the migraines go away. Thanks Dr. Counce!
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Cynthia tassey on Wednesday, February 12, 2014 8:44 AM
I felt that this was very helpful. I have migraines and next time I will have to try some of these tips.
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Dr. Counce on Friday, April 18, 2014 1:54 PM
Thank you, Ladies.
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Lawrence Aragon on Wednesday, May 07, 2014 6:08 PM
I suffer from both tension and migraine headaches. Chiropractor helps with tension and sumatriptan works most of the time for migraine headaches.
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Dr. Counce on Friday, July 18, 2014 8:03 PM
We hope you found the article helpful.


Jasmin on Thursday, May 08, 2014 12:03 AM
Read the article, Dr. Counce, interesting specialy with the food. I wonder if the different blood types also have anything to do with the way we feel, I know an article/book that gives you certain info about your blood type and what certain blood types should eat and should avoid to eating, because it has an impact in our life's ! Well Doc, I will see ya in the morning!
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Dr. Counce on Wednesday, May 21, 2014 8:52 AM
Thank you for your comments, Jas. I would love to read the book. See you in class.
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Eric Moore on Thursday, June 12, 2014 11:36 PM
Dr. Counce, interesting article. Just knowing the easy way to find out if its a migraine or not helps a lot. Even I suffer from headaches and I say they are migraines. The tension in the neck, the light making the headache worse, nausea. Now I can try these easy steps before I head off to the Dr.. But just one question, when you drink the brown beer, is there an amount you have to drink? A waiting period for it to work? Plus if I have a nap thinking when I wake up it will be gone, but its still there, could that be a sign of a migraine? I know stress triggers a lot of physical and mental things in a persons body. In todays society it seems we all say we get migraines. If the simple steps you have stated above leads to a person has migraines, should they seek Dr.'s care for it?
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Dr. Counce on Friday, July 18, 2014 8:09 PM
12 ounces is generally the amount to consume, and the effect is usually rapid, less than 30 minutes. Sleep triggers are very common. No sleep can induce them, and to much sleep can induce them. Thank you for your comments, Eric.


Nicole Hoffert on Tuesday, June 17, 2014 3:12 AM
Dr. Counce interesting article.. Found it very helpful. :)
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Dr. Counce on Friday, July 18, 2014 8:10 PM
Thank you, Nicole.


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Tina on Thursday, April 30, 2015 9:36 PM
Very interesting article. I will pass the information on to my husband who suffers from migraines off and on. He can usually stave them off when he gets the aura, by drinking water and taking meds right away. I myself am partial to the "beer test"
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Julie Chase on Friday, May 01, 2015 8:43 AM
Thank you for your comments, Tina.


Alizah Baker-Morse on Monday, June 08, 2015 9:35 PM
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Joey on Wednesday, June 07, 2017 1:40 PM
Great article! Thank you!
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Ash on Thursday, June 08, 2017 8:15 AM
Awesome article Dr. Counce!! the pictures of the visual auras are spot on!! Those things are hard to describe to people :)
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Anthony on Friday, June 09, 2017 3:49 PM
Insightful. Thank you.
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Sile on Sunday, June 11, 2017 9:57 PM
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