Do I need to go see my doctor about this migraine?

December 19, 2011 7:31 AM

Had my first migraine, now what? Do I need to see my doctor?

This past Saturday I was out running some errands when all of a sudden I had a blind spot in my right eye, and I couldn't see anything in focus. I sort of had a feeling that I might be getting a visual aura since I know what those are and have read up about them / saw videos about them. After a few minutes I was getting small C-shaped zig-zaggy colorful lines with a huge blind spot within that "C" area. It looked exactly like all of the "artists" renditions of auras that you find online. It continued to grow and spread over a huge chunk of my vision.

That lasted about 30 minutes, during which I somehow managed to drive home - although in retrospect I have no idea how I did that. After the visual aura ended my migraine started. The pain was so intense that basically everything is foggy in my memory. I went to sleep and woke up 4 hours later. I was still in pain but it was manageable. I felt weak and stayed in bed the entire weekend.

I'm at work today but I still have a headache (which is manageable at the moment).

Do I need to go see a doctor? I've never had a migraine before. Is it really necessary? What will they do for me? They'll most likely end up referring me to a neurologist, and then what?

If this is a one time thing, do I really need to see a doctor?

posted by carmel to health & fitness (21 answers total)

It's always a good idea to see the doctor so that they can make sure the headache and vision stuff isn't caused by something more serious. They can also give you pain medication and/or things that may keep the migraine from flaring into full-on all-out pain (works on some people, ymmv) if you can catch them early enough. So I'd personally say call the nurse line for your health insurance (assuming you have one) to run this by them and think about making a doctor's appointment but I wouldn't run off to the ER.
posted by jessamyn at 7:36 AM on December 19, 2011

It may be a one time thing, which would be very fortunate. However, on the off chance that it ever happens again, your best bet really is a neurologist.

A neurologist can help you rule out anything more serious, and can also work with you to see if your migraines have a traceable source (hormones? reaction to a specific food? tied to barometric pressure?) or respond to medication. I spent a decade suffering from migraines that would ruin my life for 48 hours every time they appeared, but then my new neurologist tried me on a drug that has managed to stop each headache at the aura stage. Everyone responds to medication differently, but having a doctor who's dedicated to working with you to manage your migraines is worth the hassle of finding a good one.
posted by ausdemfenster at 7:40 AM on December 19, 2011

Could be stress. Could be a brain tumor. See a doctor.
posted by univac at 7:50 AM on December 19, 2011 [1 favorite]

Obviously your best bet is to see a doctor. I've had a couple of optical migraines with exactly what you describe happening. Try to get rid of stress in your life. I have a friend who started getting them and her issue was stress as well. My last one was a few months ago. After it passed and I got back home (just like you, I should not have been driving), I tried to forget all my problems, do some favorite activities and take some deep breaths.
posted by cashman at 7:52 AM on December 19, 2011

I did the conventionally-advised thing and saw a doctor when I had symptoms similar to what you describe. After listening to my story and giving me a brief once-over, she said I probably had migraines and that I could get an MRI to rule out a brain tumor. I declined, as I had no health insurance and the MRI would run at least $1,000. That's IT. That's all she wrote. This doctor, which was a normal doctor as far as I can tell (even recommended by some of her patients) did none of this other stuff like offering me pain meds or trying to help me trace causes. So, here is a vote for "only see a doctor if you know an incredibly great one who actually gives a shit" or "if you are rich and can afford rich people doctors who actually do jack shit for their patients".

What I found on my own was that excess caffeine was a trigger for me. So, I will go against the grain and say, doctor nay, journaling to discover triggers yay. There are some common triggers, like sunlight, caffeine, and stress, but everyone is different and the best way to discover your personal triggers is to keep a detailed journal every day so you can see a pattern to when you get the migraines, and then avoid your personal triggers.
posted by parrot_person at 8:00 AM on December 19, 2011 [1 favorite]

Oh and, no referral to a neurologist here, either. Not the slightest suggestion of such.
posted by parrot_person at 8:01 AM on December 19, 2011

If you do want to start a migraine journal, My Migraine Journal is okay.

I would talk to your doctor abut it - just so you can start building a profile in case it happens again. Also, taking hormonal birth control is correlated to increased stroke risk if you have certain kinds of migraines, so your doctor might have important advice for you there.
posted by Squeak Attack at 8:20 AM on December 19, 2011

Unfortunately, migraines are actually really common, and sometimes a giant pain in the ass to fully diagnose. Yes, technically you could have a brain tumor, but you could just have a migraine -- with no underlying cause. I'm guessing you're female? (most, but not all, migrane suffers are.)

If it doesn't happen again, mention it to your GP next time you're there. If if happens again, make an appointment. And consider the ER you get other more serious symptoms with it, or if it can be described as the worst pain of your life, for example. The ER can administer drugs that will relieve it immediately, or tell if it's a stroke, among other things.

Your GP may or may not refer you to a neuro. If it's a reoccurring thing, you will probably end up there, as they're the ones who are specialized enough to help you work you what your triggers are, or any other underlying causes. Some GPs also do this, however. This can be a long, drawn out process (I'm talking months/years here), but then end result is an end to the suffering, so it's worth it.

And I pimp this book so often on ask.mefi the author owes me a cut of the profits, but it changed my life and gave me a much better understanding of what was going on -- Heal Your Headache, by David Buchholz. You can ignore the "program" if you want -- it's a little too hard core even for me.
posted by cgg at 8:21 AM on December 19, 2011 [2 favorites]

If you do have insurance, it wouldn't hurt to call your PCP. Seems worth the cost of a co-pay. I imagine they wouldn't rush you in over a single migraine, but IANAD. Definitely mention that you still have a headache.

If you don't have insurance, I'd wait for a second migraine to worry about it. I had a migraine quite similar to the one you describe (right down to the zigzag lines!) in high school and never had another that bad again - and that's with a father who routinely gets bad migraines and a sister with seizures (that is to say a family history). Over the years I've had one or two headaches with nausea and that's it. So...yeah, there's my anecdote.

Oh, and don't be afraid to take some medicine if you haven't. Aleve or Tylenol is probably a better choice that Motrin/ibuprofin for this.

(On preview, cgg's advice seems quite good.)
posted by maryr at 8:24 AM on December 19, 2011

I'd see a doctor because a scintillating scotoma can also be a symptom of eye disease.
posted by squeak at 8:48 AM on December 19, 2011

For some reason, people like to call any serious headache a "migraine."

But migraine refers to a specific medical diagnosis. There are headaches more painful than migraines that are not migraines, as well as 'mild' migraines that aren't that horribly painful but are accompanied by other symptoms.

If you haven't seen a doctor, you don't know whether or not what you had was a migraine (particularly since you say this was your first, and migraines are by definition chronic).

Go see a doctor.
posted by coolguymichael at 9:13 AM on December 19, 2011 [2 favorites]

Ugh, I'm sorry to hear you've joined this club. You've joined the ranks of half the women I know, and a good chunk of the men.

I have had the visual migraine phenomena, without the pain. (Here's hoping it stays that way!) My neurologist sent me for an MRI to rule out any remote possibility of brain rot or eye problems, but she didn't think there would be any evidence of either. And there wasn't. And that'll probably be the case for you, too. My mother and my paternal grandmother both get painful migraine and aura, and they are both under very good control right now.

Haven't figured out what my triggers are yet, but the tentative theory is that my visual static parties were brought on by my extensive, well-established, miserable sinus problems.

Your symptoms are pretty classic for migraine, but only a doctor can help you decide what to do next. I know it sucks to hear that, but a good doctor can take the uncertain edge off and give you a sense of control over this crap. And if you need to see a neurologist, so be it! It's not that bad, even for hypochondriacs like me. Try to get referred to a good, kind neurologist, and good luck.
posted by Coatlicue at 9:45 AM on December 19, 2011

Even if I knew there was no underlying issue, I'd see the MD just to get a prescription for something that you can take if you have another one.

In my experience, regular pain medication, short of morphine, won't touch a migraine. I've heard a lot of mixed results from people I know who have migraines regarding which drugs are or are not effective for them. I feel fortunate because what works for me, Midrin, is dirt cheap and I only take it when I feel a migraine coming on (the aura you describe) rather than on a daily basis. Even taking the drug I still experience some of the aura and my brain feels a little bruised after it passes but I don't get the pain. Makes a huge difference.
posted by Carbolic at 11:02 AM on December 19, 2011

Holy shit! Looks like I can forget about Midrin once my current stash runs out.
posted by Carbolic at 11:06 AM on December 19, 2011

IANYD, IIAD.

Well...when it comes to migraines, gotta say "it depends." Your story is pretty classic for migraine - the visual aura, followed by the godawful headache, which was somewhat relieved by sleep. Many people get dizzy or nauseated or have trouble with light and sound with migraines, but that's not an absolute necessity. So, sorry about that!

You don't mention anything that sounds particularly concerning (although I gotta wonder, why did you happen to have looked up migraine auras before?) but typical questions would be vision blurriness/changes that have been worsening or persist after the migraine gets better, weakness/pain/numbness/tingling/etc anywhere, family history, etc. It's going to be hard to tell after just a single such headache, but some people identify clear triggers - red wine, chocolate, smoked/deli meats, MSG, lack of sleep, skipped meals, etc. If this becomes an ongoing issue, a diary helps!

Of course, there are headaches and there are headaches. Have you had your eyes checked recently? If we were to really go out on a limb and consider the possibility of a rare/bad reason for new headaches, as opposed to the common migraine, swelling of the optic disks are an occasional clue to that sort of thing. Assuming you look good and don't have anything concerning on physical exam, you may not even need any sort of head imaging.

Now, as to whether you need medication for migraines, well, that's also hard to say after just one! A lot of people do in fact respond to over-the-counter stuff like Excedrin Migraine (that's tylenol, aspirin, and a little caffeine) or even ibuprofen - as long as it's taken as soon as you realize you're about to have a migraine. Some people need stronger abortive medications like Zomig and so on, and people with really frequent migraines often need daily medications to cut down on the frequency of their migraines. Taking too many pain relievers (more than 2-3 times a week) can cause a rebound-type headache, so it's a balancing act if you turn out to have bad migraines.

So, if you go to a neurologist now after your first migraine, basically what they can do for you right now is a good physical and neurological examination to decide whether they think you have signs of anything more concerning than a migraine, like a weak arm or abnormal eye movements or anything, and you'd probably have noticed that yourself, but maybe not. Some are more scan-happy than others, depending on their training. But I wouldn't jump to assume that over-the-counter medications can't help you - you'll only figure that out if it happens again and you try them. Migraines are also commonly managed by internal medicine and family docs, with referrals to a neurologist if things are unusual or difficult to control.
posted by vetala at 12:02 PM on December 19, 2011

What did you eat today and the day before? Did any of it involve cheddar cheese or american ? or kodak mac n cheese?
posted by majortom1981 at 12:24 PM on December 19, 2011

A new additive called annatto extract is now being used in foods . Its technically natural but not always listed in the ingredients. Its used to make yellow american and yellow cheddar yellow. IT causes the exact migraines you posted with the exact symptoms.

I get real migraines (every major and minor symptom in the book) but i also get annatto extract migraines. Annatto extract migraines suck because you cannot get rid of the pain. It will stay their as long as the annatto is in your system. I can get the eye sight to come back using Fioricet (has to be prescribed) but the pain does not go away with anything.

Its called annatto extract insensitivity. My annatto extract headaches come on exactly to the minute 4 hours after i eat something .Some people dont get them till 3 days later. I just started getting them from annatto this past january.
posted by majortom1981 at 12:33 PM on December 19, 2011

You will likely only get a referral to a neurologist if the migraines are persistent. A neurologist would run tests, which can sometimes be expensive even with insurance. You'll have to make up your own mind about whether or not it might be worth it.

If you get more of these, as other people have noted, pay attention to triggering events. A blood sugar crash can set one off for me, as can lack of sleep or dehydration.

The key to stopping one is to medicate as quickly as you suspect you're getting a migraine. Over the counter, I've found two excedrin to be most helpful. For prescription drugs sumatriptan succinate works best for me (although I've found that not all generics are created equal here).

I've had migraines with vomiting since I was four, so I feel for you. Good luck, and I hope this isn't a sign of something more serious for you.
posted by thelastcamel at 2:00 PM on December 19, 2011

A neurologist is not required for initial treatment of migraines. Like many medical problems, a general practitioner or family medicine physician can take care of it as long as there are no complicating factors. Neurologists are great if you can get to one but they often have long waits for appointments.

As others noted, prescription meds are also not always necessary, but sometimes they really help if the over the counter medications have failed.

Oftentimes with a new onset of migraines your physician will offer or do an MRI. If you go to the ER, you will get a CT instead (radiation) and possibly a spinal tap/lumbar puncture, especially if you say the magic words "worst headache of my life." (looking for subarachnoid hemorrhage from an intracranial aneurysm, or brain tumor).
posted by treehorn+bunny at 6:44 PM on December 19, 2011

Honestly, for a one time migraine, I wouldn't bother. But I say this as a chronic migraneur of 15 years who has become very bitter about doctor's general inability to help migraine patients. Since you had an aura, it would be easy to catch any future migraines with triptans (assuming you'd always get the aura - I don't) that could potentially prevent the progression into all out pain. If you were to see a doctor, I would specifically bring that up.

Otherwise, I'd think about what you did that day, whether you ate anything unusual or were particularly tired or stressed, and just keep anything of note in the back of your mind in case it ever happens again.

Someone above said that migraines are by definition chronic, and that's not really true. I have family members who have had a handful of migraines in their life. That's not something I would consider chronic. Then there are people like me who have migraines most of the time. The definition of "chronic migraine" is having migraines occur more than 15 days a month for more than 3 months.
posted by corn_bread at 8:51 AM on December 20, 2011

The general rule is that if it's the worst headache of your life, it's an automatic visit to the doctor plus probably a CT scan. Despite what treehorn said, I didn't get a spinal tap or lumbar puncture.

Please go, there is no reason you need to suffer another one. The triptans work great for me - I take Relpax as soon as I see the blind spot - and a Vicodin and either Compazine or Dramamine for nausea, and this keeps the pain manageable and it only lasts a couple of hours.

If you start getting them a lot, the doctor can try you on something like amitriptyline to prevent them.

Lots of things can bring them on, like food sensitivities, but I notice I get them a lot more when I'm really tired because I haven't slept much, or if I'm being pressured into doing something I really, really don't want to do.
posted by IndigoRain at 11:46 PM on December 20, 2011