AskMe: We Asked an Expert All of Your Questions About Migraine

Migraine can feel excruciating and may be extremely difficult to understand — even if you live with it.  Fortunately, we spoke with Dr. Thomas Berk, MD, who sits on the American Migraine Foundation‘s Editorial Board, and he answered questions from our Mighty community members about living with migraine. Here are the answers to all of your burning migraine questions.

Responses have been lightly edited for clarity.

Q: Which factors influence migraine location? Why do some attacks favor a particular side?

Berk: There aren’t great reasons why migraine specifically manifests in specific places.  That said, migraine is less side- or location-specific than many other headaches.  For instance, cluster headache always presents on the same side, whereas migraine migrates around the head.  Even people who experience migraine on one side of the head more than the other or in one location [on the head] almost always also experience pain in other locations around the head.

Q: What is the correlation between migraine and vertigo? Are there dedicated specialists for vestibular migraine? 

Berk: Vertigo can be a symptom of migraine aura and precede [a] migraine attack, and it can also be a symptom associated with a migraine attack — like light or sound sensitivity.  There are many areas of the brain which, if stimulated, can lead to symptoms of vertigo — a sensation of movement when an individual is not actually moving.  If these brain areas are affected by abnormal electrical activity of the brain prior to the migraine pain happening, the sensation is a migraine aura.  If vertigo happens at the same time as a migraine attack, it will manifest as a migraine-associated symptom.

Q: Why does opiate withdrawal often trigger a migraine?

Berk: Opiates affect specific neurotransmitter receptors of the brain. When these neurotransmitters are switched on and off abnormally, the brain of someone with migraine responds by producing a host of inflammatory neurotransmitters that propagate migraine.

Q: What is the relationship between migraine and bowel movements?

Berk: The GI system can be affected before, [during] or after a migraine … During migraine, many people experience nausea and vomiting.  Before and after a migraine, during periods of time we call the migraine “prodrome” and “postdrome,” the neurotransmitters that propagate migraine can lead to other GI symptoms, [such as] diarrhea or constipation.  Severe chronic migraine can [also] lead to a slowing of the normal movements of the GI tract, [which is] called gastroparesis.

Q: If known, what is the relationship between long-haul COVID-19 and migraine? 

Berk: Many viral illnesses actually worsen migraine and are associated with headache — as well as muscle pains and aches.  COVID-19 is also associated with acute worsening of headache in many people, and in people who have a predisposition for migraine, that headache will most likely be a “migraine-like” headache.  Long-haul COVID-19 symptoms frequently include headache — and for people with migraine, that headache replicates a migraine as well.

Thank you to the American Migraine Foundation for allowing us to speak with Dr. Berk! 

If you’re living with migraine and want to connect with others with similar experiences, join a Mighty community:

• Mighty With Migraine
• Spoonie Life Hacks