Do migraines tend to change over time?

[tsg]

I started getting frequent severe headaches about 7 years ago. At that time a neurologist diagnosed migraines based on my description (unilateral pain, sensitivity to light and noise etc) and a family history of migraines. I got these headaches fairly often (8-10 times per month) for 3 or four years, and the headaches typically responded well to immitrex.

A few years ago the headaches slowed considerably and nearly stopped altogether, and I stopped seeing the neurologist and stopped filling the immitrex prescription. Over the last year I began getting headaches again with increasing frequency (up to at least 2 times a week most weeks), but now they are always focused at the bottom back part of head where it meets my neck. These are not usually as debilitating as the migraines, but they can be, and I find it nearly impossible to focus and concentrate with these headaches. I have also recently begin to experience episodes of extreme dizziness (lasting a minute or less at a time) and blurred vision - even after having my glasses a lenses prescription very recently updated. Are these headaches probably the same migraines despite feeling totally different? Tension headaches?

[John Kenyon, CNA]

Hi there -

While this could for sure be a variation on the original migraine theme -- this does happen occasionally -- there is also the possibility that it represents a change in the central cause. While migraines do usually begin in the area you describe, they generally expand unilaterally forward rather quickly.

The concern with this sort of headache that you're having now is that one can't be certain whether this is simply a variation on that theme or if there is something that's not been evident before, now showing itself more specific to the affected area. You'll need to bring this to the attention of your doctor or neurologist, who may be able to tell you right off the bat whether this is just a new variation or if you'll require a more thorough workup to be certain there isn't an abnormality of the blood vessels at the base of the back of the skull, which sometimes turns up later on in migraine sufferers. It's not necessarily anything to worry about, just something you owe it to yourself to know, since if this were the case (unlikely but possible), then the symptoms could continue to change and become more troublesome. Best you rule this out early on.

I hope this is helpful. Please let us know how things progress.