Health Complications of Migraines and Their Treatment

Migraine attacks are often debilitating, but they generally resolve without serious consequences to your health. While it is uncommon, a migraine can be the sign of a true medical emergency. In some rare instances, a migraine-induced complication can result in long-term medical issues. And treating a migraine in and of itself can cause side effects that you need to be aware of.

Recognizing your migraine patterns is important, and even if you have recurrent migraines, you should seek medical attention if you notice a change in your migraines.

A migrainous infarction is a type of stroke that is actually caused by a migraine. This is a rare migraine complication, and it can be easily confused with a migraine aura, which makes the experience even more distressing and confusing.

An aura is usually about a 20 to 30-minute long migraine phase characterized by neurological symptoms, such as seeing spots or squiggly lines. A migrainous infarction occurs in an area of the brain that corresponds to the symptoms of an aura, which is why the experience can seem quite similar.

Stroke-Induced Headache

Keep in mind that in some instances, the pain and other symptoms of a migraine can be so disturbing that you think you are having a stroke, even though you aren't. A headache can be one of the signs, or even the only sign, of a stroke, but this is rare. In these situations, the stroke is not a migraine complication, but instead, the head pain is one of the effects of the stroke. It's worth remembering, too, that strokes usually produce more noticeable symptoms than head pain.

A persistent aura without infarction (PMA) occurs when aura symptoms persist for one week or more without any evidence of stroke. If you have a persistent aura, your medical team will want to make sure that you aren't having a stroke.

Your doctor can identify whether you are having a stroke based on your physical examination and diagnostic imaging tests such as brain computerized tomography (CT) or magnetic resonance imaging (MRI). If it turns out that you are having a persistent aura, you may need medical intervention similar to that used for status migrainous.

A migraine-associated seizure is one that occurs during or within one hour of a migraine. It is characterized by involuntary movements, changes in consciousness, and/or alterations in the electrical activity of the brain as detected by electroencephalogram (EEG).

Migraine-associated seizures are sometimes misdiagnosed because a migraine aura can mimic a seizure and vice versa. Your medical team will work with you to figure out which condition you have because the medical management for each is different.

Sometimes, migraines can last for a prolonged period of time, and may not respond to treatment. This is described as status migrainous and, ironically, it can occur after taking excessive pain or migraine medication, which can result in a medication withdrawal effect. At times, however, status migrainous can occur without a clear cause.

The symptoms of status migrainous are similar to those of your typical migraine episodes. However, in status migrainous, they are more severe and debilitating, last for longer than 72 hours, and are resistant to treatment. That being said, you can experience periods of relative relief (up to 8 hours) during sleep or due to short-term medication effects.

Usually, this prolonged type of migraine episode requires medical intervention, which can include intravenous (IV) steroids or regional anesthesia.

The most common complications of migraines, however, stem from the medications used to treat them rather than the condition itself. Medication overuse can cause serious problems, but sometimes even using migraine treatment at the recommended doses can harm your health, particularly if you have risk factors for complications or medication sensitivity.

Common migraine medication-induced side effects include the following.

Gastrointestinal (GI) Issues

Nonsteroidal anti-inflammatories (NSAIDS), which are commonly used for migraine treatment, can irritate or damage your stomach lining, particularly if you use them frequently. Abdominal discomfort, nausea, GI bleeding, dark stools, and ulcers are all signs of NSAID-induced GI effects.

Blood Pressure Changes

Blood pressure-lowering medications such as calcium channel blockers and beta blockers are sometimes used for migraine prevention. They can, however, lower your blood pressure too much, causing dizziness. The effects may even cause you to pass out if your blood pressure becomes excessively low.

Serotonin Syndrome

Antidepressants, which modify serotonin activity, can be used for headache prevention because they modulate pain. Triptans—prescription medications used to treat severe migraine attacks—also alter serotonin activity. Serotonin syndrome, a rare complication of these types of medications, is characterized by nausea, vomiting, tremors, and life-threatening muscle stiffness.

Medication Overuse Headaches

When you take medications for your migraine attacks, you can experience a withdrawal effect, also called a rebound effect, particularly if you use high doses or take your migraine medication for more than a few days in a row. This withdrawal can trigger a headache or a migraine and can predispose you to status migrainous.

Be assured that the vast majority of migraines resolve without complications. And most complications are related to medications rather than to a migraine itself. It is not completely clear why migraines can cause complications, but there is a slightly increased risk of strokes and seizures among people who have migraines.

That being said, it's important to seek medical attention right away if you experience an aura or a headache that is different or that lasts longer than your usual episodes.