As the name suggests, these are migraines that happen in cycles. They’re sometimes called cluster migraines, but that’s not correct. They’re not the same as cluster headaches, which are short, intense, and happen daily.
They also differ from regular migraines in how long they last and how they’re treated.
They may happen every day or several times a week for 1 to 6 weeks, with low-grade head pain in between. On average, people who get them have about 10 attacks a month. They can last anywhere from a few hours up to 2 days during this “on” cycle. The average attack lasts about 6 hours.
It’s followed by an “off” cycle that can last for weeks or months.
You may feel them on one side or both sides of your head. If it starts on one side, it may move to the other side as the attack happens.
Before it starts, you may see auras or notice that your vision isn’t right -- kind of like a blind spot. Other signs (called premonitory signs) that one is coming on include:
- A hard time concentrating
- A stiff neck
Who’s at Risk
There is no single test that can diagnose this condition. Your doctor will start with a review of your medical history. They’ll also try to rule out other causes with:
- Blood tests: These can rule out blood vessel problems and infections.
- MRI: Magnetic resonance imaging (MRI) shows your brain and blood vessels. It helps doctors rule out tumors, bleeding in the brain, and other neurological issues.
- CT scan: A computerized tomography (CT) scan uses X-rays to show detailed images of different parts of your brain. Doctors will check for brain damage.
- Spinal tap: If your doctor thinks you have an infection or bleeding in the brain, they may recommend a spinal tap. This is also known as a lumbar puncture. Your doctor will use a needle to take a sample of your spinal fluid and have it tested in a lab.
Your doctor will go through your migraine history in detail. They’ll ask how often they happen, how much pain they cause, what symptoms come with them, and how much they affect your daily life.
The exact cause isn’t completely understood. But these two things may play a role:
- Changes in brain chemicals, including serotonin levels, which drop when you have a migraine
- Hormonal changes, such as a drop in estrogen in women before or during their periods, or when pregnant or going through menopause
Changes in how your brain interacts with a nerve in your head called the trigeminal nerve may be an important part of it. Imbalances in brain chemicals may also play a part. Serotonin levels drop during a migraine attack. This chemical helps to manage pain in your nervous system.
Treatment and Side Effects
The treatment for cyclic migraines differs from that for the regular kind. For those, your doctor may suggest a nonprescription non-steroidal anti-inflammatory drug (NSAID), such as acetaminophen, aspirin, or ibuprofen. They may also advise caffeine.
The most effective treatment for the cyclic type is lithium carbonate. This is a lithium salt that comes as a tablet. It calms the central nervous system to act as a mood stabilizer. You need a prescription to get it.
The most common side effects of lithium carbonate are:
- Loss of appetite
- Slight hand tremors
- A need to pee more often
- More thirst
Your doctor also may prescribe indomethacin. This is an NSAID used to relieve pain. Most people can take this drug without side effects. But some may have an upset stomach, heartburn, indigestion, or nausea. If you have kidney or heart disease, talk with your doctor before you take this kind of drug.
A migraine journal can help you manage your attacks. Write down when you have them and how long they last. Include any symptoms you had before it started. Keep track of the pain level and what makes it feel better. Also, make notes on what doesn’t work.
When you see your doctor, you’ll have the answers to their questions in your journal. You won’t have to rely on your memory. Detailed answers will help them identify and diagnose your condition.
Your journal may help you pinpoint your triggers -- the things that cause your migraines to start -- and avoid them. The most common ones include: