Q. Many of my migraines will last days, even with medication. After the pain has subsided, I will have soreness all the way down the side of my face, neck and back. Does that mean I’m really having tension-type headaches? What can I do to stop the soreness? —Lori N.
A. It sounds like you are probably experiencing what is called “allodynia.” Cutaneous allodynia is hypersensitivity to touch or temperature, a common condition that may feel like skin, scalp or muscle soreness. Given the muscle factor, I understand why you would think it’s due to tension-type headache; but this soreness is more often the result, not the cause, of a headache attack. This sensitivity is seen in some patients with a chronic tension-type headache but is more frequently a component of migraine. Following a severe migraine, many patients will often report discomfort from pressure applied to the head and neck, and some even complain of their hair or teeth hurting.
I look at migraine as a three-stage process: Stage 1 of migraine responds nicely and completely to medication; Stage 2 is more severe, with medication providing significant relief of the headache without clearing it completely; and Stage 3 is when nothing you do will turn off the migraine and it just needs to run its course and burn out. Once the migraine has hit Stage 3, as you mentioned, it will go on for days and you may be left with soreness. The longer the headache lasts and the more intense it is, the more soreness you will experience. Instead of your muscles being sore from running, a brain workout generally manifests as hypersensitivity of the nerves and soreness of skin and muscles connected to those nerves. This most often happens in the face and neck, but can sometimes extend down into the limbs.
You want to be aggressive with treatment if you’re a person who can get an attack lasting several days. It’s imperative that you catch your migraine within one or two hours with fast-acting, strong migraine medication. If you can, go with migraine-specific medication like injectable triptans. In such situations, a combination of a migraine medication and a nonsteroidal anti-inflammatory drug (NSAID) can often be helpful in aborting the migraine.
Robert G. Kaniecki, MD, University of Pittsburgh, Penn.
