Chronic Migraines and Facial Spasms: A Patient's Journey

Headache and facial twitching?

I kindly ask the doctor to take a moment to look at my concerns so that I can reference them during my medical visits.
Thank you.
About four to five years ago, I was diagnosed with migraine status.
My headaches have never improved over the years; they occur daily with varying intensity.
When they are severe, I am unable to function normally and can only rest in bed (probably a pain level of 10).
In addition to headaches and dizziness, I have experienced numbness on the left side of my face extending to my left ear, but this symptom resolves after some time, occurring about five times.
Furthermore, my face experiences daily twitching or spasms, affecting my eye sockets, eyelids, forehead, cheeks, and lips.
The twitching near my eyes often prevents me from sleeping well.

The sensation of pressure in my head feels like cerebral congestion, as if every blood vessel in my head is about to burst.
My heartbeat feels like a pump inflating my blood vessels, causing my head to throb in sync with my heartbeat.
The most intense pain is located around my eye sockets, nose, and the triangular area around my nose, which feels sore and completely tense, as if I am constantly frowning.
I often fear that the pressure in my blood vessels might lead to a stroke.

Regardless of whether I wear a helmet, tie my hair (loosely), wear glasses, or use hair clips, these actions can trigger my headaches.
Strangely, if I change positions with my head or body, my heart starts to beat forcefully, and then my head begins to throb.
For example, lifting my head from a downward position, transitioning from standing to sitting, sitting up from lying down, or rolling over can all trigger this response.

I would like to ask the doctor if these unusual symptoms truly belong to the category of migraines.
Am I at risk of having a stroke? I am genuinely frightened.
Additionally, if these symptoms are indeed classified as migraines, I would like to know if allergies or exposure to smoke can exacerbate migraine conditions.
I live in an environment with smoke daily, and I have noticed that taking antihistamines alleviates my headache symptoms.
Thank you for your assistance, doctor.

Xiao Shu, 20~29 year old female. Ask Date: 2009/05/12

Dr. Lin Zijing reply Neurology

Your headaches are so frequent and severe that you should consult a physician for evaluation or consider preventive medication treatment.
Recent medical studies indicate that multiple episodes of migraines can indeed increase the risk of ischemic stroke, as migraines are associated with vascular spasms, and long-term use of migraine medications can lead to prolonged vasoconstriction and cerebral ischemic stroke.
Furthermore, chronic migraines can lead to tension-type headaches and depressive symptoms, which in turn exacerbate the frequency and severity of headaches.
To prevent stroke, it is important to maintain normal blood pressure and avoid smoking, as well as to consume plenty of fruits and vegetables, and strive to maintain a regular routine and engage in regular exercise.

Reply Date: 2009/05/12

More Info

Chronic migraines can be a debilitating condition, and your experience reflects the challenges many patients face when dealing with this disorder. It’s important to understand that migraines are not just severe headaches; they can involve a range of neurological symptoms, including facial spasms, sensory changes, and even anxiety about potential complications like stroke.

From your description, it seems you have been diagnosed with "status migrainosus," which is a prolonged migraine attack lasting more than 72 hours. This condition can lead to significant impairment in daily functioning, as you have experienced. The fact that you have daily headaches with varying intensity, along with episodes of facial numbness and spasms, suggests a complex interplay of migraine pathology and possibly other neurological issues.

The facial spasms you describe, affecting various parts of your face, could be related to a phenomenon known as "hemifacial spasm," which can occur in conjunction with migraines. This condition is characterized by involuntary contractions of the facial muscles, often triggered by irritation of the facial nerve. It’s crucial to discuss these symptoms with a neurologist, as they may require specific treatment options.

Your concern about the sensation of pressure in your head and the fear of a potential stroke is understandable. Migraines can indeed cause sensations that mimic other serious conditions, but it’s essential to differentiate between migraine-related symptoms and signs of more severe issues. The feeling of your blood vessels being under pressure is a common description among migraine sufferers, but it does not necessarily indicate an imminent risk of stroke. However, if you experience sudden changes in vision, speech difficulties, or weakness, you should seek immediate medical attention.

Regarding your question about environmental triggers, such as smoke and allergens, these can indeed exacerbate migraine symptoms. Many patients report that exposure to strong odors, including smoke, can trigger or worsen their migraines. Antihistamines may help alleviate some of the symptoms if allergies are contributing to your headaches, but they should be used under the guidance of a healthcare professional.

In terms of management, it’s crucial to have a comprehensive treatment plan. This may include:
1. Preventive Medications: These are taken daily to reduce the frequency and severity of migraines. Options include beta-blockers, anticonvulsants, and certain antidepressants.

2. Abortive Medications: These are used to treat a migraine once it starts. Triptans are commonly prescribed for this purpose.

3. Lifestyle Modifications: Identifying and avoiding triggers, maintaining a regular sleep schedule, staying hydrated, and managing stress can significantly help.

4. Neuromodulation Techniques: Some patients benefit from devices that stimulate nerves to reduce headache frequency.

5. Cognitive Behavioral Therapy (CBT): This can help manage the anxiety and fear associated with chronic pain conditions.

6. Regular Follow-ups: Keeping in touch with your healthcare provider to monitor your condition and adjust treatment as necessary is vital.

In conclusion, your symptoms are complex and warrant a thorough evaluation by a neurologist who specializes in headaches. They can help clarify the diagnosis and tailor a treatment plan that addresses both your migraines and the associated facial spasms. Remember, you are not alone in this journey, and there are effective treatments available to help manage your condition.

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