I've been a migraineur for almost 12 years now. What you've listed sounds like pretty standard common migraine (migraine without aura) symptoms.
Vestibular migraine isn't wholly accepted as a true migraine variant (yet? who knows). The reason for this is that many of the neurological symptoms associated with migraine are caused by the usual irritation and excitation of major nerves around the brain and face. We know migraines can be accompanied by sinus inflammation, tearing, and postnasal drip (all of which abruptly disappear once the migraine resolves). It makes perfect sense that the inner ear can be affected to because of the intimate relationship between the sinuses and inner ear. Tinnitus during migraine can be easily attributed to over-excitation of auditory nerves, especially if the migraine itself was triggered by excess extracellular glutamate (which is common). This is the same reason tinnitus is a common symptom of benzo withdrawal, or anything that has downregulated GABA. A migraine attack can also screw with someone's ability to speak clearly or coherently (I used to get this one all the time, speech slurring and skipping whole parts of sentences). It can also cause weakness in muscles (I'm not just talking about hemiplegic migraine here) and affect walking, standing, holding objects in the hand, stuff that requires a high degree of fine motor coordination like typing and writing by hand. Other neurological symptoms include stuff like sensitivity to motion, increased urination, excessive yawning "for no reason", difficulties with reading comprehension, other cognitive skills, other things. Migraine is definitely not just a really bad headache.
Most doctors, even neurologists, have not kept current with the scientific literature on migraine. They are woefully undereducated in the mechanism of migraine, causes, effective prophylaxis and proper abortives. We still see MDs giving migraineurs prescriptions for narcotic and opiate painkillers (these are the worst classes of drug a doc can prescribe for migraine because they not only do not interrupt a migraine but can make it worse and increase frequency of migraine on the rebound). All I have to say about that is that if his neurologist didn't give him one of the triptans to try then it's time for a new neurologist.
It is true that some of the SSRIs have been used off-label for migraine prophylaxis, and from what I can tell their efficacy is about the same as treating depression itself (meaning they don't seem to outperform placebo, results vary in the extremes including the meds triggering migraines and making them worse). The tricyclics seem to be popular for some apparent reason, amytriptyline particularly. For me personally, amitriptyline was a nightmare, I kept waking up with headaches that quickly became migraines. But I have spoken to other migraineurs who believe it helps them.
Some of the anticonvulsants have been tried on migraines, also with varying degrees of success. The type of migraine also makes a difference here. Classic migraine (migraine with aura) has a slightly different mechanism than common migraine (migraine without aura) and responds better to treatments that have less effect on common migraine. Gabapentin, depakote, topamax are the favorite anticonvulsants prescribed by doctors. I have tried all three and I could only tolerate the gabapentin's side effects (topamax triggered nasty migraines for me) at low doses.
Other shit commonly attempted in migraine prophylaxis: atypical antipsychotics, beta-blockers, hormones, botox
I will just put a personal note in here to say that I've been through all of the above except botox over the past decade, and the only prescriptions so far that have truly worked to reduce both the frequency and severity of attacks is bupropion and ambien. I only list ambien here because a migraineur's need for regular sleep pattern comes before anything else. This includes keeping the same hours on weekends, no staying up late to party, read, or whatever it is people like to do on weekends. Go to sleep at the same time every single day, no exceptions. Do not "sleep in" on the weekends either, keep the schedule the same, sleep the usual weekday hours. The migraine brain does not like change. Most people probably do not need to resort to sleep aids like ambien in order to achieve this, they can do it just by making lifestyle changes and sticking to those changes, but some do need it if they have a long history of abnormal sleep patterns. The bupropion is not as commonly prescribed for migraine prevention and from what I've read about it so far, its efficacy seems to vary just as much as all the other migraine prophylactics.
The bottom line is figuring out what your specific problems are. Migraine brains tend towards over-excitation and hyper-reactiveness to environmental triggers that wouldn't affect others. Neuronal excitability is altered in migraineurs. I'll list a small variety of issues commonly observed in migraine:
inadequate dopamine going around to modulate glutamate
hypersensitivity to dopaminergic stimulation (this is why opiates and opiods are usually shit treatments for migraines; they are dopamine agonists that also mess with glutamate) (possible applications for dopamine antagonists and reuptake inhibitors) (counterintuitive but the reuptake inhibitors don't force extra dopamine where it's not supposed to go, unlike agonists, so this could help so people keep dopamine leveled out if they don't tolerate the antagonists well)
inadequate GABA going around to control glutamate
inadequate mitochondrial energy production and/or transport (this is a big one because it impacts so many different things in brain that are known to be associated with migraine)
spikes in serotonin level (the belief that chronically low serotonin is the cause of migraines is generally wrong, we now know that lowered serotonin in often observed during a migraine attack because, for as yet unknown reasons during the cascade of effects once migraine is triggered, the body starts dumping serotonin and excreting it through urine--the opposite has been observed at the onset of migraine prodrome, a sudden increase in serotonin followed by serotonin loss) This is why they started throwing SSRIs, tricyclics at migraineurs, with limited success.
Genetic mutations found to be associated with migraine:
CKIdelta (two distinct mutations in here affecting synthesis of casein kinase 1)
PGCP and MTDH/AEG-1 on chromosome 8 (EAAT1 and/or EAAT2 abnormalities affecting glutamate uptake & interfering with the brain's ability to clear glutamate)
Prophylactic supplementation demonstrated to be effective across different migraine types (in order of importance according to my personal experience)
coQ10 (I do 100 mg once a day after a few months of 150-300mg /day as done in different migraine studies)
riboflavin (studied at 400mg/day in migraineurs but I've found effectiveness at 150-200 mg)
magnesium (inclusion of all major electrolytes including potassium and calcium must be kept in mind) (up to 600 mg/day in migraine studies)
butterbur (this can be risky if butterbur is purchased from poor manufacturers) (maybe keep this as a last resort kind of thing)
COMBINE! Nutrition-related supplements for migraine prophylaxis are not very effective taken alone, they need to work together to get any return on your money.
Very little clinical evidence for at this time, but honorable mentions:
all other active B vitamins (no analogs to interfere with uptake of active Bs)
methylcobalamin or hydroxocobalamin (up to 5 mg, sublingual, no cyanocobalamin)
pantethine (300 mg, can go up to 600 mg so don't worry about extra in B complex if it's there)
Albion multimineral
zinc (up to 35 mg with multimineral)
lysine (500 mg twice daily)
taurine (500 mg once or twice daily)
citrulline (500 mg once of twice daily)
creatine (500 mg once daily) (there is no good reason to go over 1 gram a day, ever and if used inappropriately can easily trigger migraines)
carnitine (tested with magnesium in migraine reduction) (not acetylcarnitine, these do not have identical mechanisms with carnitine in the brain)
theanine
GABA
vitamin D (no more than 2,000 IU)
vitamin C (no more than 500 mg)
vitamin A (as beta carotene no more than 10,000 IU)
vitamin E (natural d-alpha, 200 IU)
n-3 (low EPA, DHA no more than 450 mg -- scientific evidence supporting omega 3 supplements in migraine is weak and conflicting)
None of these are likely to abort a migraine in progress nor are intended to abort migraines (except perhaps lysine which actually is sometimes given intravenously by doctors for this purpose). Neither are most of these likely to be terribly effective by themselves (eg all the supplements that support mitochondrial energy and transport -- coQ10, riboflavin, creatine, citrulline, ribose, carnitine, pantethine, taurine, electrolytes -- work best when taken together in modest doses) . Those last ones are important because low cellular energy = decreased glutamate excitotoxicity threshold = beaucoup migraines ... low cell energy also interfering with histamine breakdown and various important neurotransmitter synthesis, other shit that matters to migraineurs
Keep in mind to try:
zyrtec 10 mg (not claritin)
other antihistamines
Stop immediately:
daily caffeine use (taper down) (caffeine withdrawal symptoms often last a week but can go up to a month) (people that say caffeine kills their headaches are dealing with caffeine withdrawal even 5-6 days out) (after the withdrawal period it's okay to still have some caffeine periodically)
energy drinks (stop today and this is not simply due to caffeine)
skipping meals
drinking alcohol
daily or regular OTC analgesic use (excedrin, ibuprofen, tylenol, aspirin, etc)
smoking (patches and vaping are okay for migraine because the triggers involve nearly everything but the nicotine in tobacco products)
Reduce in diet or simply be aware of common triggers:
nitrates (common sources: deli meats, hotdogs, celery, lettuce, commercially bottled water, etc)
histamine
tyramine
phenylethlyamine (because of tyramine)
phenylalanine (goes back to tyramine)
eggs
dairy
soy sauce, teriyaki sauce
most fruit juices
high protein meals (don't slam your body with protein, you want a slow but steady influx over the day)
smoked or dried foods (meats, sometimes fruits)
artificial sugars (stop eating "sugar-free" crap) (strongly avoid aspartames)
stop eating "low-fat" and "nonfat" crap
stop eating "low carb" crap (migraneurs need complex carbs, but not simple carbs)
Popular supplements that can easily trigger migraines:
ginseng
arginine
glutamine
tyrosine
phenylalanine (all forms)
various protein powders/drinks/snackbars (these usually deliver relatively high concentrations of glutamic acid, aspartic acid, phenylalanine, tyrosine, tryptophan; these are best taken in smaller amounts over the day as one would get from whole foods)
noopept
sunifiram (or anything else that is strongly glutamatergic)
aspartates
Lifestyle DO:
consistent sleeping hours
mild-moderate exercise (big workouts can trigger migraines)
mind the air quality in your home
healthy snacks throughout the day
well-rounded diet
hydrate
fiber (one reason is to keep estrogen moving out of the body; affects serotonin and a whole host of shit)
probiotic (among other things, probiotics help GABA in the gut--this is why kefir is an old-school feel-good food)
'ware the noise pollution
'ware the bright lights
'ware the strong odors (perfume, cologne, cleaning products, etc)
'ware the weather (barometric pressure)
Dogmatic or quack bullshit you might find on the internet claiming to be the answer to migraine:
low-carb diets (unless by "low-carb" they mean only weeding out simple carbs while leaving plenty of complex carbs)
high-protein diets
other extreme diets (high fat, super high carb, gluten-free, wheat-free, raw vegan, vegan, etc. Migraineurs need balance above all things. There is no reason for these until you have a diagnosis of certain conditions that your personal migraines are linked to and that need certain kinds of strict diets)
(migraineurs try these diets all the time and more often than not, they get an increase in migraines. A reduction in common migraines are the exceptions with all of these diets, not the rule)
high dose coconut oil
high dose fish oil
high dose vitamin C
nearly every "migraine diet" in history (aside from avoiding super common triggers like alcohol, migraineurs are too different for these diets to work on most)
chiropractic (as migraine is a genetic/neurological problem, this will not work for true migraines but may help headaches specifically caused by physical injury)
acupuncture (similar to chiropratics but less useful, mostly as placebo, does not perform better than "fake" acupuncture)
phytoestrogen scaring (phytoestrogens are not true estrogens and actually have some antiestrogen properties which is why they are associated with lower rates of prostate, uterine, ovarian, breast cancers -- meanwhile, the dairy products that are chock full of true mammalian estrogen have none of these properties. I'm not saying dairy is bad because, for people who are lactose tolerance, it's not really such a bad thing. I'm just saying don't let bullshit like this lead to your making changes in your diet that could leave you worse off than before)
chocolate scaring (chocolate is not really a trigger, it's just associated with migraine due to the cravings people get while in prodrome; the migraine already started and the brain is trying to stop it)
MSG scaring (aside from being wary of soy sauces, teriyaki sauces due to the fact that they are fermented) (studies keep failing to find that MSG consumption exacerbates migraines) (remember that this is just glutamate which you do need to have in your diet and get all the time from protein, but don't want a lot of in one sitting: we're back to balance)
These are tiny, off the top of my head lists. It's a mess, I know. Don't look to me for more comprehensive answers because 1) we still have a long way to go to learn more about migraine, and 2) I don't know everything about migraines despite being very strongly motivated in the last decade to learn as much as one person can learn about migraines, in order to stop them
While there is quite a lot of bullshit and old myths about migraines on the internet, this can be successfully navigated by doing five things: sticking to the scientific literature and keeping notes on yourself, looking for patterns, turning your fear of migraines into willpower to stick to methods that work to reduce them, and experimenting on yourself, to try to pinpoint what your own weaknesses are and what works best to mitigate those weaknesses. No two migraineurs seem to have the same sensitivities, triggers, or effective prophylactics, prescription or not.
The best advice to give a migraineur is to get on the internet and educate themselves about migraine. Knowledge is the best medicine for most people getting migraines. This will save a migraineur months and years of suffering, playing musical chairs with prescriptions and their side effects, and general frustration with their doctors. Right now, with how many doctors ignorant of the most current discoveries in migraine, that is the only real way a migraineur can take charge, empower themselves to get their migraines under control so the migraines don't control them. As much, heh. The migraines still control you a bit because you are basically rearranging your life around them, even if you achieve a major reduction in the migraines, because you have to keep doing it, probably for the rest of your life or until better pharmaceuticals are invented.
Edited by Duchykins, 24 June 2015 - 11:37 PM.