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The Scenario:
Janet is a woman of 18 who grew up in Tucson, Arizona, and decided to go to college at USC. She enrolled as a freshman this past fall, and was making friends, enjoying her classes for the most part, and loving southern California weather. Although she wasn't sexually active when she started school, she went on the pill just in case. Within a couple of months, however, she began to develop headaches. They were mostly located on the right side and could be quite severe and pounding. She noticed that the headaches were sometimes present as soon as she woke up in the morning, and they could last all day. Ibuprofen helped a little bit.
Janet came home for Christmas break. She got together with some friends, had some wine and cheese, stayed up late, and got a little drunk. The next morning she awoke feeling nauseated. She got up to go to the bathroom and noticed that she had trouble using her left hand. She didn't have any strength in it and could not even use it to open the door. There were also wavy lines all around her vision. Soon thereafter, she started with a really severe headache, and started to throw up. The light in the bathroom made her headache even worse. She stumbled back to bed.
Questions:
Answer:
Was it a stroke, a brain tumor, a blood clot in the brain? Fortunately, Janet had none of these. What she did have was a migraine headache.
We know this from a number of clues. First, her headache was throbbing, and located on one side of the head (not front-and-back as is typical of a tension headache). Second, they were present when she first woke up in the morning. Interestingly, migraines often start first thing in the morning, and at the start of a vacation or weekend -- the opposite of what you'd expect from tension.
On the morning of her big headache, Janet had done some things that can trigger migraines. She had red wine and aged cheese, and had just come home for vacation. And perhaps the hormones in her birth control pills had helped to precipitate her migraines in the first place.
The wavy lines in the vision, nausea, and worsening of the pain by bright lights is typical of a migraine. Occasionally, a migraine can cause weakness of one side of the body mimicking a stroke. It can be scary, and other more serious problems need to be ruled out, but this effect is temporary.
She may need medication for her headaches, but staying away from trigger foods (add to the list caffeine, MSG, chocolate) and maybe discontinuing the pill should help. Stress often contributes to migraines as well. Perhaps the stress of starting college was also a factor.
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