Are Your Attacks Evolving?

By Holly Harding

1 min read

Whether due to aging, hormonal shifts, or life transitions (such as changes in career or marital status), migraine attacks may evolve over time. When this occurs, it can be challenging to respond to the condition. Prodromes or first signals that once let us know an attack was unfolding may change entirely, making it difficult to know when to take our rescue medications (which work best when taken at the first sign of an attack).

How have my migraine signals changed?

In this video, Holly shares how her first signs and signals are changing over time, as well as the actual sensation of the attack itself. She discusses how she is navigating these changes and invites you to share your experiences on the topic of evolving attacks in the comment section below. We are eager to learn from you, and thank you for taking the time to share your wisdom with us.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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azreynolds Member
Holly, I think it's interesting that you are noticing a change in your migraines right at about 40 years. I also had an increase in frequency and pain about the same time, but as they became daily, I was convinced that the fragrance of the super strong detergents were playing a major part in my reactions. Perhaps just the number of decades were the true culprit. Looking back over 58 years of migraines, I count numerous peaks and valleys. Peaking with such hope and high expectations for new medications, only to find myself in the dark valley again for longer and longer spells. I can't compare my prodromes for all this time because I didn't know what those were. (Did that terminology even exist 50 years ago?) And factoring in all the different stresses in life, and car accidents, certainly has to take blame for some of the lows, so I can't really be accurate in my statement. In spite of that, I know for a fact that 40 years in from my first migraine, I experienced a huge change for the worse. Not only going from episodic to chronic, but quickly going from chronic to daily unrelenting pain. Add in the constant fainting and weird episodes, it was unbearable. No wonder I lost my job. I was completely unreliable. Hopefully this next statement is not a prediction, but...add on another 15 years to this timeline and my auras started increasing, changing from tiny twinkle lights to total blindness caused by bright yellow shards of glass that wipe out my vision in a split second. AIWS episodes also went from things looking like children's furniture, to growing 6ft arms and legs, and physically feeling that the world has warped into a huge bowl that I felt like I was climbing up the sides when I walked. Why? Why the sudden change at 40 years, and then 50 years? My neurologist says that we have a pain bucket. Once that pain bucket is full, our bodies have to adjust in order to absorb the rest of the new pain. Our spine can only filter so much and our body reacts differently as we pile on more pain. He said all pain and trauma add to the bucket, so accidents, rapes, operations, broken bones, etc. all add together and max out our system. Maybe after our pain bucket overflows it causes our migraines to over react(?). Makes one wonder what the future holds. Happy holidays! 
1. Holly Harding Moderator & Contributor
 <inline-mention username="azreynolds" user-id="3677307"/> Hi Annzie- always love to hear the way you think and the wisdom you are willing to share with the rest of us. That's such an interesting theory for sure- that of pain buckets. And how our bodies might be trying to adjust over time to the overload. Who knows? And no, I don't believe prodrome and postdrome terms have been around for that long! I only heard them applied to migraine in the past 5-7 years?!? I may be wrong on that. Anyway- I hope you are enjoying some respite from your pain and symptoms so you can take part in holidays in the way you want here and there- whatever way is possible given how our special bodies work! Much love to you- so grateful to you, my friend. - Holly (migraine.com team).
azreynolds Member
Holly, I would love to say I'm doing well for the holidays, but truth is I'm trying to adjust to new glasses which have my full prescription for 9.5 lens with a prism. (That means coke bottle lens. Hmm, will kids today even know what that means? Lol.) Its so nauseating and causing migraines different from what I'm used to. It really brings home how my BI seriously messed up my vision. It also helps me to realize why my migraines were so bad before this doctor started working with me. Hopefully he will be able to fix what his associates did this time. Good thing about these heavy horrible glasses i
azreynolds Member
It cut off my reply. I was saying the good thing is it's making me wear my sclerla contacts more than usual. 
1. Holly Harding Moderator & Contributor
 <inline-mention username="azreynolds" user-id="3677307"/> Your journey is most definitely multi-tiered with many chapters, my dear. I'm just so grateful you're willing to share it with us as I know many of us are benefitting from your wisdom and experience. I'm sorry these issues with your vision continue causing such havoc for you and impacting your migraines for the worse. Who could've dreamed they could get worse! But you are continuing to learn as you go along- like peeling back layers of an onion. Those glasses do sound horrible. I would think they would hurt the bridge of your nose to wear? Sending love- Holly (migraine.com team).
ardenhansen Member
I have had a glorious three years migraine free upon taking the aimovig injections. Now I am troubled by noticing the headache in mild form is starting to exist when I wake up. These minor disturbances are nothing like I used to experience for 40 plus years previously. I can ignore up to a point and then I take a Naratriptan to knock the annoying migriane out. I am trying to avoid getting fearful again of sneak attacks by the demon migraine. There is always the same dilemma, is it going to get worse and therefore treat with triptan or is it on its way out and just wait it out. Since I am nearing 80 I figure I might as well do whatever it takes to sabotage the migraine and enjoy the remaining years of my life the best I can. God bless Aimovig! It was a super miracle. That's my story. 
1. Holly Harding Moderator & Contributor
 <inline-mention username="ardenhansen" user-id="3673808"/> So grateful you took the time to share some of your journey with us here. And wonderful to hear how Aimovig has been a Godsend for you. I know exactly what you mean by feeling the fear creep up as you begin to sense some of the old symptoms return. As any experienced migraine patient knows (and you are very experienced, unfortunately), treating migraine is all about nipping it in the bud - most effective if we can catch it as it's knocking at the door, before it enters our home and takes over our bodies. That can lead us to living in such a vigilant way that we become finely tuned in to every little shift in our selves. On the careful lookout for the first sign of an attack. I'm with you that proactively treating an attack before it unfolds is preferable to waiting for it to fully announce itself. The downside to this, of course, is that we must watch our intake of the rescue medications we take. I also take a triptan at the first sign of an attack- and that happens for me on a near daily basis. This is something I've cleared with my doctor. I would think as long as you check in with yours about this, you'd be good to go. Of course, the other sticking point is cost and insurance limits on these meds! It seems that just about everything having to do with migraine is complicated! At any rate, I love your attitude that sabotaging the attack and enjoying your life overrides all else! I couldn't agree more. So glad you're with us. Please continue to share your well-earned wisdom with us so that we may learn from you. Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team.
2. Melissa Arnold Community Admin
 <inline-mention username="ardenhansen" user-id="3673808"/> My heart goes out to you. It can be so hard not to become overly focused on little changes in your condition when you've been chronically ill. For me, it's like feeling unsafe in your own body. On a practical level, it might be a good idea to sit down with your doctor and make them aware of what's going on. They might recommend a change in your medication routine, or at the very least you'll be on the same page and have the medical support you need. As for the very valid fears you experience, have you considered talking to a therapist that specializes in chronic illness? Even if you're dealing with an "average" level of concern, it can be so helpful to have a space to work through it and get some tips. It's been a big help for me. I hope you can figure out what's going on and that these changes are nothing but a blip on your radar. Take care of yourself! -Melissa, <a href='https://migraine.com' target='_blank'>migraine.com</a> team
camcguirt Member
Hi Holly - I found your video to be interesting. I have suffered for 30 odd years not- i just turned 53 yo- and I feel like ive tried everything. I can relate to so much of what you said. I am trying HRT to see if that will alleviate some of this. I also am on AJOVY which initially helped with intensity. Id say it helped with frequency too but I think im back to my chronic migraines so I really cant be sure if thats a true statement anymore. Im in a place now where I feel quite frustrated with my neurologist. Am considering a change. So yes, i def have noticed my migraines have evolved as well. I thnk with the AJOVY, at first they seemed better and now, a year later (or maybe its been closer to a year and a half )I feel like im getting more intense migraines more often again. I have wondered about the fact that I use the AJOVY and then for abortive meds I use Nurtec. My neurologist hasn’t suggested that I shouldn’t but it seems like one maybe overkill. I am curious to know if anybody else out there gets a migraine a day or so after giving themselves the AJOVY shot ? It happens to me every month and I dont know if its a coincidence but it has happened every time I give myself the shot and I can be sure ill get a migraine the next day or two. I have not seen this as a side effect and my doctor says shes never heard that before. Anyways, Holly I appreciated your video. And feeling so similar to your experiences. Good luck !
1. camcguirt Member
 <inline-mention username="Holly Harding" user-id="3755969"/> thanks so much for all that info. I will look into those things ASAP! I especially am intersted in the idea of changing CGRP’s. I hadnt even considered that and I will take that to my doc. Yes, my doc claims she is a headache specialist but she has a lot of balls in the air and I just dont feel like she is that interested. Im sure it gets frustrating for the doctor too, though, trying to work with migraines. Each and every person is so very different ! By the way, I do think the HRT has helped with frequency of my migraines, as mine are VERY hormonally triggered. My sleep and my hot flashes improved greatly too ! Good luck and thanks again for the support ! Courtney 
2. Holly Harding Moderator & Contributor
 <inline-mention username="camcguirt" user-id="3692617"/> Hi Courtney- Thanks for letting me know about the positive impact of your HRT. I also have hormonally triggered migraine attacks and am still taking a continuous birth control pill in order to keep my hormones from fluctuating. Soon, I'll have to shift out of this and move into a more menopause-friendly type therapy. I appreciate your insights. Regarding your doctor- it's very kind and thoughtful for you to consider her own potential burnout that likely does accompany that challenges of working with migraine patients. I've thought of this too. Still, they have chosen this profession and as I said this relationship for us is key to help manage the condition. We need someone who is willing to be curious about various and new therapies- and will dig deep looking for solutions on our behalf. It's not unreasonable for you to ask for a good partnership where you feel heard, respected and considered. Really glad you chimed in here- very nice to "meet" you and hope you'll stay in touch! Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team.
wirr Member
Hello Holly, As I have written before, I believe that my migraine attacks are triggered solely by hormones, since no trigger can be found and the attacks always come according to schedule. The symptoms change with the strength of the attacks. This is expressed, for example, in the fact that I can't sleep for days after certain attacks and I don't miss it either. Then there are the weaker ones, with whom I can stay lying down without any problems. If I have very heavy attacks with persistent auras, then I go through practically all forms of attacks over a long period of time, from heavy attacks slowly until they fade away to light attacks. This goes on for many months or years. As far as the medication is concerned, I had the following change in attack while taking topiramate, in addition to a whole series of side effects, such as weakness, tiredness, disturbances of consciousness, thinking problems, etc. Very slowly, with the dosing up, something that I called false attacks crept in. It felt like being in the middle of an attack within 2-3 minutes. I was currently wearing a smartwatch that could measure heart rate and stress levels. Whenever such an attack came and I was sitting with my wife, I said look, it's starting again. Together we were then able to observe how the two values suddenly changed. Stress level from 25-35 up to 99. It doesn't get any higher. Such an attack lasted about 40 minutes to an hour and then it was gone as suddenly as it had come. At some point I had 7 attacks in one day and then weaned off the medication. Since, as you will remember, I mainly deal with prolonged auras and vestibular migraines, the only acute medication I have available is MCP, which is very helpful because I can't move a millimeter otherwise because of nausea and dizziness. For headaches, if they are unbearable, sumatriptan or high-dose aspirin helps. But since I always have recurring headaches over many days, I usually refrain from doing so, because all hell breaks loose after the triptan has worn off. Next year I have another appointment at the specialist clinic. Here on site, no doctor or neurologist can do anything with my complex migraine. How I hate taking on this special position. I often even have to justify myself to pure headache migraine sufferers who don't believe me. Although some attacks start with a typical visual migraine aura. Keep up!
1. wirr Member
 <inline-mention username="kaitlynsutton" user-id="4171751"/> What did I do wrong? Did it post every time? If so, then when it occurs again, I'll check on another computer to see if it's just on the one PC that it's not showing up. Then I won't do you any work. Browser errors or something like that. I thought your server was messing around. Sorry for the inconvenience! 
2. Holly Harding Moderator & Contributor
 <inline-mention username="wirr" user-id="3682405"/> You did nothing wrong- no worries. The site is being a little wonky. Best way to double-check whether or not a comment has posted is to refresh the page after you've entered it. This is what I do as it happens to me as well. On to the topic at hand. You do a great job illustrating both the stubborn nature of chronic migraine- those parts of this condition that can last for years- that can be difficult if not impossible to treat. As well as those parts that evolve and change. Those triggers, symptoms, and signals that shift over time making our response and ability to treat it such a challenge. So either way- whether the condition is stagnant or moveable, we are up against a rock and a hard place in our response to it. A situation that requires us to stay at the table- as you illustrate- continuing to try new treatments - as we introduce ourselves to new side effects - meeting with our doctors to attempt new approaches to this debilitating disease which requires us to dig so very deep. I love your response to "keep up." We must. So glad you're with us, as always. Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team.
kateymac Member
Hi Holly - thanks for this topic. Hmmm… migraines evolving? Let me count the ways! Years ago. My prodrome went from a clear aura to , well just about anything. (Hyperactivity/extreme fatigue, brain fog, depression, hyper happiness, etc.) A few haven’t changed, like my mom can tell it’s coming just by looking at me; and the old weather triggers have stayed. My migraines have changed over and over again , through the years. During the past several years, neurological symptoms and sensitivities have taken a front seat. Ive read several times that this often happens to women in their 50s with around 20 years of daily migraine. Umm… that’s me. What i can never find is info on how long this perma-warped reality lasts. Do “women in their 60s” find some return to previous baseline? Anybody? Kate🌷
1. Holly Harding Moderator & Contributor
 <inline-mention username="kateymac" user-id="3784217"/> You and I really share so many similarities, Kate- in terms of timing- length of migraine condition, type of migraine and age. I'm with you on asking these questions as well. At first as I was under the extreme pain in my 30's and 40's, I tried hard to shift my gaze to the horizon - with hopes that pre-menopause or menopause would bring some relief. But, as you mentioned above, in many ways, the condition has become more complicated - shifting and changing- and in others ways remaining far more entrenched than I could've ever imagined. So, up goes my hopeful gaze again- to the horizon of my 60's. Will that be the decade of relief? As I write this, I've just responded to several wonderful 80-year-old members who are still navigating daily life with migraine. A hard reality to consider. At the same time, they sound like the most wise and incredible women out there. Though I wouldn't wish this on anyone, I'm glad to be connected with you - it's so helpful to know others navigating this same terrain. Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team.
kateymac Member
<inline-mention username="Holly Harding" user-id="3755969"/> Thanks so much, Holly. Right back at’cha.😊 <inline-mention username="ardenhansen" user-id="3673808"/>
Trudy C Member
Hi Holly - so interesting to read everyone's changing experience with migraines and how they evolve. I too had my worst migraines in my late 40's and early 50's. I am now 62 and they are less severe when they happen, which may because the hormonal factor is no longer so great. My big change is that I now wake up with the migraines, and they are already in an advanced stage. ( I now rarely get a migraine during the day) Because they are advanced it makes it tougher to treat. Usually rizatriptan (beneath the tongue) helps followed by aspirin and codeine. I find that when I am unusually tired when I go to bed, there is a good chance I will wake up with a migraine. Why do I now wake up with them as opposed to getting them during the day? I have done some reading but have not come up with an answer. I am always careful not to sleep in - that has always been a migraine trigger for me. A healthy diet, exercise, and avoiding red wine and msg, has helped me a lot. I can tell you that for me, my migraines are not as intense, and less frequent now that I am in my 60's. My mother, who had migraines all her life, found that her's diminished over the years so by the time she passed away at 94, they were few and far between and were easily overcome with some tylenol. Hope this encourages all of you 😀 PS - over the years I have pretty well tried it all; biofeedback, magnets, acupuncture, acupressure, chiropractor, naturopath, cutting chocolate & dairy out of my diet for a year, dental work, topical ointments, and all kinds of drugs-triptans, etc. 
1. Holly Harding Moderator & Contributor
 <inline-mention username="Trudy C" user-id="3909965"/> Thanks for sharing how this piece resonated with you. I'm so sorry to hear how you are now waking with migraine - a change for you. You are right that this reality is so tough because you sleep through the warning signs and awaken with it full-blown and harder to treat. Have you spoken with your migraine specialist about this? (And hoping you are working with a migraine specialist with migraine attacks that are this frequent). If you need a list of specialists in your area, we can send a link. Sleep hygiene can be key when it comes to the gestalt of managing migraine. It may be it's time for a tune-up with your doctor and the creation of a strategy that focuses on sleep- like a medication that helps you fall asleep and stay asleep (there are some meds out there that do so and are also known preventatives for migraine- I take one called Trazadone- might be worth asking your dr. about). And perhaps it'd be worth talking to a specialist about proactively doing a short-term trial of triptans at night - to see if that would prevent them from developing while sleeping. I'm assuming you've tried the new CGRP treatments (though you didn't mention them in your list): <a href='https://migraine.com/cgrp-new-direction-migraine-treatment' target='_blank'>https://migraine.com/cgrp-new-direction-migraine-treatment</a>. If not, that would also be worth discussing with your doctor. That said, I know it can be exhausting trying new treatments and sometimes we need a break from that. We are here for you at every step and in this with you. Thanks for offering your guidance and perspective. Definitely interesting to hear about the overall arch of your migraine frequency/severity. Glad you're with us! Please stay in touch. Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team.
2. Trudy C Member
 <inline-mention username="Holly Harding" user-id="3755969"/> Compared to my earlier years, the headaches I wake up with are about a 6 (out of 10) and I can usually clear them with meds. They also wake me up early enough that I can treat them and by the time I need to go to work they are either gone or very mild. I get them maybe 4-5 times a month so that is no big deal to me. I have never seen a migraine specialist because migraines were a normal thing in my family home lol. It was just part of life. They are an awful lot better now that I am in my 60's 😀
Melissa Arnold Community Admin
Hi <inline-mention username="Holly Harding" user-id="3755969"/> -- I know that articles are usually held for a while, so did you have your appointment with your doctor? I'm genuinely curious about their thoughts and if there's going to be a change in your protocol moving forward. Sending you much love and peace this holiday season -- the timing of these things is always the worst, isn't it? <3 -Melissa, <a href='https://migraine.com' target='_blank'>migraine.com</a> team
1. Melissa Arnold Community Admin
 <inline-mention username="Holly Harding" user-id="3755969"/> Doing OK, thanks. Navigating the first holiday season without my grandmother, so that has its unique challenges ... but still looking forward to time with family and more sweets than I should probably have. Thinking of you! -Melissa, <a href='https://migraine.com' target='_blank'>migraine.com</a> team
2. Holly Harding Moderator & Contributor
 <inline-mention username="Melissa Arnold" user-id="3827796"/> So sorry to hear about the tough adjustment of experiencing the holidays without your beloved grandmother. I know so many people think of the holidays as being warm and wonderful but for many it can be a real challenge due to loss and heartache. Glad you will be surrounded by family and, if you ask me, indulging in sweets is a fine way to give yourself a bit of a hug when you need it! All love to you and so glad to know you- Holly (migraine.com team).
mpgodfrey60 Member
You must have my house bugged with cameras or listening devices. Two days ago I had one of my more painful attacks. I called my mother to explain it to her and mentioned that my migraines have evolved over time. I am 46 now. Started having attacks when I was about 12. They have made a couple of changes actually. In my younger days I was warned of an upcoming attack with squiggly lines in my vision. Those went away and were replaced with constant yawning before an attack. The location of the pain has changed as well. At first they were traditionally behind my left eye. Then they moved to more of the side of my head. Now they are mainly located in the back of my head and produce pain that is much worse than I've ever had. Before, I would get nauseated and after I would throw up a few times the pain would ease a little. Now, the pain doesn't subside at all. I can sometimes fall asleep and wake up painless but most of the time I wake up and it is still there, and much worse than before I fell asleep. I eventually get nauseated again and after throwing up what seems like 50 times the pain eases enough for me to sleep it away. It's just that the time with the pain is so bad now. I can't find any way to comfort myself.
1. Nancy Harris Bonk Moderator
 <inline-mention username="mpgodfrey60" user-id="3838591"/> Thank you for reaching out and sharing your experience with us. I'm so sorry you are in constant pain, I understand how frustrating and exhausting that is and wanted to let you know you're not alone. It's not uncommon for our migraine patterns and/or symptoms to change over time - mine sure have. Having said that when this happens it's always a good idea to let the doctor know so he/she can make sure everything checks out OK. Speaking of doctors, have you had a chance to speak with your doctor about this unrelenting pain? Try not to lose hope, there are over 100 medications, supplements, devices, complementary therapies and lifestyle modifications that can be used to treat migraine and most of us are on a combination of them, I am! Please keep me posted on how you are doing and I hope today is a low pain day, Nancy Harris Bonk, Patient Leader/Moderator <a href='https://migraine.com' target='_blank'>Migraine.com</a> Team
mpgodfrey60 Member
I haven't spoken to a doctor about these new ones. My regular doctor retired and I am trying to find a new one that I like. I have really paid attention to things that have always triggered them but most of the time they just come along regardless. I saw where someone had mentioned sleep apnea in one of the responses. I have done a sleep test and have a machine ordered so hopefully that will help. I'm looking forward to seeing what kind of difference the machine makes, if any, with these headaches. Thank you for the chat. I'll keep you posted.
1. Holly Harding Moderator & Contributor
 <inline-mention username="mpgodfrey60" user-id="3838591"/> So glad you're with us and we'd love to hear if the sleep machine makes a difference for you. Glad this article resonated- we're very glad to hear your perspective and learn from your well-earned wisdom. I'm not sure where you're from, but if you're in the States, we have a resource with some of the migraine specialists divided by State, in case that might be of use to you: <a href='https://migraine.com/blog/healthcare-providers-turn-to-for-help' target='_blank'>https://migraine.com/blog/healthcare-providers-turn-to-for-help</a>. Stay in touch! Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team.
mpgodfrey60 Member
Thank you so much for this. I am in Louisiana and it looks like there is a specialist just down the road from me in Shreveport.
1. Holly Harding Moderator & Contributor
 <inline-mention username="mpgodfrey60" user-id="3838591"/> Amazing! Please let us know how else we can be of assistance. We are here for you any time. Warmly- Holly <a href='https://-migraine.com' target='_blank' rel='noopener noreferrer ugc'>-migraine.com</a> team.
Xeno Member
My migraines have definitely evolved but it has been mostly positive. I first started getting migraines in my early 20s (I'm 47 now). The triggers has changed, from food to extreme temperature changes to sleep issues, and they way I've been able to manage them have changed too. Thankfully I've haven't have a truly debilitating episode for years but I do still little ones several times a week. I guess they would be headaches and not migraines? I am getting tested for vestibular migraines at the end of the month though. 
1. Cheryl Picerno Moderator
 <inline-mention username="Xeno" user-id="5530393"/> The evolving capacity for migraine disease is one of its most challenging aspects. If we can keep pace with different management strategies, that gives us a better quality of life. I think it's great that you have not had a debilitating episode for so long, but your other headaches are probably not just headaches. I've learned over time and trials to always keep an eye on the smaller aspects regarding migraine and other headache disorders. If your symptoms are light and your quality of life remains good and stable you are managing the disease well. Kudos to you and your doctor! Please let us know how you do with the vestibular testing. I will be praying for a good report. Thank you for being a part of the community and sharing your experience. Warmly, Cheryl <a href='https://migraine.com' target='_blank'>migraine.com</a> team
2. Nancy Harris Bonk Moderator
 <inline-mention username="Xeno" user-id="5530393"/> Thank you for sharing your journey with us. You're not alone in seeing migraine patterns and symptoms change over time, mine sure have! Here's the thing - migraine is thought to be a neurological disease falling on a spectrum from mild to severely debilitating. I would encourage you to keep an eye on the "little one" as these may transform into more chronic ones! Looking forward to your update about vestibular migraine! Wishing you a low pain day, Nancy Harris Bonk, Patient Leader/Moderator <a href='https://migraine.com' target='_blank'>Migraine.com</a> Team