#Hypomania as an aura in #migraine

Abstract

"We report a 19-year-old man presenting to the department of Psychiatry for the evaluation of prominent behavioral symptoms associated with episodic headaches, with normal inter-episodic periods. A diagnosis of classic migraine with hypomanic aura was made. Other possible co-morbid or causative illnesses were excluded and preventive therapy with valproate was started due to the prominent affective symptoms as a part of the migranous aura. ...Recent research into the mechanisms of migraine has identified that the cortical hyperexcitability and an imbalance between neuronal inhibition and excitement mediated by gamma-aminobutyric acid and excitatory amino acids respectively may be the underlying mechanism. The high rate of affective disorders in patients with migraine, association of migraine with an aura comprising of mood symptoms and good response to treatment with mood-stabilisers might give newer insights into the pathophysiology of mood disorder as well." (PubMed)

 Hypomania and depression are both mood related aura symptoms that can occur with migraines. It is more common for me to get a depressed mood than hypomania but I have had the hypomania symptoms... I often refer to them as my manic migraines. In this case study the person had these symptoms "He would feel extremely happy. He would be hyperactive, demand money, express grandiosity. This stage would last for 15-20 minutes. Stage II- He would develop severe holo-cranial headache, throbbing in character associated with photophobia, phonophobia, photopsia and fortification figures. Visual symptoms lasted for 15-20 minutes. During this phase he would be extremely destructive, breaking up household articles, be abusive and assaultive towards family members. This phase would last approximately 4-5 hours. Stage III- Immediately after the headache he would sleep off for 1-2 hours. Stage IV- He would be extremely remorseful about his aggressive outburst. He would have full memory about the incidents and would be symptom-free till the next attack." (Neurology India)

Here are some general hypomania symptoms found on PsychCentral:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
  • More talkative than usual or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Distractibility (e.g., attention too easily drawn to unimportant or irrelevant external stimuli)
  • Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

And many of those are what I experience when I have this aura. Which is why it is so noticeable for me in particular since I am very reserved, think before I speak Not chatty person. Sleeping, well, that is not noticeable given my chronic insomnia and really I am usually beyond the aura phase by then. What I notice is this extreme chattiness and Need to fill the air and also apparently very little need to think before I speak. And I will just keep on going and going too. I have racing thoughts. A thousand thoughts a minute it seems. In that aspect I like this aura better than that sense of zombified mind. I can at least still think. I feel like I can think really well in fact. I feel like I am really productive. I get a lot done. I am really jittery though. Can't sit still. Lots of nervous energy.

And you know I can be very thankful to this aura back in the day. When I had to defend my Masters thesis I worried I would get a migraine, have aphasia, be unable to think clearly and just do a horrific job when this group of professors asked me questions. And I did get a migraine. And instead of that I got this hypomania. And even helped with my fear of public speaking even though I was insanely jittery. I was able to think so clearly that I flew through their questions and articulated my thesis clearly.

When it comes down to it with the hypomania symptom I can articulate clearly at least. Instead of aphasia. And that slowly of my thinking. But I have so many thoughts it is like a thousand escape for every one I can keep track of. And while I am very productive, it is like a fantastic illusion... very productive but in extreme pain. People do not see those migraines very well. They just see the excessive chattiness. And frankly, I loath the excessive chattiness since that is so damned out of character for me. And I never quite feel comfortable in my skin. I will say though that I prefer it to the depression aura state which is pretty sudden, deep and dangerous. But I really think that would depend on the person. For me it never has seemed to cause as many problems as the depression. Maybe I bought a few too many books online a few times... things like that, but nothing extreme. But the potential is definitely there for it to cause problems. So looking for preventatives that are specific for this sort of thing is a good idea if this is an issue. I know I had an issue with the depression related migraines. And really I don't like the migraines messing with my mood like that. Fine, then not fine, then fine, then not fine... it is erratic.

It is very rare in me to have this aura though. Enough for me to notice its peculiar nature for sure. Enough to make up a name for it in my list names I have for my migraines.
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