Hi Doc,

I think you are saying that in your mind, the absence of 'typical symptoms' does not lead you away from migraine. Just FWIW, when I said I was led away from migraine by the abscence of these sx, I didn't mean I was ruling out migraine, only that I felt it was less likely than if the presentation were typical -- less likely, not non-existent, nor even insigificant. I hope that is a bit clearer.

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My comment on treating clearly mixed type headaches was more of a preface; yes, those suck but they are a nobrainer to treat, and the sooner the better, as with anything.

The type of attack I described afterwards is not the kind I'd call "clearly mixed". It surprised me to find out that a triptan would resolve tension/stiffness, moreover in places other than my head. I guess I sometimes get that as part of prodrome. I wondered if perhaps some of your tricky-to-distinguish attacks might have similar sorts of features.

It still happens now and then, that I fail to catch whatever is truly happening and wind up out of commission for 1-2 days d/t medication and/or intractable pain. I don't know if we can hope to make the right call 100% of the time, you know? We can only hope to get better and better at it.


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I am glad your back is better for the moment. Perhaps they will make some medical advances that will give you more hopeful options for treatment.

Take care.

waves