The “IC’s Related Conditions” series takes a look at conditions that can go hand-in-hand with IC. Not all patients have all of these conditions, but IC patients are more prone to be diagnosed with these conditions than the general population. (As always, this is not intended as medical advice and is for informational purposes only. Any and all medical questions should be addressed with your doctor.)

Patients with IC, IBS, vulvodynia, fibromyalgia, TMJ and migraine headaches now fall into a new diagnosis: “chronic overlapping pain conditions.”  An estimated 18% of IC patients also deal with migraines.(1) Migraines can be as debilitating as bladder symptoms and leave their sufferers longing for a dark, quiet room and sleep. Women are three times more likely to suffer from migraines then men.(2)

Symptoms

Migraines are more than just a bad headache. They actually have four stages of symptoms; however, not all patients have symptoms during all four stages.

  • The prodrome stage is first and begins a day or two before the migraine. This stage can include symptoms such as constipation, mood changes, increased thirst, frequent yawning, food cravings and stiffness in the neck.
  • The aura stage is next and happens before or during migraines. Auras are usually visual and cause you to see different shapes, bright spots or flashes of light. Auras can also cause vision loss, tingling in an arm or leg, weakness or numbness in the face or on one side of the body, problems speaking and uncontrolled jerking. The symptoms usually begin gradually and build up over several minutes and then last for 20 to 60 minutes.
  • The attack stage is what people most commonly associate with migraines and can last from four to 72 hours if it isn’t treated. Symptoms include: pain in your head (on one side or both sides) that can be throbbing or pulsing, sensitivity to light and sound, sensitivity to smells, sensitivity to touch and/or nausea and vomiting.
  • The post-drome stage is the final one in which the pain has subsided, but you people feel drained for about a day. Suddenly moving your head can often cause the pain to return briefly during this stage.(3)

Types

Migraines have two major categories: with an aura and without an aura. Aura migraines, however, are not as common and only occur in about 25% of all migraine sufferers.(4) There are also several subtypes of migraines:

Migraines without an aura (previously called “common migraines”)

If you have had at least five attacks that have lasted for four to 72 hours if not treated or the treatment doesn’t work, you may have migraines without an aura. Additional signs include at least two of the following: occurs only on one side of the head, has pulsating or throbbing pain, is moderate or severe in pain level and/or pain worsens with movement. The attacks also need to include at least one: light sensitivity, sound sensitivity and/or nausea.(5) If you meet the above criteria and have no other health problem causing the migraines, then you could have migraines without an aura.

Migraines with an aura (previously called “classical migraines”)

Having at least two migraine attacks with certain characteristics can be indicative of migraines with an aura. You must have an aura that goes away and includes at least one of the following: visual problems, sensory problems, speech problems, weakness, difficulty speaking clearly, vertigo, ringing in the ears, problems hearing, double vision, an inability to control body movements and/decreased consciousness. The aura also has to have at least two of these traits: one symptom that spreads gradually over five or more minutes, each symptom lasts between five minutes and an hour, at least one symptom is only on one side of the head and/or the aura occurs with a headache or one hour before the headache starts.(5) If you meet the above criteria and have no other health problem causing the migraines, then you could have migraines with an aura.

Migraine subtypes

There are a few medically recognized migraine subtypes that can fall within migraines with or without an aura.(5)

  • Acute migraines are episodic and occur 14 days a month or less.
  • Chronic migraines are usually a mix of migraines and tension headaches. Chronic migraines are severe headaches for more than 15 days a month for three or more months with more than eight of those headaches considered migraines.
  • Vestibular migraines have vertigo associated with them. Around 40% of migraine suffers have some sort of vestibular-related symptoms, such as balance issues or dizziness.
  • Optical migraines are sometimes called eye migraines and are a more rare type of migraine with an aura. It differs from a migraine with an aura in that it affects one eye only. Optical migraines may also cause flashes of light, a blind spot, partial loss of vision or loss of vision in one eye within an hour of the headache.
  • Hormonal migraines are linked to estrogen and can occur during your period, ovulation, pregnancy and perimenopause. Up to 60% of women have hormonal migraines, which tend to be more intense, longer lasting and cause more nausea.
  • Acephalgic migraines are migraines with only an aura and no headache. They are more common in people who don’t start having migraines until they are 40 or older.

Causes and risk factors

Just what exactly causes migraines isn’t clear and can vary from one person to another or even from one migraine to another within the same person. That said, doctors have found some factors that contribute to migraines most often, including: bright lights, extreme weather, dehydration, hormone changes in women, high stress, noise, skipping meals, changes in weather pressure, changes in sleep, different smells, intense physical activity, some foods, smoking, alcohol and traveling.(5) Certain medications, such as oral contraceptives and vasodilators (like nitroglycerin), can also trigger migraines.(3)

Some foods that commonly cause migraines include caffeinated beverages, alcoholic beverages, salty foods, processed foods and foods with additives such as aspartame or monosodium glutamate (MSG).(3) Many of those are troublesome for IC bladders as well, so cutting them out of your diet could help in more way than one.

To determine what is triggering your migraines, try keeping a migraine journal to track what you’ve eaten, what you’ve done and your menstrual cycle when you have migraines. That journal can help you and your doctor determine what is setting off your migraine so you can avoid those triggers or, at the very least, have an idea when a migraine is on its way.

Along with being female, certain risk factors make you more likely to have migraines. If you have a family member with migraines, you are more likely to develop them. While migraines can start at any age, they usually first occur in adolescence and peak in your 30s. So, the older you are, the less likely you are to have migraines.

Diagnosis

Doctors typically diagnose migraines in three ways: taking a medical history, performing a physical examination and ordering scans. The first step to diagnosis is getting a complete medical history. Doctors will want to know your personal medical history as well as your family’s medical history, since migraines often run in families. You can expect to answer questions about your symptoms as well as any other medical conditions you have and their symptoms. Your doctor may talk with you about your diet, stress level and activity level.

Next, your doctor will most likely do a neurological test to check your reflexes and how you respond to sensations as well as take your blood pressure and pulse. Your doctor will most likely check your head, shoulders and neck, too. He or she might even check your short-term memory.

Many times after getting a thorough medical history and doing a physical examination, doctors will diagnose a patient with migraines. However, your doctor might want to be sure nothing else is causing your symptoms and will order scans, especially if your symptoms began suddenly or you’re having other symptoms not usually associated with migraines. MRI or CT scans don’t detect migraines, but they can determine if there is anything else causing your migraines and symptoms.(6)

Treatment

Treatment for migraines varies based on your type of migraine, the severity of your migraines and numerous other factors. Treatments typically fall into two main categories: pain relief and prevention.

Pain-relieving medications

Best taken at the start of migraine symptoms, pain-relieving medications are available over-the-counter and by prescription. OTC pain relievers are the typical ones such as aspirin, acetaminophen and ibuprofen. OTC migraine medications, which can help with mild migraine pain, are often a combination of caffeine, aspirin and acetaminophen.(7) IC patients who are sensitive to caffeine should avoid medications that contain caffeine, so be sure to check out the ingredients before you try OTC migraine medications.

A variety of prescription pain-relieving medications are available that your doctor may use based on your symptoms and medical history.(7)

  • Triptans treat migraines by blocking the pain pathways to the brain. Taken as a pill, shot or nasal spray, triptans include sumatriptan (Imitrex, Tosymra) and ritzatriptan (Maxalt).
  • Dihydroergotamines are available as a nasal spray or injection and work best for migraines that last 24 hours or longer.
  • Lasmiditan (Reyvow) is an oral tablet that relieves pain and helps with other migraines symptoms such as nausea, and light and sound sensitivity. However, this medication can cause dizziness and fatigue, so it should be used with care.
  • Ubrogepant (Ubrelvy) is an oral gene-related peptide receptor used to treat acute migraines in adults. It relieves pain as well as other migraine symptoms within two hours of taking it.
  • Opioid medications are used for people who are unable to take other migraine medications. Narcotics that contain codeine can be the most helpful for migraine treatment, but opioids can be addictive so should be used with care.
  • Anti-nausea medications (chlorpromazine, metoclopramide [Reglan] or prochlorperazine [Compro]) are prescribed along with a pain-relieving medication for those who have migraines with an aura accompanied by nausea and vomiting.

Preventive medications

If you have chronic, frequent migraines that don’t respond well to treatment, your doctor might opt to prescribe medications to help prevent migraines. Several preventive medications are available.(7)

  • Blood pressure lowering medications can help prevent migraines with an aura. These include both beta blockers and calcium channel blockers.
  • Antidepressants that are tricyclic, such as amitriptyline, can prevent migraines. Though it can have side effects of sleepiness and weight gain, it is also effective at treating IC symptoms for many patients.
  • Anti-seizure medications such as valproate and topiramate (Topomax) can help reduce the number of migraines you have but can also cause dizziness, weight change, nausea and more.
  • Botox injections given around every 12 weeks can help prevent migraines for some people.
  • Calcitonin gene-related peptide (CGRP) monoclonal antibodies are given by monthly injection to prevent migraines. Their most likely side effect is a reaction at the injection site.

Self-help treatments

Whether you are taking OTC, prescription or no medications, some self-help treatments can also be beneficial in relieving and preventing migraines. Once the symptoms start, head to a dark, quiet room and close your eyes or nap. Consider using a cool cloth or ice pack on your forehead or the back of your neck.(7)

To help prevent migraines, be sure you’re staying hydrated, getting enough sleep, eating healthy foods (and avoiding any foods or beverages that trigger your migraines) and exercise regularly. Yoga can be good for stretching tight muscles. Psychotherapy can also be beneficial for managing stress, because stress can exacerbate or trigger migraines.

Alternative medicine

Therapies that aren’t as traditional can also help with treating and preventing migraines. Acupuncture, biofeedback and massage are helpful for some patients. Certain herbs, vitamins and minerals have also been helpful to some people. (Before trying any supplement, please check with your doctor first.) Ginger powder, for example, has been shown to be as effective as certain migraine prescriptions and could be worth a try. Magnesium deficiency can trigger hormonal migraines or migraines with auras, so you might consider adding a magnesium supplement. B vitamins, which are water soluble, help regulate neurotransmitters in the brain and, as such, an reduce migraine frequency and severity. A complex B-vitamin could be helpful.(8)

References

  1. Clemens JQ, et. al. Temporal Ordering of Interstitial Cystitis/Bladder Pain Syndrome and Non-bladder Conditions. Urology. Dec. 2012 Volume 80, No. 6.
  2. Migraine Research Foundation. Migraine is a Women’s Health Issue.
  3. Mayo Clinic. Migraines.
  4. Bhargavea HD. Types of Migraine Headaches. WebMD. Nov. 9, 2020.
  5. Nall R. Everything You Want to Know about A Migraine. Healthline. Dec. 20, 2017.
  6. Behring S. What Happens During a Migraine Diagnosis?. Healthline. March 30, 2021.
  7. Mayo Clinic. Migraine: Diagnosis and Treatment.
  8. Galan N. Natural Remedies for Migraines. Medical News Today. Aug. 20, 2018.