Q. Do my symptoms seem like migraine or something worse?

Hello doctor,

I am a 31-year-old female who had never suffered from headaches before this year. I did have occasional (what I called) tension headaches, mild pains behind one eye that would last a few hours, and that is about it. Last year, I gave birth to my first child by C-section. 2 to 3 days after the spinal anaesthesia, I developed positional headaches that were incredibly intense. I was told they were related to the anaesthesia. I could not sit or stand up, and the pain was the worst thing imaginable. I would actually cry on the toilet when I needed to go. On a scale of 1 to 10, it was an 11. When I lay down, it got better, a 2 to 3 out of 10. The pain went away after 6 to 7 days, and I got back to normal. However, during these seven days, I did experience once a scintillating scotoma, which was almost identical to the auras that precede migraines. A lot of blurry shining lights gradually grew larger and became a sparkling fortification spectrum in a C-shape, which grew even larger until it left the vision field towards the left side. Then I had no problems whatsoever for the next six months or so, until one and a half months ago, when I started having the aura again, and it has happened six times so far. I was very overworked and overtired when they started, with the baby starting solids and not sleeping well. It has been so far five times on the left side of the vision and once on the right side (although the same day I had it on the right side, a few hours later, it also happened on the left side, the same day). The transition of the scintillating scotoma from a dot to a large C, leaving my field of vision, lasts about 30 minutes, and it is the same every time. I do not have any other symptoms, although I had mild nausea a couple of times during the aura. The headaches that follow are mild, like a stronger pressure in the back of the head on the opposite side of the scotoma. So, it has been mostly on the right side. A couple of hours after the aura, I can always feel a sharper pain on the right side, inside my head, towards the back of the head (occipitally), usually when I move, bend over, cough, strain, etc. It is every time on the same side in the same spot. This pain disappears after a day or so. But for the last two weeks or so, I have been left with a slightly painful pressure in my head that is pretty constant daily. It sometimes goes away, especially when I am relaxed, but it comes back when I am more tense and active. It feels a lot like a tension-type headache. There is also a sensation of a full head and a bit of lightheadedness, like I am not focusing my eyes well (but not actually losing any balance or visual acuity). There is no particular pain when moving, coughing, and bending over, as I have during a migraine. But I do feel more pressure in the back of my head on the right. Not sure if it is psychological or if it is really something there. I should also mention that I did not take any medication for the migraines and once tried Ibuprofen for a tension headache, but it did not really work. Sometimes, a glass of wine works better, actually. My brother started having the same aura (he described it to me in detail, and it is the same thing I have) when he was 35, which was five years ago. His headaches are mild to moderate, but they are behind his eye and not at the back of the head like mine. He also does not have the head pressure every day like I started to have, and his migraines alternate sides, not like mine, which are pretty much on the right side of the head (left vision field). I am scheduled for an MRI next week, so I will find out more soon. But I wanted to hear your opinion since I am so very scared that I have a tumour in there, something really bad. I very much want to see my baby grow up and be there for him. I am super worried, and I just had another aura yesterday evening, and now I get a sharp pain in my right occipital area when bending over.

Do my symptoms really seem like migraines, or maybe something worse?

I have read that I am a bit too old to start having migraines (31) and that the pain should be more intense and not always on the same side (which is indicative of a brain tumor), and that they should be on the front of my head not at the back of my head. Is that true?

Thank you.

Hello doctor,

I am writing to let you know my magnetic resonance imaging (MRI) results came out clear, with just a pineal cyst of 0.39 inches and three non-specific micro-lesions on the white matter. They did not use contrast (they said it was not necessary). I also had a magnetic resonance angiography (MRA) at the same time (without contrast also), and everything looked normal with my blood vessels too. I went to a Neurologist who told me I was fine and that it was just migraines with aura from the stress. However (and I'm not sure if this is related, but I am assuming it was also neurological) - a few times now in the last two weeks or so, I have started to see strange patterns when I wake up from sleep. Yesterday I woke up at 1 am pretty agitated, and when I opened my eyes in the darkness, there was this grid of lines arranged as squares. The squares were large, like one to two inches each, and this covered my vision field. I could still see, but there are these lines superposed that look like afterimages from when you look at bright things. I could still see them when I closed my eyes, and they did not appear to move when I moved my eyes. They looked fixed in place. The images on the retina, which move when I move my eyes, were layered over this grid thing and moved over it and twirled. Really weird. The grid thing disappeared soon after, say 1 minute. After going back to sleep, I woke up this morning to see my vision field a bit more luminous than usual, but this time no clear pattern, just bright with yellowish, orangish greenish light. Also disappeared within 1-2 minutes. Last week I woke up to see a pattern of triangles of sorts (also made of thick outlines, like the squares), about the same size as the squares but a triangle in shape. Not clearly defined, the edges were not sharp but like afterimages. They disappeared soon after. And I think I might have had similar things, but I cannot remember clearly since they appear immediately after waking up. They are not anything like auras. They do not grow or change, they disappear more quickly, and I have no headache, not even the slightest discomfort in the head. I might have had some swishing in my ears each time I have seen these patterns, but I am not 100 % sure. What I know is that I feel agitated and anxious, and last night at 1 am jumped out of bed super scared and could not sleep for hours. Just sat in the living room shaking and scared that my brain is shutting down or I am otherwise losing myself. In the last week, I have also noticed quick flashes of light in various places in my visual field. They last under a second and are punctiform and bright. Sometimes I see them when moving my eyes or when I blink. I had an eye exam as well a couple of weeks ago, which looked at my retina, but everything looked ok. I didn't even need glasses. What I should mention is that I've been taking 2.5mg of melatonin supplement every evening for three weeks now because I have trouble falling asleep. I sometimes have trouble staying asleep as well. I wake up at four to five am and cannot go back to sleep for one to two hours. And yesterday, I did go to see a movie that was 3d and needed 3d glasses. Not sure if this was a trigger. In any case, I am scared and do not know what to think.

1. Could this be the melatonin?
2. Could it be that I am still leaking tiny amounts of cerebrospinal fluid (CSF) from that anaesthesia eight months ago?
3. Could it be multiple sclerosis (MS) or something of the sort? Could it be my anxiety and being over-attentive to stuff? (I am willing to assume they never happened since they look disturbing, and I think I would have remembered).
4. Could it just be something from being stressed or having sleep issues?

I have looked online, and I came about something called hypnopompic hallucinations. I noticed people who take drugs often have them, as well as people with narcolepsy. I do not take any drugs. But my brain's chemistry seems to have gone crazy lately, and I worry so much. I would much appreciate your insight.

Thank you.