Does Migraine Cause Fever 2024
Migraine is a genetic and familial neurologic problem present in 13% of the American population. Usual symptoms are one-sided severe, throbbing pain and sensitivity to light, sound, and movement. Most patients have nausea and/or vomiting.
Migraine is the most common medical problem for women, present in 25%. The most common symptom of a migraine is that it is one-sided.
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This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.
It is rare for a migraine attack to have fever and an underlying infection is usually the cause. The fever should be aggressively worked up and the patient should see their general doctor.
Associated questions
Is the headache with fever like a migraine?
The headache fever is on both sides of the head and mild to moderate in intensity. It feels like pressure, pulsing, stabbing, or dull. It is not the severe one-sided headache like migraine that puts the patient to bed with nausea, vomiting, and prostration.
What types of infection may cause fever with migraine?
Covid 19 usually starts with fever on both sides of the head which is mild, moderate, and non-throbbing.
Influenza, also called, the flu, is caused by the influenza virus. Although sometimes mild, the infection itself with its associated generalized headache, may be severe and lethal for older persons and babies.
Flu also has muscle aching, a runny nose, cough, fatigue, and sore throat. It may be treated with rest, mild pain killers, and cough medicine. Severe patients may benefit from antiviral drugs, if treated early in the course of the illness, and which reduce the severity and duration of the illness.
Epstein-Barr virus
Epstein-Barr virus causes mononucleosis, a common infection in teenagers. It spreads through bodily fluids, particularly saliva, which promotes the name for young romancers--"the kissing disease.”
Epstein-Barr virus may cause headache, fever, body aching, severe tiredness, and sore throat. Headache here is much like Tension-Type headache. Treatment is rest and hydration.
Sinus headache
Sinus headache as a term was invented in the 1950’s by the pseudoephedrine industry, maker of Sin-Aid, and other over the counter headache medicines containing pseudoephedrine.
There really is no legitimate “sinus headache” and the name is not in the Third International Classification of Headache. Most persons who think they have sinus headache have migraine, expressing it as posterior sinus and ocular pain.
There is diagnosis called “acute rhinosinusitis” which presents with frontal, behind the eyes headache, fever, and green and yellow nasal discharge. The illness may commonly occur after a cold.
Plain sinus X-ray may be diagnostic, and the patient is treated with a course of oral antibiotics.
Sinus headache
Acute rhinosinusitis may have accompanying symptoms of face pressure pain, sore throat, cough, runny, stopped up nose. In addition to antibiotics treatment is decongestants, steam, or warm compresses.
Read my article about “Sinus, Allergy, or Migraine headache” on my website.
Familial Hemiplegic migraine
There is one reported known migraine condition that is associated with fever—Familial hemiplegic migraine.
Diagnosis of FHM according to the International Classification of Headache Disorders 3, is made according to these criteria:
Two attacks of each of:
Aura with motor weakness accompanied by either reversible visual symptoms (flickering lights, spots, lines, etc.), reversible sensory symptoms (pins and needles, numbness, etc.) or speech symptoms
At least two occurrences of:
One or more aura symptoms that develop over at least 5 minutes
These symptoms lasting more than 5 minutes and less than 24 hours
Headache beginning within 60 minutes of aura onset: These headaches can last 4–72 hours, occur on only one side of the head, pulsate, be of moderate to severe intensity, and may be aggravated by common physical activities such as walking. These headaches must also be accompanied by nausea and vomiting, photophobia, and or phonophobia.
At least one close (first- or second-degree) relative with FHM
No other likely cause
Sporadic forms follow the same diagnostic criteria, with the exception of family history.
Severe attacks of hemiplegic migraine can lead to fever, seizures, or coma.
Familial Hemiplegic Migraine has known associated genetic involvement.
FMH is extremely rare and occurs in approximately 0.01% of the general population.
There are three kinds of Familial Hemiplegic Migraine, each with different genes involved.
FHM1 has mutations in the CACNA1A gene on chromosome 19.
FHM2 has mutations in the ATP1A2 gene on chromosome 1.
FHM3 has mutations in the SCN1A gene on chromosome 2.
There may be other loci which are not yet identified.
What type of inheritance is associated with FHM?
FHM is generally an autosomal dominant type of inheritance, although some cases have had a sporadic inheritance. Autosomal dominant inheritance means that one-half of children have a chance of getting the genetic make up for FHM.
Familial Hemiplegic Migraine
Read my article about “Familial Hemiplegic Migraine” on my website. www.doctormigraine.com.
Meningitis
The meninges are the plastic like tissue that surrounds the brain. Medical students are taught the following dictum: fever, headache, and a stiff neck are cardinal signs of meningitis.
Infection, immune disorders, or cancer commonly cause meningitis. Meningitis is a serious, life-threating condition requiring emergency medical evaluation and a spinal tap.
Symptoms of meningitis are neck pain or stiffness, photophobia, headache, confusion, nausea, and vomiting.
Encephalitis
The brain is called the encephalon and brain inflammation causes encephalitis. Encephalitis rare but extremely dangerous. Early symptoms are high fever and headache, followed by confusion, epileptic seizure, personality change, trouble talking, and loss of consciousness.
Viruses that cause encephalitis are: Herpes simplex virus (HSV), 1 and 2, Epstein-Barr virus, varicella-zoster virus, poliovirus, coxsackievirus, West Nile, La Crosse, St. Louis, western and eastern equine virus, Powassan virus, Rabies virus, measles (rubeola), mumps, and German measles (rubella).
Dental abscesses
Infections in the gums are tricky, rare causes of headache and fever. A dental abscess is a collection of pus in the teeth or gums. It results from a bacterial infection around or in a tooth. This should be evaluated by a dentist.
Cancerous Tumor
The cancer may be known or occult and may cause diffuse headache and fever.
Diagnosis of migraine
The patient who has “migraine and fever” should have an accurate diagnosis of migraine. It takes at least 5 attacks to make a proper diagnosis of migraine.
Migraine is a primary headache disorder with recurrent moderate to severe headaches which may be one sided, throbbing or pulsing, and associated with nausea, vomiting, sensitivity to light, or sound.
As a rule, a migraine, lasts 4-72 hours. Migraine headaches are worsened by activity and the affected persons wants to lie down or sleep.
Thirty percent of persons with migraine have an aura or warning that comes with the headache, which is usually visual, but may be numbness on one side, or trouble speaking. Sometimes the aura comes with small or even no headache. This is called Migraine with aura.
Migraine attacks may also be generalized instead of being one-sided. They may be located in the temples or behind the eye, on one side. Sometimes they start in the back of the head on one side and then come forward into the front of the head, behind one eye.
Migraine and Tension Type Headaches are 99% of headaches that occur. Tension Type headaches are usually mild to moderate in intensity, bilateral (on both sides of the head), and in the back of the neck and shoulders.
Read my article on “What is Migraine,” on my website, www.doctormigraine.com.
Migraine headache
Fever diagnosis should be certified by using a thermometer.
Temperature rated 100.4 degrees Fahrenheit, or more is a fever.
Thermometer
Documented case of fever caused by migraine.
Carlos M Ordás, et al wrote in Pain Med 2013 Aug;14(8):1260-4. On “Increase in body temperature during migraine attack.”
Abstract
Introduction: Intermittent fever has been occasionally related to migraine, either as a migraine equivalent or as a migraine accompaniment. We present a case of recurrent increase in body temperature consistently associated with migraine headaches.
Methods: A 15-year-old girl reported a 3-year lasting history of migraine without aura, with a feeling of warmth occurring in each episode. Ancillary tests did not show any evidence of secondary headaches or any systemic disease. A 2-month headache diary was obtained, with daily records of headache intensity (0, no headache; 1, mild pain; 2, moderate pain; 3, severe pain) and simultaneous measurements of axillary temperature. Both parameters were registered in the evening, at 6:00 pm every day. The distribution of headache intensity and body temperature as well as the relationship between both variables over time were analyzed with nonparametric tests.
Results: The number of days without pain was 28 (45.2%); a mild headache was present on 13 days (21%), a moderate headache on 15 days (24.2%), and a severe headache on 6 days (9.7%). Headache days were associated with higher body temperature than headache-free days (median values: 37.3°C vs 36.6°C; Mann-Whitney U-test, P < 0.001). Moreover, a positive correlation was found between headache intensity and body temperature (Spearman's rho coefficient: 0.83, P < 0.001).
Conclusions: Recurrent increase in body temperature may be another manifestation of the complex clinical spectrum of migraine. This symptom is probably related to hypothalamic involvement.
Meningitis is an inflammation of the protective membranes that cover the brain and spinal cord and is most often caused by a bacterial or viral infection of the brain and spinal fluid, according to the Centers for Disease Control and Prevention (CDC). Babies and children are at the highest risk for meningitis, though it can happen at any age. “Sometimes those patients have other symptoms to go along with that, like neck pain, neck stiffness, or neurologic symptoms [such as confusion],” says Strauss.
Rare cases of increased temperature with migraine
As the case above states, very rarely migraine will come with an elevated temperature ( this is usually called a fever but some writers do not want to use this word) and in this circumstance elevated temperature is considered considered related to migraine, either as a migraine equivalent or as a migraine accompaniment.
Comments regarding fever in “Migraine” by Oliver Sachs MD, Vintage books 1992, pgs 23 and 37-38.
“Many patients may complain that they feel feverish during the course of a common migraine, and they may indeed demonstrate flushing of the face, coldness and cyanosis of extremities, shivering, sweating, and alternating feelings of heat and cold, preceding or accompanying the onset of headache. The symptoms are not necessarily accompanied by fever, although the latter may be present, and are of considerable severity, especially in youthful patients.”
Periodic fever “High fever may occur in the course of severe common migraines, particularly in children. It may also be abstracted as an isolated periodic symptom occurring in its own right, and sometimes alternating with common migraines.
I have seen half a dozen patients, currently suffering from common or classical migraines, who had such attacks of periodic neurogenic fever in the past. The differential diagnosis may be laborious and tricky. In such cases, for all possible causes of organic disease must be considered and excluded before one dare postulate functional or neurogenic origin for such a symptom. The following case-history is summarized from Wolff. (The author of the currently disputed theory of migraine relating to vasodilatation, Wolff, H.G. (1963). Headache and other Head-Pain. Oxford University Press, New York.)
The patient, an engineer, aged 43, began suffering from intermittent attacks of fever of 104°F. In 1928, and he had continued to be afflicted with them…until 1940. It is of special interest that similar intermittent attacks of fever associated with “sick-headache.,” nausea and vomiting, had occurred in the patient’s father…
During late adolescence the patient himself began suffering from periodic headaches, especially frequent at times of emotional strain and diagnosed as migraine...Before each febrile episode. There were prodromal symptoms…a feeling of unrest, and difficulty in concentration. The temperature rose rapidly to peak and return to normal within 12 hours. Leukocytosis (in the neighborhood of 15,000 cells) occurred. After the fevers h’s e had a “purged” feeling with a sense of special well-being and mental efficiency.
The admirable case-history illustrates that attacks of febrile migraine equivalent might present a similar sequence to attacks of common migraine, with prodromal “arousal,” and post—migrainous rebound and replenishment. It may also be noted that the patient’s fever ceased following therapeutic discussion of his emotional problems and general situation, and the presumed mechanism of his attacks.” End quote by Sachs.
Concluding thought
Fever with headache is almost always due to infection; rarely it may be due to migraine. Dr. Daniel
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All the best.
Britt Talley Daniel MD
