Q. I’m starting to notice a couple of changes with my migraines and wonder if these are common. One is that I am getting mini-cluster headaches once or twice a day, 2 or 3 days before a big migraine attack, and the other is nausea with no migraine pain. I typically get the nausea after the migraine pain has begun, but is it possible it can switch?

A. I don’t know what you mean by a “mini cluster,” but it is certainly possible that an individual person might have two distinct headache types. Note that the symptoms of migraine and cluster are distinctly different from each other.

In either event, if you are experiencing flurries of migraine headaches, your physician might consider using brief bursts of longer acting triptans, such as frovatriptan or naratriptan, when these attacks occur, if clinically appropriate in a given individual.

Nausea without headache might occur in migraine sufferers; however, a primary cause of nausea without headache needs to be sought, including examining the gastrointestinal tract or the brain. The atypical pattern of your symptoms might best be evaluated by a headache expert.

Edmund Messina MD, FAHS
Medical Director
Michigan Headache Clinic
East Lansing, Michigan