Hi Baad Dawg.
As long as we are understanding, i'm not trying to be anyone's doctor here...just sharing information...i dont mind sharing some generalities.
That is super that you have been checked by a neurologist and have the reassurance of a scan. You have a doc-pt relationship so he/she is your doc. That is so important. Internet sharing is no subsitute for a real consultation with a doc.
Migraines are typically: throbbing, associated with light/sound sensitivity. they can be on one side of the head or the other..sometimes both. sometimes with nausea. Sometimes preceded by vision changes.
Some people are genetically predisposed. Then it is a question of how many triggers does it take to reach that migraine threshold. Some triggers are: heat, dehydration, fluctuations in blood sugar, nitrates, blue cheese, strong smells, glare, fatigue, sleeping in too late, stress, rises in blood pressure, pain in other areas of the head/neck.
The purpose of those preventative meds it to raise the migraine threshold so that it takes a lot more to trigger a headache. Neurologists generally recommend preventatives if people are losing 4 days per month with headache. Betablockers are a good starting point, especially if there is a hint of high blood pressure. Calcium channel blockers can be used (verapamil). Recently Topamax has been FDA approved for migraine prevention...and it works pretty well in most cases. Specifically for exercise induced headaches, a dose of indocin is sometimes used an hour before exertion. Indocin is a anti-inflammatory medicine...so it has risk of ulcer, etc. I have some patients that use it before certain ...ummmm....activity...and it has been a blessing to them. On a more natural approach, there have been some studies that suggest magnesium, riboflavin, co-enzyme Q10 can reduce migraines. There is a commercially available supplement called Migrelief that is helpful for some of my patients.
Re. the temporal pattern..spells of a bad week for headaches...we see that in migraines for some people. I notice it for myself...I have migraines.
We also see it in "cluster" headaches. Cluster headaches are thought to be a variant of migraine...more common in men (especially men with hazel color eyes), typically extremely severe, onesided headache with watery eye, drooping eyelid on the side of the headache. Last for about 2-3 hours...then subside...only to come back the next day. They are strongly triggered by alcohol. They are called cluster, because the attacks come in clusters...daily for a few weeks, then they subside for perhaps a year or two. We use verapamil for those.