On migraines

I woke up with a migraine this morning. Not a particularly bad one. But it inspired me to write a post all the same. I've suffered with migraines on and off for most of my life. I remember having them as a child. My mom had them as a child as well, so she recognized them when they cropped up in me (and my sister). I guess I had a form called cluster headaches. My mom gave me brewer's yeast supplements (four gigantic, brown, ugly pills a day) and taught me to massage my temples to help alleviate the headaches. At some point, I outgrew them.

I remember them coming back in college. I took lots of aspirin but it never really helped. They would get worse and/or more frequent for a stretch, then taper off again. More of the same in grad school I think. It never really occurred to me to see a doctor about it.

After grad school, one of my jobs required a lot of field work. I started noticing a few things. (1) My headaches were much more frequent on the weekends. (2) In the field, we'd spend the morning working outside, frequently in uncomfortably hot or cold weather. I'd be fine until lunchtime, when we'd go inside to more comfortable temps. Within 10 minutes of going back outside after lunch though, BAM!, headache. It seemed clear that stress and atmospheric changes were two of my migraine triggers. (In addition to red wine, dehydration (even mild dehydration), changes in sleep patterns, and low blood sugar -- all of which I identified over the course of the next few months to years.)

My headaches also started worsening. I'd wake up with a headache on Saturday morning and it would last all weekend, sometimes getting so bad that I would vomit from the pain. Vomit until my guts were empty and there was nothing left to bring up. Then I would have dry heaves. Not even water would stay down sometimes. And of course, the retching would make my head throb and pound even more.

Finally I mentioned this to a doctor. She sent me in for MRIs, because with sudden onset of severe headaches, they like to rule out neurological causes (like tumors, obstructed blood flow, etc). MRIs are pretty scary, that was the second time I've had one. This time I had a contrast and a non-contrast scan. Contrast is worse because they inject you with some nasty dye that makes your mouth taste like blood and copper, makes you feel like you have to pee, makes you feel weak and trembly, and generally is extremely unpleasant. The MRIs came back clean, and the doc diagnosed migraines and prescribed some kind of NSAID-sedative combo (I forget the name). These did help, mainly because they knocked me out while the painkiller took effect. But taking them basically put me out of commission for the day, as much as the migraine did. Over time, I needed to take more and more of them to get relief. Not good. Eventually they stopped working altogether.

Back to another doctor (I had relocated in the meantime), who suggested I should see a neurologist. DUH. Neurologist checked my MRI scans from before. ran some other tests, and prescribed some triptans. I tried a few different ones, many of which did not help. One did a little. But like the NSAID-sedative combo before, it really knocked me out. And it took longer and Longer and LONGER to bring relief. Then I noticed that after taking the triptans, my headache actually got worse before it would get better. And the headaches were increasing in frequency again, to the point where I was having them more often than I was allowed to take the triptans. (There's a limit on how often you can take them because frequent dosing can cause rebound headaches.) I started looking for other treatment strategies. Lying down in a dark, cool room with a cool damp mask or cloth over my eyes seemed to help a little, but again, took me out of commission. I found some peppermint infused eye masks at Bath & Body Works that really helped a lot, but of course they stopped making those. In addition, I started noticing that my headache never quite went away. The triptans would, after some time and much pain, take the edge off, but within half a day or so, the headache would be back, full-strength. Oh, also, triptans are EXPENSIVE, and my insurance would only allow me to receive a certain number in one prescription. Neurologist said the next step would be taking a daily medication to help prevent the migraines. However, there are no drugs currently available that were specifically developed for this purpose -- docs prescribe other drugs that seem to have secondary effects on migraines. These include beta blockers, antidepressants, anti-seizure meds and other heavy-duty drugs. Each of which, of course, has its own warnings and side effects. I was not keen on this idea.

Something had to give.

I spent some time thinking about what could have changed that suddenly caused my headaches to worsen so drastically, but couldn't think of anything. Until one day, I realized that the worsening sort of coincided with a new piercing I had gotten in the cartilage at the top of my ear. It couldn't be that, right? Right?! But the piercing never had healed up properly anyway, and I was desperate, so I took it out, just in case it was related to the headaches. And what do you know? Within a few weeks, the frequency and severity of my headaches was diminishing noticeably. I quit taking the triptans (which I never really liked anyway) and instead bought some OTC Excedrin for migraines. I was pretty shocked when it actually worked. I threw out the rest of the triptans and quit seeing the neurologist. The OTC drugs didn't knock me out or make me fuzzy all day, and they actually got rid of my headache completely. I was quite encouraged by my new success in treating my headaches, enough so that I pressed ahead in looking for a way to reduce them, or even eliminate them altogether.

I did some research online to find out the latest info on more natural, less distateful migraine prevention. I found a few studies that suggested that magnesium and/or B2 can help to "buffer" the expansion and contraction of blood vessels in the brain. (Blood vessel contraction, or vasoconstriction, is associated with migraine headaches; in fact, the NSAID-sedative drug I took for a while also included a vasodilator.) So I decided to give it a shot. I did some more research on magnesium and B2 supplements to find out which types and doses might be good and headed to the drugstore. I'm actually not a big proponent of across-the-board vitamin supplements, but I thought this would be worth a try. Whereas I was definitely not hip to taking daily doses of prescription meds (particularly off-label, and for a condition that I thought should be addressable with less drastic means), I was willing to try these daily vitamin/mineral supplements.

After a few weeks, I started feeling like I had fewer headaches. One major mistake I made is that I never kept a headache journal. This is really good idea, especially if you are evaluating various therapeutic or preventive strategies. In the most basic version, you simply record each headache that you have, date/time, any treatments undertaken, and the results. It is helpful to make notes every day, even when you do not have a headache, and to also record things like what you ate and drank (and when), time of onset of any headaches, headache severity (using any scale you like, as long as it is consistent), and anything else that you think might affect your headaches (stress level, atmospheric variations, etc). This can help you identify new triggers and assess the effectiveness of any treatments or preventions you may be using somewhat more objectively. In any case, I did not do this. Regardless, I definitely felt better. I was having headaches less often, they were less severe, and often a single dose of Excedrin for migraines would bring lasting relief, in less than an hour. So I continued with the supplements.

After a few months, having a headache became the exception rather than the rule. At that time, I noticed that if I didn't take the supplements one day, then I would have a headache the next day. But now that it's been a few years, I can skip a day or even two without necessarily having a headache. I wouldn't say that I am cured, but I will say that I have been able to successfully control my headaches for a few years now. They are much much less frequent and severe than they were, and when I do get one, I can usually knock it right out with some OTC NSAIDs and a quick nap, very manageable.

Can't tell you why I felt the need to write all that down, but there it is.