Me & My Migraines – A Preventative Update & a Good Excuse

So it has been a while since my last blog post and even longer since my last update on my struggle with migraines.  It’s all my migraines fault!

As I sat in the patient exam room, the nurse took my temperature, monitored my pulse, and took my blood pressure.  I had scheduled an appointment a few weeks earlier with a desire to discuss further treatment options for my migraines.  They were growing in frequency and intensity and were not controlled real well by the sumatriptans that I have relied on the last ten year to live a normal life.  Though I didn’t mention that I was currently experiencing yet another migraine on this exam day, it must have been apparent since the nurse, with extra compassion, said she hoped I felt better soon and dimmed the lights as she departed for my short wait for doctor to enter.

My former PCP had left the practice several months ago, so this was to be my first visit with my new PCP.  He was somewhat familiar since I had selected him for my husband, and my husband has been under his care for about a year and reported good things about him.

Dr. G entered the exam room, took one look, and realized I was knee-deep in a migraine attack.  He kept the lights low and introduced a medical student who was shadowing him for the day.  Dr. G took a quick history of my migraines and my treatment of them and noted that about 30 minutes earlier, I had taken a sumatriptan with the hope of overcoming the current attack.  It still wasn’t controlling it.  He advised the medical student that with my discussion of my migraine history, my medical chart, and my current state, he was not going to put me through the pain of an exam, particularly the pain of flashing a light in my eyes.  We were all quite confident of what was going on here.

His next question was one that would start a new course for me.  “What are you taking to prevent the onset of the migraines?”  I looked at him with no answer.  “You mean in all these years, no one has discussed prevention?”  My answer was, “no.”  I explained that for the most part, I was able to control the attacks, at least until the last several months.  Historically, I had a handful of migraines each month and the triptans would manage them.  However, for the last several months, I was getting several migraines each week and sometimes the triptans would work, sometimes not.  I was also at the point where I was rationing the triptans because I couldn’t refill the prescription as frequently as my head pain required.  I explained that my work was being negatively affected and my parenting was also suffering since my goal these days was to get through the day such that I could lie down and sleep.  However, even sleep was being interrupted frequently now because the pain would awaken me necessitating a trip to the bathroom to get yet another triptan.

My goal, I thought, was to obtain yet another referral to a neurologist and/or an integrated team of pain specialists.  In years past, I was told my migraines were hormonal and not neurologically based.  But perhaps this had changed I thought.  Perhaps I have both going on.  I had noticed several peri-menopausal symptoms, so my other hypothesis was that my hormones were particularly wacky and that perhaps I could find the integrated team of doctors who could treat me for both neurological and hormonal issues.  I had heard of at least two other women who found migraine relief through this type of integrated treatment approach.

Dr. G had other ideas.  “First,” he said, “We’re going to work on ridding you of your current migraine.  We need to break the cycle of pain you are on.  Then, we’re going to work on preventing your migraines.”  He explained several options.

• Blood pressure medications.
• Low-dose anti-seizure medications.
• Low-dose antidepressants.
• Lose-dose birth control pill.  Even over age 40 where there is no incidence of high blood pressure and the individual is a non-smoker many migraine sufferers have found relief with a lose-dose birth control pill – essentially, a low-dose hormonal replacement.

My blood pressure is very low, so my perception was that this preventative approach would put me super slow motion like that of a sloth and likely would not be effective.  He laughed and agreed I was not a candidate for blood pressure medications.  I inquired whether the anti-seizure mediations made sense since my migraines have been determined to be hormonal in origin.  He agreed that their effect might be limited.

That left the anti-depressants and the birth control pill (hormone replacement).  I admitted that the pill concerned me because of the research associated with hormone replacement after age 35 resulting in cancers.  I also mentioned that in the past, these pills made my migraines consistent but did not relieve them.  That left the anti-depressants.

Dr. G indicated that he believed these medications would be the best for me, but that so many patients have issues with the stigma of taking anti-depressants that he often has a difficult time convincing people to try this treatment course.  I explained to him that I would much rather be stigmatized with the ability to fully function as a mother, wife, and professional than feel like I do right now.  “Let’s try the anti-depressants,” was my reply.

He wrote out the prescription and noted that this was a first step.  If these don’t work, we can increase the strength.  If that doesn’t work, we try other avenues until we get the migraines under control.  “You have too many years until you are through menopause when it is likely these migraines will largely subside,” he said, and I agreed.

“Now,” he said, “Let’s work on getting rid of your current migraine.  I’m ordering a shot of Toradol.  This should relieve your pain today, so we can start from a painless state.”  He explained that this drug was not a narcotic, since I indicated I was concerned about driving home.  He said that it was much like a super-Ibuprofen and that I would be fine.  He wished me luck, handed me my prescription and orders to come back in about a month to assess.

Though I was still in much pain, I felt optimistic for the first time in several months.  Just the thought having several avenues of treatment gave me hope.  Minutes later, the nurse returned.  This shot will need to go in your hip and I’m told it burns a bit she had explained.  It had been years since I had a shot in the hip.  I followed directions and exposed some hip.  Burns a bit?  Ah, yes, but more than a bit!  For a few seconds, I forgot about the migraine pain since the pain in my backside superseded it!  But, it was over quickly and I made my way to check out.

I dropped off my prescriptions at CVS, took in some dry cleaning, and then made my way to the post office to pick up some stamps.  As I was standing in line, the Toradol took effect.  It was if I had walked out of a dark cave or out of a thick fog.  For the first time since late summer, I realized I was pain free.  I realized only then that I had indeed been in a constant state of pain for several months.  The pain had crept up on me without my knowledge.  I was having migraine attacks that I was progressively treating with triptans, but the medication was no longer bringing my pain down to zero.  It was enabling me to get barely functional such that I could get through the day, but getting through was it.  I was delivering my work projects at the deadline when generally by nature, I deliver in advance of the deadline.  I was parenting with an effort to get them prepared for the next day and not enjoying the current day with them.  I was parenting with very little patience, and the boys indeed were reacting in negative ways to my impatience.

I had forgotten what pain-free felt like.  It was amazing!  I thought to myself that while so many take prescription drugs, legally or illegally, to feel nothing or to feel some type of euphoria, for me, just feeling nothing was everything.  Feeling normal felt so abnormal and it was simply amazing.  “Next,” said the postal clerk, bringing me back to consciousness.

So it has been several weeks, and the daily low-dose of antidepressants seems to be working.  I have had a few migraines, but they have been quickly controlled by the triptans.  I’ve had my follow-up appointment with Dr. G and thanked him profusely.  Now being the aggressive pain manager he is, he suggested that I increase the dosage in an attempt to eradicate the incidence of migraines all together.  I responded that at the current dosage, I’m noticing none of the long list of side-effects that antidepressants can have and that if I can reduce my migraines to a handful a month and that they can be controlled by the triptans, I’m happy with that.  I can deal with this state-of-being for the next 12-15 years until I make my way through the tunnel of menopause.  More importantly, I can look forward to 12-15 years of being a fully function mom, wife, and professional again.

So this is my excuse for the delay in blog posts.  Though I have been largely pain-free for a several weeks now, after five or so months of constant pain and just getting through the day, I’ve had a lot of catching up to do.  There are still things undone, but I’m getting there, and importantly, I am no longer attempting to get through the day but rather enjoying the day – well most days.  And even the not-so-enjoyable days are better because, for the most part, they too are pain free!