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Friday, October 23, 2009

The Migraine Post

In which I expound upon my migraines, including their causes, effects, attempted treatments, and proposed treatment through lifestyle alteration, with much verbosity.

This post is for my own sake. Maybe there are migraineurs out there who can derive some use from it as well, but primarily this is for me to try to track, make sense of, and deal with what has become the primary feature of my life. I came across this quotation in an issue of Scientific American, from Didion's "In Bed": "For I had no brain tumor, no eyestrain, no high blood pressure, nothing wrong with me at all: I simply had migraine headaches, and migraine headaches were, as everyone who did not have them knew, imaginary." I've had both the phrases "just a headache" and "just a migraine" tossed my way. I know I've written what seem—even to me—like whiny, self-pitying posts over the years. If you were annoyed by them then, I advise you to stop reading; this is going to be exhaustive.

The History

I never used to get headaches, migraine or otherwise. Some time in the summer before my final year of undergrad (the summer of 2005), I started having to pull over on the side of the road during the hour-long drive home, and take a quick nap. It wasn't tiredness, it was nausea; I had no headache-type pain, just this nausea that made my body want to shut down and sleep until it subsided. It wasn't frequent, and I didn't think much about it.

In the fall, the pain started too. Every single day. Sometimes I would go to my morning class and then pop some ibuprofen and go straight to bed. More often, I'd skip the class part. Sometimes my cafeteria meal would consist of some packets of crackers and ice cream. Sometimes I would work my shift in the library with the office lights turned off and my head on the desk.

A friend of mine was into reiki, and offered to try to help. I didn't set much store by it, but eventually I caved—no harm in trying— and asked him to do his thing. He seemed physically affected when he touched my head, and said "you've got a lot of pain, kid." I borrowed one of his energy crystals—you'll try anything when you're desperate—and later when I gave it back he handled it like a hot potato and ran to the sink to cool it down. Another friend gave allegedly great massages; when she tried to work on my neck, she quickly became reluctant to touch me because of the immense pain she sensed.

I didn't even think of getting medical help until that winter; I wrote one of my final exams with my head lying on the desk, handed my paper in after half an hour, walked out the classroom door and into the nearest washroom, and promptly threw up. That night, I called my Mom (who was conveniently in town for a conference) in tears, and she took me to the emergency room. They gave me a triptan through IV, and diagnosed me with migraine. The nurse also suffered from migraines; we asked her what she did for hers, and I think of her words often: "I die. Every time, I die."

When I went to see my family doctor with my new diagnosis, she advised me to just go to the emergency whenever I got a migraine. Later, in the university clinic, the doctor on duty started me on my first preventative medication: amitriptyline. It did wonders, almost immediately! It was incredible to feel the evening coming on and have no pain. It didn't last, though. Another doctor gave me a prescription for Maxalt, which the doctor in ER had recommended I look into. He also referred me to a neurologist.

The neurologist's eyes boggled a little when I told him how frequent my migraines were, and again when I told him what my family doctor had "prescribed." I began on topiramate, and it too worked for a little while, though it had terrible side effects, primarily the deepest depression I have ever known. I changed to propranolol, which did help, even if it didn't "cure" me entirely. It helped so well, in fact, that he thought it safe to wean off, and said he was glad to have helped me. This was after quite a few visits, trials, and errors, and by this time I had graduated with my BA and had moved to another province to commence my MA. And it wasn't without its side-effects: I had trouble searching for words; I couldn't think quickly (and am well aware that I came across as a fool in my seminars).

So I weaned off, but the headaches became more frequent. Moreover, the nausea became a huge problem. I had a bad first year in grad school, so by this time I had temporarily withdrawn. But I was planning to return, and there was no way I'd be able to do so in that state. So I went back to the neurologist, and resumed the propranolol. That's where I am today.

Dealing With Pain

Before I was diagnosed, I dealt with the pain by sleeping until it went away. I took copious amounts of ibuprofen—four 200mg tablets at a time, sometimes 16 of them in a day. Of course I could never break the cycle; I'd wake up feeling well but the pain would inevitably return later that evening, or the next morning.

Once things were a little more in control, my method of dealing with my migraines was (and currently is) as follows:
  • take daily preventative medication
  • wear earplugs whenever humanly possible
  • sleep with an icepack for a pillow
  • get fresh air by walking to Starbucks for a blended drink (curiously, the only thing I can stomach when nauseated)
  • hide in a fetal position in bed and shirk coursework for the day
  • try taking a couple acetaminophen, or a Sudafed if it feels like my sinuses are involved
  • take a triptan if I need it to get through night-class
  • never go out for fun, ever; if it's necessary to do so, make sure I have a holiday the next day so that I can recuperate
When I imagine that I'm one of the world's lucky migraine-free inhabitants, I don't think I could conceive that a head pain could honestly have such a big impact on a migraineur. Such a pointless pain. Truly, it is unfathomable just how much it impacts one's life. Everything in my life is weighed around my headaches. Want to go out to a movie? Want to go out to a pub? Want to get together with friends for board games? Want to go to a concert? And yes, I play MMOs; Want to go on a quick adventure with gaming friends? —I usually decline all of these.

Because I know the next day will find me wallowing in bed, the blinds closed and the lights off, earplugs shoved in my ears, my hands clamped around my temples, an icepack caressing the crown of my head, interrupted by the occasional mad dash for the washroom when the nausea gets to be too much. I know I will die the entire day long. I know that a few gulps of water will be enough to violently upset my stomach. Heck, it'll probably happen regardless of whether I go out or not, but I'm not about to aggravate an already unstable head.

If I may indulge in a π-type moment, here are my failed treatments to date: high-dose ibuprofen, massage, caffeine, antidepressants, reiki, marijuana, beta-blockers, feverfew. No results.

My Own Triggers

Migraine diary? What am I supposed to write in it? The fact that I can't identify any common thread to my migraines? Tracking triggers has seemed like a fruitless endeavor, but here are some of them:
  • Foods: certain foods could be triggers for me, though I don't know what at this point. I'll expound more on diet a little later.
  • Pressure changes: I'm fairly certain this is one of mine. When the barometric pressure changes, my head gets angry.
  • Hormonal changes: again, pretty certain. I can't really predict this, because for some reason I don't follow the lunar calendar.
  • Muscle tension: my neck and shoulders seem to be in an unsolveable knot. Whenever I stop to think about it, I become aware of this enormous tension.
  • Eyestrain: I now wear glasses whenever I'm at my computer at home, and occasionally at work. They are probably the subtlest prescription possible since I have better-than-perfect vision, but they are supposed to save my eyes from doing all the work.
  • Bright lights: not so much a trigger as an aggravation. I wear sunglasses even when it's cloudy.
  • Noise: like I mentioned, I wear earplugs very often. Even the tiny physical pressure it exerts can relieve a bit of pain.
  • Stress: most of the time, I'm a very stress-free person; I don't have a lot of the responsibilities (e.g. work-related, etc) that most people have. I do occasionally get severely upset/stressed, but I'm not sure how to measure the impact.
  • Dehydration: I know I should drink more water. I know that nausea can erase all my efforts to drink more. It's gross, but water actually induces vomiting if I'm already nauseated.
  • Irregular sleeping habits: as a rule, I'm a poor sleeper. This is high on my priority list.
  • Irregular eating habits: I also need to work on this. Sometimes I find myself in night-class without having eaten a proper supper. Other times I find myself at home without having eaten a proper supper. Totally preventable.
  • Sinus problems: to my surprise, I recently found that a Sudafed relieved some of my headache pain when my other standbys had failed. We had mold in our apartment over the summer, and I suspect it aggravated my sinuses (which now feel permanently 'fuzzy').
And then there are the other well-known triggers like smoking and alcohol consumption, neither of which really come into my life.

Eradicating Pain?

The top migraine medications can only take me so far, and perhaps I'm as far as they'll go even now. The number of things that can be triggers is pretty disheartening. Jane McGonigal recently described her experience of conquering a concussion through a game, and I was inspired to take on my own Nemesis in a more proactive way than previously. It comes down to a complete lifestyle revamp.

It appears that, at this point, I need to set myself a very strict daily schedule. What time to get up, what time to eat meals and what to eat, how many glasses of water to drink and when to drink them by, what vitamins to take, when to take some time to exercise and how long, when to do homework, when to go to sleep. Something practical.

So here's my plan, and I'll evaluate it as I go along.

Diet: I'm starting off by primarily following the guidelines here as closely as possible; this means avoiding caffeine, MSG, foods containing tyramine. Cutting out as many potential triggers as possible, then eventually reintroducing things 1 or 2 at a time to figure out which (if any) are my specific triggers.

Water: to start with, I've scheduled in 3 glasses of water throughout my day. Sadly, that is a start for me. I don't like the taste of water, and it's all too easy to postpone it, so I need to force myself into this habit.

Exercise: I used to do pilates every day, and I'm going to resume that in the mornings. Running is a bit too strenuous and has triggered headaches in the past.

Other: I'm going to invest in some top-notch sunglasses to replace the near-disposable ones I currently use. A massage to unkink my shoulders and neck would probably be beneficial. I really want to try to solve my sinus problem, but I have not heard favourable reports about having them unblocked at a clinic. I hope to try reflexology within the year. Acupuncture is also on the list. Everything is fair game when you're desperate: meditation, prayer. Maybe even hypnosis.

I dream of a life where pain doesn't rule. If this new approach doesn't work, I can only hope that I will eventually outgrow my headaches.

Monday, October 12, 2009

Everyone loves pumpkins

Thanksgiving is probably my favourite day of the year. Everything about it is straight from my list of favourites: pumpkins, roasted fowlbeasts (or something equally delicious), cranberries, garden vegetables, the colour of the leaves, the perfect autumn weather, the harvest atmosphere, cats... etc.

Thanksgiving dinner yesterday was relatively small—only 6 of us—but delicious! There's something intrinsically cozy about my relatives' heritage home. I stumbled across this recipe for pumpkin loaf while browsing (and drooling) through Tastespotting, and 3/4 of one of the loaves was eaten in the couple hours before we left for dinner.