The migraine thing

I’d like to thank those who commented and emailed me about this latest brush with Demon Migraine. Your concern is appreciated. It’s humbling that people who have never met you in person would take time to voice their support and offer suggestions.

For me, this is just a part of life, as it has been for over a 4 decades. I thought you might be interested in how this journey/ordeal has played out over that times, and it might show up in search results for someone who is trying to research their own brush with this.

The definition of migraine, as well as the mechanism(s) of how it does what it does, are the object of debate within the scientific circles where migraine is researched. The Merck Manual describes migraine as a “episodic primary headache disorder“. The National Institute for Neurological Disorders and Stroke say that “migraine is the result of fundamental neurological abnormalities caused by genetic mutations at work in the brain”. I’ve also seen it describes as a “neurological deficit disorder”, although I can’t find that one at the moment. The science has changed a lot just in the last decade, but various reputable organizations disagree over what migraine is, what causes it and how to treat it. Obviously, that doesn’t exactly make getting help easier, and trust me, you need help when you suffer from migraines.

Unfortunately, the medical community isn’t necessicarily great at helping, even with the 6th most common cause of disability on the planet. In the time since my migraines went from episodic (once in a while) to chronic (15+ per month) and from migraine without aura to migraine with aura and without aura, I’ve had all sorts of well-meaning medical interventions, most of which only worked for a while. It doesn’t help that I’m male and most migraine sufferers are female. Or that I had the first identifiable migraine around the age of 20, but that they didn’t get frequent until my late 40s, when I was diagnosed by sheer accident. My primary care physician made a valiant attempt at treatment, but eventually I was referred to a neurology practice, who over time made things a lot worse by prescribing the wrong meds and too many of the right ones, the combination of which sent things spiraling and, at least in part, led to my retirement at the age of 56. It also doesn’t help that most medical professionals are woefully ignorant of the subject, and that, if you get desperate enough (and in my view, foolish enough) to go to an ER with a bad episode, you run a good chance of being classified as “drug seeking” by a medical idiot. It hasn’t happened to me, but I know a couple of folks who have had it happen.

For the record, opioid pain meds do a grand total of dick for a migraine, unless they give you enough to knock you out. Unfortunately, not every medical practitioner out there knows that, and those who don’t rarely are intelligent enough to believe you know your problem better than they do, and that when you ask for a big honkin’ steroid shot plus anti-inflammatories, you aren’t asking for pain meds. Yeah, I have had that argument-twice-and I damn near got arrested once. Fortunately I wasn’t coordinated enough to quite get my hands on the so-and-so’s throat and some calmer medical professionals “prevailed”.

I have considered that these things didn’t get out of hand until I was identified and treated, and I wonder if there might be some connection between the treatments and the number and intensity of episodes. The only way to test this is to go off all five of the preventative drugs I’m taking and to take none of my three rescue drugs I use when a migraine comes to call, and then give it a year or so to see how that works. This doesn’t sound like a test I want to try.

My neurologist, who I am fortunate to have, is one of the top guys in his field. I’m lucky he’s within driving distance. He’s concerned that, after a few years of success, I’m almost back to the place I was when I first came under his care. We’re going to be looking at some things, including the possibility of a neck injury that could be the aggravating factor that started things going downhill. He did stop short of ordering another MRI, which I’m grateful for. Those are expensive, and as I asked him once, “Doc, if this was a tumor, wouldn’t I be dead after 40+ years of this by now?”

At least I know, mostly, what my triggers are. One of the worst is weather. Any sudden change in barometric pressure puts my on edge, and I’ve been able to accidentally induce a migraine by driving up a mountain too fast. And hurricanes-those are ungodly.

Another trigger is ethanol. As much as I used to enjoy a good drink or three or a few beers, that stuff is kryptonite to me. I can drink one beer and have about a 50-50 chance of a migraine. Two and I’ll have one. The last beer I had was at Daughter’s wedding reception in 2018. It may be the last I ever have.

Nitrates and nitrites, used in food preservation, are no bueno. Things like sausage, pepperoni and bacon are on the list of things I can eat only if I can find the “uncured” versions. I do eat regular cured bacon from time to time, because while I can do without pizza and beer, life without bacon is too dreary to contemplate.

Bright lights and extremely strong odors can trigger a migraine. I used to love the smell of a properly perfumed female, and now perfume is deadly. So are cigarette smoke and strong chemical odors. Department store perfume counters and grocery store detergent aisles are no-go areas.

Stress, unless it’s really rapid onset, is a contributor but not a trigger. But let me get angry enough, and yeah, I can set one off. I used to do that when I was working. Another thing that you’re warned about, being ultra-regular in your sleep habits, doesn’t seem to be a big thing as long as I get enough sleep. Going short on sleep for several days is not a good thing, and raises the likelihood of a migraine.

Despite everyone, including my neurologist, warning me off chocolate and caffeine, those don’t seem to cause problems. In fact, I crave them when I’m having a migraine. No explanation, but once upon a time there was a theory that vasodilatation in the cerebral arteries was a cause of migraine, and caffeine is a vasoconstrictor. Again, I have to wonder.

But enough of this, at least for now. I had 4 bad days and I may get through a third reasonably good day without a migraine-if the rescue med I just took does it’s job. I need to get away from the computer and the lights.

Damn cold front.