Sometimes I feel like a super hero: taking on several projects at once and testing my ability to multitask and schedule to accomplish all my goals on time with quality work. When I get on a roll, I feel like no one and nothing can stop me. Like any super hero, however, I have my Kryptonite: the migraine headache. When the migraine comes on, my progress is brought to a complete halt and I am powerless. Light becomes unbearable, sound becomes intolerable, and I feel like a hatchet has sliced through my cerebrum and is lodged in my skull. For years, I suffered from these headaches and felt totally helpless. When the migraine came on, all I could do was lay in a dark, silent room, sometimes for days, praying for relief, as no over-the-counter medication could touch the pain.
According to the Migraine Research Foundation, over 10% of people in the US suffer from migraine, a syndrome characterized by pain usually on one side of the head “accompanied by one or more of the following: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face.” Migraine disproportionally affects women and is often familial. Despite its prevalence and its ranking in the top 20 of most debilitating medical conditions, little is known about the cause of migraine and less than 0.03% of the annual NIH research budget is devoted to studying migraine. Migraine is difficult to diagnose and treat because symptoms vary so widely between sufferers.
Treatment options have changed dramatically over the years. Some migraine sufferers find relief with a simple analgesic combined with caffeine (e.g. Excedrin Migraine or asprin, acetominophen and a cup of coffee). Migraine headaches used to be commonly treated with narcotics, including shots of Demerol in the hind quarters. Treatment with narcotics, however, is notorious for causing rebound headaches. The narcotic relieves headache pain for a while, but as soon as the drug wears off, the headache returns and is sometimes even more intense. Migraine treatment was revolutionized by the introduction of the Triptans (e.g. Imitrex, Maxalt, Zomig, etc) in the 1990s. Triptans trigger the release of serotonin in cranial blood vessels causing them to constrict and inhibit the release of neuropeptides that are thought to be associated with pain. Unfortunately, triptans can only be used to abort a headache once it has started. The medication must be taken as early as possible during the migraine to be most effective. Triptans changed my life as they could stop or dramatically reduce my headache within a few hours.
Triptans do have many unpleasant side effects, some almost as undesirable as the migraine itself. Constriction of blood vessels can cause cramping in the legs and arms and tightness in the chest. In my experience, they make me very tired after the pain goes away, which allows me to function at least even though I don’t feel the best. Different triptans have different side effects, so if you try Imitrex, for example, and can’t bear the side effects, try Maxalt or Zomig to see if those are more effective. Imitrex is also available in injectable or inhaled formats with the idea that the faster the drug is delivered to the blood stream, the more effective it will be. Those that experience aura might take the drug at that time to stop the headache pain before it starts. (Aura is commonly a visual disturbance such as flashing lights visible only to the sufferer, but can also be auditory or sensory. Aura acts as a warning signal that a migraine is about to arrive. Not all migraine sufferers experience aura.)
Recently, I experienced a migraine that would not go away with my prescription triptan. I went to the emergency room because the pain was so intense. They treated me with a cocktail of diphenhydramine, toradol, and phenergan, which was quite effective. Phenergan eases nausea, toradol is a pain reliever, diphenhydramine is an antihistamine, but it is unclear why this can sometimes be effective for migraines.
Since there is no drug to prevent migraine, those who suffer from migraine can attempt to identify triggers. Migraine headaches can be triggered by things such as foods, alcohol, stress, smells, and hormonal changes. To identify your triggers, try keeping a headache journal. Write down the dates and times the headaches come. If no pattern emerges, try thinking about or journaling details like what the weather was like, what you ate those days, or what was going on in your life. If you are able to identify triggers, you may be able to reduce the frequency of your headaches or at least plan for when you expect them to come (in cases where they are linked to weather, hormones, or stress). Of course always talk to your doctor about your particular symptoms and the appropriate form of treatment for you.
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