My Top 25 migraine treatments

Disclaimer: This is just how these things worked for me -- not what is statistically proven to work well for most people. I advise trying everything and anything before dismissing any course of treatment out of hand.

I was going to do this list from last to first in effectiveness -- for suspense -- but then I decided most people want to know what works best first so why bother being coy?

It was kind of difficult to rank these, especially the ones in the middle, but they fall into three basic categories: Stuff that worked at least for a time, stuff that didn't work at all for headaches but was useful in other ways and stuff that didn't work and in fact made things worse. When it was tough to decide which slot something should go in, I looked at things like cost and unpleasantness as tie breakers.

I suppose I should note that I am currently on an antidepressant, doxepin, prescribed by my current neurologist, but I've only been on it for about a week, and although so far it hasn't been very helpful and makes me very, very sleepy besides -- I hate to weigh in on it till I've given it a fair trial.

Anyway, without any further ado:


Number 1 (drum roll)

Triptan drugs (Maxalt, Relpax, Frova, among others)
I was actually a little surprised when I realized how much I have depended on this class of drugs over the past nine years. Relpax was the first drug I was prescribed for migraine, and currently I'm using Maxalt. I've tried some of the others when given samples, and they all seem to work about the same for me.
You'd think I'd be more grateful for the medicine than enables me to have a somewhat "normal" life (whatever THAT is) -- but no, all I can do is insult them. Mainly I object to the side effects, which for me are overpowering fatigue and a general sense of malaise and spaciness.

But without them, I probably would be spending 4-5 days a month in bed and I doubt I would have been able to continue being employed (what kind of job do you know of that gives you that much sick time?) However, there are other issues with them, like that you shouldn't take them too often or you will start developing what they call "rebound" or medication overuse headaches. And for me, I almost have to take the stuff before I know for sure the headache is going to turn into a migraine or it isn't effective. This makes it difficult not to take it too often. Frustrating. But still, as I said, I don't think I'd have been able to keep working without them.

2) Tofranil PM (a tricyclic antidepressant)
Tricyclics are an older class of antidepressants that are probably more often used to treat migraine these days. Aaaaahhh Tofranil. Of every preventative drug I was on, this one worked the best for the longest. And it helped me sleep better and feel more cheerful. Got about 10 full months of relief before developing a tolerance (I guess is what happens. Side effects were dry mouth and slight constipation. Easily tolerated in exchange for the benefits.

3) Topomax (an epilepsy medication)
This was highly effective for about eight months, but I had to increase the dosage every couple months or so. By the end when I was on the maximum dosage before it quit working, I felt like I was slowly being poisoned to death. It messes up your appetite so you lose weight, which I didn't mind, but it also has cognitive side effects leading it to also be referred to affectionately as "dope-omax" and "stupid-max." Actually, it was kind of funny sometimes. I'd try to say a simple word like "match" or "car" but what came out was "penny" or "house." Also, oddly, it makes carbonated drinks taste bad.

4)Coenzyme Q10 (this supplement is related to mitochondrial DNA)
I read that studies find CoQ10 can cut migraine attacks by about half, so I thought it was worth checking out -- I believe it has helped. At first the improvement was dramatic, and I felt very hopeful about it, but as with most things, its effectiveness waned with time. But anyway CoQ10 is the best supplement I've tried so far for migraine, it is reasonably cheap, has few side effects and is probably good for some other stuff as well, so it's still part of my daily regimen.

5) Hormone replacement therapy
I've been on bio-identical progesterone prescribed by my gynecologist for about the past four months, and I believe it has helped, but it seems as if its effectiveness has begun to wane. I'm going to keep on it and see how it goes.

6)Wild yam extract (taken for hormonal support)
For the first few months I took it, it seemed to be effective, but after that, it didn't seem to make much difference.

7)Progesterone creme
See Wild yam, above. The reason I rated it lower is that it's more expensive. Wild yam is quite cheap. Neither had any noticeable side effects.

8)Topical magnesium supplement
This, too, seemed to be helpful for a few months. I'm not sure what's with that. Could be psychological, I suppose. Who knows?

9)Meditation
You know, I can't really claim this doesn't work. I was just thinking about it again this morning and I bet if I checked into a monastery for six months and meditated about 10 hours a day I could kick this. Seems like it's worth trying, anyway. If that says anything about how I feel about migraine. While my sporadic attempts at using it haven't seemed to help to avert attacks, sometimes I use breathing exercises to cope with the pain, and it is moderately helpful for that.

10) Dr. Steve's lozenges (made of stuff like ginger, feverfew and some other herbs)
Dr. Steve contacted me from this blog, and his remedy seemed to help at first, then lost effectiveness (deja vu all over again, right?). He was really nice about sending me free samples to try, though. I suggest at least giving it a try.

11) Yoga
I find yoga enjoyable and it helps with relaxation and stress reduction, which you'd think would help a great deal. Which is why I think that stress is not one of my significant triggers, because even when I was doing yoga weekly, it did not substantially disrupt my pattern of migraine attacks. However, if stress is a trigger for you, I HIGHLY recommend yoga. If you find the right teacher, it's wonderfully trance inducing.

12) Exercise in general -- bike riding, walking and running mainly
Although exercise has been effective in the past at eliminating headaches of the tension variety, I've had very limited success in using it to beat migraine. I used to have this working theory that whoever said you couldn't run away from your problems wasn't running far enough or fast enough, but when it comes to migraine, even a daily, moderate to strenuous regimen has not been sufficient for me to outrun it. However, as I said before, if stress is a significant trigger, I think it could be helpful.

13) Neurostimulator
To be honest, I'm really not sure where to rank this one, which is why I decided just to stick it in the middle. If I were to do a cost-benefit analysis, considering all factors, I'd say my return on the investment is slight at best. A previous blog post contains more details about my experience with this device. However, I can't say it hasn't helped at all. It's possibly saved me from having to take meds a couple of times a month, but I'm not completely convinced of that. I am going to try turning it off for a few weeks -- maybe even a month -- to compare. So far though every time I try turning it off, when I start getting a headache I get scared and turn it back on. I don't know if it helps, but it might,

14) Nasal rinses with a neti pot
Great for the sinuses, and can be rather soothing to an achy head, especially when the saline solution is heated to about 100 degrees, but I don't think it ever significantly decreased the frequency or intensity of my migraines. However, I have not had a sinus infection since I started using it, and I was plagued with them previously.

15)Chiropractic adjustments
I tried this for about three months and enjoyed getting my back cracked and doing this thing where these electrodes were placed at the base of my skull, and at first I thought it was helping, but after a while it was back to the same old same old -- I'd have kept doing it anyway, because as I said it was enjoyable, but it was effing expensive and my insurance didn't cover it.

16) Biofeedback
Tried it for a few sessions, but quit going when I realized that a good yoga class gave me more benefits than the techniques the practitioner was teaching me. Not a bad concept, but to my mind, for serious relaxation yoga and meditation are probably more effective.

17)Dr. David Buchholz's regimen
I cut out a whole list of foods he claims are triggers for some people for about three months. Stuff like bananas, avocados, onions, cheese, nuts, fresh baked baked baked goods -- a lot of things that are hard to avoid, but I did it. Didn't seem to make a bit of difference.

18) Food allergy and sensitivity testing
This, too, came back a whole long list of stuff I should avoid, and for about three months I diligently culled them from my diet (with occasional lapses -- sue me) This diet included avoiding milk and dairy products, chicken eggs, sugar, vinegar, yeast, olives, mushrooms, venison (that one was tough to avoid, lemmee tell ya) red beans, and I forget what all. Also, you weren't supposed to eat the same thing twice in four days, to avoid developing new sensitivities through repetitive eating. So, at the same time you're taking out a bunch of dietary staples, you're supposed to increase the variety of your diet. A recipe for frustration is what that is. Doing this diet the best I could for about three months didn't appear to make a dent -- but on the plus side, I lost about 10 pounds. I still feel kind of superstitious about those foods, and try to avoid them when I can, but I don't really believe my triggers are food related.

19) Butterbur
nada, nothing, zip, zilch.

20)Wild oregano oil
I tried this a long time ago, on the theory that my (rather mild) pollen allergies were a trigger. I still believe they are, but this stuff didn't seem to help too much. This was something I tried a long time ago, and my memory of it is a little fuzzy. Mostly I remember it tasted nasty. I thought it kind of helped for a little while, but truly, I barely remember.

21) Acupuncture
This wasn't very helpful. Mostly I ended up with throbbing pain at the base of my skull from the actupuncturist using increasingly large needles in an attempt to stab the migraine into submission.

22) Seasonique birth control pills (this was prescribed by a nurse practitioner at my gyno's office after a discussion about whether my hormone levels were causing migraines) It's been a while, but I seem to recall side affects of insomnia and headaches and no benefits.

23) Amitriptyline HCL (another antidepressant) Not quite so dramatic -- but it didn't help and after a couple of weeks I was having suicidal thoughts out of nowhere, which was freaky, so I had to get off it.

24) Celexa (an antidepressant) I was prescribed this by the Worst. Neurologist. Ever. So I wasn't surprised when it didn't work. The first time I took it I had raging insomnia and woke up the next day with a migraine that knocked me out for two days. I was too scared to give it another try.

25)Beta blockers -- otherwise known as blood pressure medicine. Although I have heard these work well for some people, they caused me to feel so weak and sick and shaky I couldn't make it a whole week on the stuff. I think I tried two -- propranolol and nadolol.


26) okay, I know I said 25, but I thought I should mention a few other things I've tried including various homeopathic remedies, aromatherapy remedies, magnetic bracelet... I'm pretty sure there are a few other wacky things I've tried over the years as well but overall, this is a reasonably comprehensive list. Also, for clarification, don't talk to me about over the counter headache meds like Exedrin Migraine, Advil Migraine, Tylenol, BC powders or anything like that. Those things haven't been effective for me for years.

P.S. Sorry, was reading over this and realized I never mentioned Allegra -- I believe my mild pollen allergies do contribute to the critical mass of my migraines, as they tend to be slightly more frequent during the spring tree pollen season and the fall ragweed season. This year, I popped an Allegra each morning. Obviously it did not eradicate my migraines, but I believe it probably helped me to avoid taking stronger drugs on some occasions. I'm not sure where I would place it -- somewhere after CoQ10 in my box o' tricks to thwart migraine.

Stuff I still haven't tried:
Botox, depacote, reiki, hypnosis, a couple other antidepressants I've heard have helped some people -- cymbalta is one, but I dont' remember the other one right off hand -- I think I read about it on the Mayo Clinic website;

The procedure, part II

I think I started this more than a month ago so I really ought to finish it...

When we last saw our plucky heroine, she was awaiting surgery for a neurostimulator implant at Humble Surgical Hospital in Texas, with great trepidation.

It was strange coming out of the anesthetic.

Before I reached consciousness I remember saying over and over in my mind -- at least I think it was only in my mind -- "I believe. I believe. I believe..." Just what I believed then was a mystery to me when I finally came to completely. God? Modern medicine? Ghosts? Who knows?

My throat hurt and I desperately wanted water, but all I could do was croak "hurt," to which a nurse said she would give me more pain meds -- I said "No, no!" because the last thing I wanted at the moment was more drugs -- I was totally fucked up on dilaudid. They told me about a button I could press for more drugs. I wondered what was to stop patients from overdosing.

It seemed like it was hours before they finally gave me water.

Throughout the night they continued to wake me up at intervals, and each time I remember thinking, "Oh God, I did it. I actually did it." And not in a good way, either.

The next day was beyond awful, but I guess it doesn't materially explain anything about what it's like having this device implanted in my body, so I'll skip it. Suffice it to say I had a bad reaction to the dilaudid and the surgery was probably about twice as difficult to recover from as I'd expected -- the doc told me they could do it as an outpatient procedure, they just recommended the overnight stay "for the patient's comfort." I actually think I'd have been better off at home without the intravenous pain meds, but then, that's that perfect hindsight vision.

In any case, a technician came and programed the device for the first time before I was discharged. I was given a handheld device that controlled the programs, of which I was given four at first. The programs controlled the intensity and the frequency (I guess that's what it is, anyway) of the stimulation, and I could control each of the four leads separately, if I wished to.

Once I got up and around, I found the wires in my head much more painful than I had realized they would be. It felt something like wearing a tight, rather heavy wire mesh cap on my head.

The pain from the incision in my butt wasn't that bad -- in fact, I barely took the pain killers they prescribed for after the surgery. I took half of one maybe 3-4 times. Mostly the dilaudid had made me so sick I wasn't really in the mood for more medication.

It seemed to be helping at first. I don't recall having any major migraines the first couple of months -- but I think it was a fluke. I think I was just in one of my good phases, which I do have from time to time, happily. But I liked to think that the device was actually stopping them before they even started. So I was prepared to make peace with the infinite weirdness it was sharing my body with a foreign device.

The stimulation itself feels a little odd as well. In some ways reminiscent of the pins and needle tingling of a limb that's fallen asleep. At low levels it's somewhat pleasant, but when turned way up (which I do when a headache starts) it can get a bit uncomfortable.

This might be the moment to say I was raised in the Christian Science faith, and although my family wasn't fanatical about it -- we went to doctors and took medicine for colds and such -- there was a certain underlying mindset that health was a more or less spiritual condition, mind over matter, that sort of thing. Sorry I'm not explaining it better, but I'm not sure how much a theological discussion will add to this already lengthy blog post...

Anyway, I just wanted to explain how extreme and intrusive this all seemed to me. I have crazy scars on my scalp (which are covered by my hair, but they still feel really weird) and you can actually feel the wires under my skin and even see them faintly in my forehead. I wear bangs to cover it up. There are also ugly scars in the middle of my back and of course on my butt, which doesn't thrill me.

However, as time went on and the wires and device healed into place, it became slightly less uncomfortable. Full recovery from the surgery took at least a couple of months and going back to work the week after it was a mistake. Taking two weeks off probably wouldn't have been excessive. I didn't really feel the doctor adequately prepared me for what to expect, but I don't know if my experience was typical. Knowing me, it probably wasn't.

I hadn't had the thing very long when all of a sudden the two front leads stopped working. The programs with those leads wouldn't load, for some reason. A couple of programs controlling only the back two leads worked, but pretty soon (by September --I had the procedure in June) I started having migraines again. I went in once and the tech was able to get all four leads up and running, but it wasn't long before the front two conked out again.

When I went back, she couldn't get them going again, and she told me I'd have to have a revision -- basically go back in for surgery, which I dreaded.

Fortunately, the revision was an out patient surgery and they didn't have to mess with the wires in my head -- only the incisions in my back and butt were reopened.

So we did that, got them working again, did more programing -- and by the next month I was back to the same old routine. After the first surgery the tech had told me it might take a few months to tinker with the programming to get it working for me, so I tried not to get too discouraged.

But I've gone back for programming a couple of times since then, and it pretty much seems like I'm taking about the same amount of medicine and spending about the same amount of time in agony as I ever did.

I'm going to go back again for more programming (I've been putting it off because a.)I don't have much hope it's really going to help and b.) I haven't felt like driving over to The Woodlands, which is where Dr. Chapman's office is. But if I still don't see some substantial results, I'm going to look into having it taken out -- which I am also putting off because hello, surgery, not fun!

There are a few more details and odds and ends, but I'll leave that for another post.

Adios, fellow migraineurs -- may you stay one step ahead of your migraine demons, or something like that.

Oh, the places you'll puke!

Here's a little known thing about migraine for people who don't have migraines (you know, those people who think it's "just a headache"): Nausea and vomiting are a signature motif of the migraine experience.

It's something I don't talk about too much, cause it's kind of gross, really, so what better place than here to spew? (So to speak...)

This weekend, when I spent a great deal of time staring into my toilet bowl (only to realize it was disgustingly dirty -- one of the first things I did when I came out of it was to give a good scrubbing) I started thinking about all the places I've puked.

There's my apartment, of course, but that's to be expected. During a bad migraine I usually make a little nest of blankets or towels on the bathroom floor so I can rest up before dragging myself back to bed.

I pulled over and puked out the car door on my way home from work one day. I puked in a restroom stall at work once. I was just happy no one walked in mid-puke -- I'm sure they would have thought the worst.

By far the nicest place I've puked was the Crowne Plaza hotel in Alexandria, Va. If you're going to have a migraine, I recommend the Crowne Plaza. The bed was comfortable, the room was dark and cool and smelled nice, and the bathroom was beautiful and immaculate. Also, they let me check out late when I explained about the migraine situation.

The worst place I've puked was in a port-a-potty in Austin, Tx, but maybe it's not fair to include that because it was from food poisoning, not migraine. Worst place I've puked from migraine was probably a roadside in Louisiana. That or a rest stop in Louisiana. It's a toss up. Nothing against Louisiana, however. I have a great affection for the state otherwise. That Napoleonic Code rocks!


Oh, and I puked on a sidewalk in Washington D.C. A lady looked at me like I had the plague, but I suppose that's to be expected when one vomits on the sidewalk. Funny thing about that was, I felt like upchuck was imminent, so I crouched down, but nothing came up, so I stood again. I took two steps and water just started shooting out my mouth. That was actually one of the more pleasant vomiting experiences I've had, because I'd been drinking a ton of water. Water (in large amounts) is the easiest thing to puke, followed by vanilla ice cream or milkshake. Lentil soup is awful to barf up, as are jalapenos. Oddly, cranberry juice makes for an unpleasant puking experience. Really, most foods are significantly worse coming up than going down.

I puked in a park near my house (same trip at the Louisiana rest stop barf break -- tried to make it home to the privacy of my own toilet, but no dice).

I puked at a Texas truck stop -- fortunately it was a fairly nice, new, clean truck stop, so it wasn't so bad.

Puking and travel seem to go hand in hand, and I think I know why that is -- I've noticed activity and exposure to light tend to increase nausea, so if I have a migraine while I'm traveling, I'm a lot more likely to be in situations where I'm forced to be up and around and out in the harsh light of day.

There are actually a couple of good things about puking during a migraine. For one, it breaks up the monotony a little. When you're lying in bed and you keep looking at the clock and every minute feels like 10, taking a puke break eats up some time, and changes the scenery a bit. Also, it is tiring so sometimes I can fall asleep for a little while after a good puke, which also passes the time painlessly. Other than that, there's really not much to be said for it.

Weird new pains

Well, sadly, the beneficial effects of the CoQ10 seem to be ebbing -- as everything else that ever helped seems to have done eventually. I got two-three good months out of it, so I guess that's something. Also, I'm not sure if it helped with my chronic low-grade depression or if that came about because of the relief from pain...

Anyway, today has been, well, not terrible, but just kind of trying.
I had a fun assignment out at a wildlife refuge for most of the morning, but the whole time had the nagging throb of a threatening headache that skimmed a bit of the fun off the surface.

By the time I got back to the office, the signs were unmistakable and it was time to take maxalt. I got it out of my purse and held the packet in my hand, sat there looking at it and thinking about how much I hated the way it made me feel and set it down on my desk. I thought, "well, maybe nothing much will come of it, and if it does, I'll just call in sick tomorrow if I have to. I still have one sick day left to get me through to April 1, when the clock starts again on sick time (yeah, I know, that's a strange timetable for sick time -- too complicated to explain).

But it kept intensifying and thinking about how much worse a full blown migraine feels than the unpleasant side effects of triptan drugs finally persuaded me to just take the damn thing. I did, but when it hadn't had much effect in an hour, I started to think maybe I'd waited too long and braced myself for the onslaught.

It never quite came. I went home and laid on my bed for a while and felt things shifting about inside my skull. Couldn't tell quite what direction things were headed. Now, a couple hours later, I'm feeling the sensations of the maxalt starting to work -- but there's something slightly worrisome: I'm feeling this weird pain at the back of my head, starting near the top and kind of branching down the sides. Not sure what that is and it's something new.

Anyway, it's disappointing about the coQ10 -- I really hoped that might be of some lasting benefit, but I'm back in one of those phases where I've been fighting a headache for about the past 10 days and I start getting worn out with it and worrying about how much worse things might get. I hate myself for all my worrying. It doesn't help anything, and in fact probably makes it worse.

As I said, I'm looking into another option, but I haven't had a chance to get around to making an entry about it here. I will, I promise. But in the meantime, here's a link to a news story about it:

http://www.mlive.com/living/kalamazoo/index.ssf/2009/10/nerve-stimulation_implants_eas.html

Anyway, it seems a little extreme, but I can't say as I really feel that great about taking triptans 10-15 times a month. The literature that comes with the prescriptions says something about an increased risk of stroke, which is something that concerns me.

Soooo... I will try to get to that post about neurostimulation soon, I promise, oh my vast audience of avid followers!

A ray of hope

Sorry, I've been away for a while -- a bit longer than two months, to be precise.

So where were we?

I'd just had a bad headache and as usual, I had put off using medicine I knew would work because I dreaded the side effects so much.

I've been a bit more pragmatic since then. December was not a great month in my head, but I dealt with it more effectively -- I took medicine when I needed to and while I didn't avoid all pain, I didn't spend any days in bed moaning in agony.

I also gave Excedrin Migraine a try. It works, but the side effects, while different than Maxalt, are still unpleasant. For one thing, there's a shit load of caffiene in that stuff. I try not to take it after 4 or 5 p.m., because I can't fall asleep. Also it upsets my tummy and generally makes me feel a little cruddy (I've never dealt well with caffiene -- it's what's kept me from getting addicted to coffee or Coca-cola) But I did use it a few days when I was at work and needed to be alert.

I'd been trying an herb called butterbur, which I thought maybe was helping, but since I still ended up using harsh medicines about nine times, in retrospect, perhaps it wasn't working that well after all.

But toward the end of the month I got an email from someone who claimed to be a doctor and offered to send me a free trial of a medication he had developed. Dr. Steve Roberts is his name. I wasn't sure what to think. I checked out his Web site and did a little searching around on the Internet about him, and there was indeed a Dr. Steve Roberts who appeared to be a reputable migraine expert and this seemed to be one and the same as the one who contacted me. I figured he either found this blog or found me on one of a number of migraine forums where I have posted questions.

I figured chances were slight that he was a psycho out there looking to poison people, and since the ingredient listed in his concotion didn't appear to be anything that could harm me, I thought, 'what have I got to lose?'

So I said, 'Sure. Send me the stuff.'

It's called Banjo. Here's the link with more information:

http://drstevesbanjo.com

When I got it, I was still a bit nervous about it, so it took me a couple of days to start with it, but then by the third day I was feeling a bit headachy, so I jumped in. I did not end up getting having a migraine or even a headache that day.

I had a pretty decent January, all in all. I had two times when I succumbed to Maxalt. Dr. Steve (who has been very accessible and responsive) asked me if I took two of the lozenges when I began to have the headache and I don't believe I did. In any case, going from nine to two in a month is a good sign (although I have had good months before). So, I'm cautiously optimistic.

I am going to keep using Banjo and see what happens. I would really like to have my life back from the migraine monster.

Migraine is the Devil

But then, we already knew that...
Well, I had my second two-day knock-down drag-out headache in two weeks. I took my last sick day last time, so this time I guess I'm out on a "personal day" (this year they took away one sick day and gave us an extra personal day, whatever that is)
This headache was fairly run of the mill, except of course that it's dragged on FOREVER and that gets very old.
But as usual, the worst of it is the fear. Where is this going? Is it going to get worse? Am I going to lose more and more days to this monster?
This time, laying there in pain with nothing much to occupy my mind, I considered writing a sonnet about the monster/devil that is migraine.
I came up with a partial first line, but now I've already forgotten it. Something about a monster that eats days...

Anyway, this one was my fault for experimenting, I suppose.
On Saturday I was getting a headache and I tried hitting it with BC powder, which sometimes works. It seemed to dull it for an hour or so, but then it started coming back. The Maxalt has been hitting me pretty hard, so I thought I'd try half of one to see what happened -- and it worked pretty well. Okay, it was slightly more than a half because I broke it in two when I was standing in a long line at Ross trying not to lose my mind while one lady's transaction seemed to take about 20 minutes or so... but I digress. Anyway, I took the bigger "half" of the broken tablet, and, as I said, it worked pretty well. Headache went away and I was only slightly tired -- not overpoweringly sleepy.

So, on Sunday when my head began to hurt again, I took the other, smaller half. Didn't seem to have any effect at all, so in another couple hours I tried a BC. Which, again, had no impact whatsoever.
So by dark, I was in bed, and the fire had started.

Missing work was more of a problem than usual because this is Thanksgiving week and they always need extra stories to get through the days when people are out. Holidays in the newspaper business are really hardly worth the trouble. All the days off mean is you get to do the same amount of work in less time. I know, poor me. Poooooor, poooooor meeeee.

Anyway -- in denial, I got up and my head seemed slightly better, so I decided the migraine was on its way out. But it was getting late so I called in and said I'd be late -- about an hour. About an hour and a half later, with the head throbbing again, I called back and said, uh, sorry -- I was lying. Head's worse again and I don't know when I'll be in.

Oh -- here's one new thing about this one. When it started being a migraine it was on the left side of my head, but by last night, it had moved over to the right side. I don't recall it ever doing that before. Again with the fear... how much worse is it going to get? What if I can't work? What's going to happen to me?

A possibly tedious recounting of my four-headache week...

Last week was not a great week in my head.
The headache I woke up with Monday faded away before noon, which was a great relief.
Tuesday was okay.
Wednesday started out fine, but by lunchtime the noise was starting up in my head and it became that question of whether to take Relpax or risk the consequences -- a question I had to answer before eating lunch.
If I time it just right, often I can take it just in time so that it's bad enough so I am certain it was necessary but not so far gone that it won't do any good. I've gotten pretty good at gauging that, generally. On Wednesday I decided to take it, and I think it was justified.
It made me feel really, really sleepy as it sometimes does, but I managed to get through the day.
Just as it was taking effect I was interviewing two geology professors at Lamar University. When it hits me hard like that I often wonder if other people notice something odd about me -- like maybe they wonder if I'm on drugs, which I am, but not maybe the way they think.
Anyway, I got through the day and did most of what I meant to do.
Thursday, by late afternoon, my head began to ache.
Generally, I try to avoid taking Relpax two days in a row, as I think that's too often. And so far, it hasn't often been necessary (that is, since I got off the cycle of rebound headaches, which is the reason I limit my use of Relpax in the first place).
Anyway, out of sheer desperation, I took a whooooole bunch of ibuprofen -- about six 200 milligram tablets. It made me feel a little weird, but miraculously, it seemed to do the trick.
Who knows -- maybe the headache would have faded away on its own.
Friday was okay.
But Saturday, I woke up with a headache -- and I had to work.
I thought about trying the ibuprofen again, but I didn't have any at home. My assignment was to cover a historic gun exhibition in Orange (about 20 miles from Beaumont, where I live) so I got ready for work and drove over there, stopping at a convenience store for ibuprofen. I took five, and I think it might have blunted the progress for a little while. Hard to say.
But two hours later, it seemed to be building again.
I left the museum where the exhibit was being held and went back out into the heat and got in my un-air conditioned car.
I felt afraid to take the drug (because of the side effects) and afraid not to (for obvious reasons).
I looked around me, trying to read the landscape -- maybe it seems stupid to believe in signs -- it's not exactly that I think mystical messages are planted for my edification, it's more that I think my subconscious will use the objects and activities going on around me to help me navigate. Either way, maybe it sounds goofy.
Anyway, I saw nothing much that stood out to me one way or the other and drove on apathetically.
It occurred to me that the consequences of doing nothing could be extremely painful and at the same time, I realized that I WANTED to take Relpax.
So I did.
And again, I think it was the choice that most helped me get through the day I had planned.
Part of my day Saturday was training a new reporter on the duties of the Saturday shift, and I'm pretty sure that would not have gone well with a raging headache -- much less a full-blown migraine.
And this very green rookie reporter would not have been able to cope on her own with the Saturday routine.
So, all well and good.
But I woke this morning with a faint pain in my head.
Nothing major, but waking with pain is usually a poor start to a day.
I have an obligation later today -- but I don't think it would be appropriate for me to take Relpax again.
I was doing so well there for a while.
Granted, this week my period started, which makes it more likely for me to have headaches, but I don't always have FOUR the week of my period.
It seems to go in cycles that way -- but when I get into a bad patch like this, I'm always afraid it's never going to end -- that this is just going to be my life from now on.
It's especially worrisome because, from what I've read, migraine is not considered a disability. Which seems odd to me.
True, for many people, they are not a daily or even weekly occurrence. But when they are, they make it very difficult to work and be productive.
I'm not really sure how this fits in with my ambitious mission statement of finding solutions and cures and all that.

Hormones or sinuses?

Well, it's both.
I think.
Five years ago when all this really started becoming a problem, I remember a female friend about my age (41 then) saying something about declining hormone levels.
I didn't want to hear that.
I'm not ready to think about menopause.
But over the years, it's been there in the back of my mind, lurking.
So in December, when the pain was starting to interfere with my job and my life, I decided to go see my gynecologist.
We talked and she suggested I try birth control pills to help even out my hormones.
I left with a six month supply of Seasonale.
But then I started thinking about some of the questions she had asked me.
I'd been making all these assumptions about hormones, but when I considered the pattern of my headaches, it didn't make complete sense.
Sure, I usually got a headache or two or three around my period, but I also did the week after that and the week after that.
Was I overlooking the sinus aspect of it?
I had been taking Tylenol sinus medicine when I thought it might be sinus pain (sometime a tricky call) but it hadn't been working lately.
Maybe I needed to try something different.
So I went to the drugstore and looked around. I got some nasal spray for sinus pressure.
The next day (Dec. 31) when my head started to hurt right on schedule, I hit it with that.
The pain stopped, and I didn't have another headache for several days.
I noticed that the stuff said not to use it more than three days in a row (or something like that) so I picked up some pills for sinus pressure relief.
Those got me through last week with minimal amounts of pain.
So, the moral of the story is, don't let your fears blind you to your options.
But -- the hormones are still a factor.
My period started yesterday and with it came a nasty headache.
It started in slow, and I took a sinus pill even though I could tell right away it wasn't a sinus headache -- just wishful thinking, something I'm all too prone to fall into.
I took a nap, hoping I could head it off by relaxing.
There was no stopping it.
By nightfall, there it was.
Not the worst migraine, just bad enough to keep me in the house in my robe all day -- in bed most of the day.
I try to avoid taking the Relpax I've been prescribed because I know from past experience taking it too much leads to rebound headaches -- also, sometimes the Relpax makes me so tired and spaced out I end up just laying around in bed all day anyway.
When I was younger I never had a headache that lasted longer than a day, but in recent years that's changed.
So when I awoke at 5 a.m. and my head was still pounding, hoping to have a slightly more productive day Sunday than I did Saturday, I popped a Relpax.
I suppose it helped.
The pain dulled to a low-grade ache.
Anyway, I didn't mean to drone on this way. My point is, now I'm thinking about the hormonal aspect of it again.
But I'm leery of the Seasonale. So I got online and started doing some research. I promptly found a Web site with literally hundreds of posts from women on problems associated with Seasonale: excessive bleeding; severe cramps; weight gain; nausea; hair loss; sexual side effects; depression -- and migraine headaches!
Today would be the day I'm supposed to start the stuff if I'm going to, but now I'm scared.
I think I'm just going to have to wait another month and see how it goes.

A little background

I've been prone to headaches all my life, but up till the spring of 2004, things were fairly manageable.
In past years, while I had headaches two or three times a month, mostly they were easily managed with ibuprofen.
I learned that regular exercise, riding my bike, yoga, things like that, helped a great deal to keep things under control.
I had what I would have termed a knock-down, drag-out migraine only once every two or three years.
And even those -- they never lasted longer than a day, I could usually sleep through the worst of them, and when I woke up they were gone.
Then, early in 2004, things started to change.
I began having headaches that ibuprofen wouldn't cure, and they started progressing with greater frequency into intense migraines.
I got my first prescription for a migraine medication -- Relpax -- that spring.
I only took it once that spring -- I was at work and it made me feel very strange. Kind of fatigued and spacey. It noticeably affected my ability to do my job.
Things settled down in the summer. I didn't feel the need to take Relpax again until perhaps late August or early September.
It wasn't uncommon for me to have a headache or two while I was on my period, but I started having more and more of them.
One month I would have them three or four days in a row.
The next month it would be six or seven.
Then, by November, I was having them every day.
Maybe I should mention here that when they first started, I tended to think the headaches were stress related. I did -- and do -- have a stressful job.
In the past, I'd found exercise was a good prevention and cure for tension headaches, so I began getting up an hour earlier than normal each day and going for a bike ride. Now, I love riding my bike, but even more than that, I love sleep. I hate getting up early, so I want you to appreciate what a sacrifice I was making.
But it didn't work.
Usually by late morning the headache was starting its faint, annoying buzz, which by afternoon reached a crescendo.
I treated the headaches with Relpax -- the only thing I'd found that worked.
I knew it wasn't right for me to be taking the stuff every day, so I trotted on back to the doctor. She put me on another prescription drug, Topamax. It's a seizure medication that is also used as a prophylactic for migraine.
I started out at the minimum dosage, and it worked pretty well at that level for a while. After a couple of months, it stopped working, so the doctor increased the dosage, and it went along that way for a while until about eight months later I was at the maximum dosage, which made me feel kind of sick all the time and eventually stopped working and I was taking it and Relpax every day and honestly, between all the side effects of both of them I don't know how I functioned.
So back I went to the doctor, who prescribed an antidepressant, tofranil.
So I tapered off the Topamax and onto the tofranil which worked, again, for about eight months, then gradually stopped being very effective and I was back to treating the headaches with Relpax every day.
I had this gut feeling that taking the Relpax was part of the problem, but I think I was too scared to put it to the test.
Let me just insert here that I had also been to a neurologist, had an MRI and ruled out brain tumors as a cause.
Also somewhere in there, I'd gone to an allergy doctor, who tested me for allergies. I tested positive for dust mites, some tree and weed pollens. He gave me samples of various allergy drugs that didn't seem to do a damn thing for my headaches.
He wanted me to get allergy shots, but wouldn't let me do the shots on my own, wanted me to pay him $20 a pop to administer the shot. I balked, both at the cost and, well, I was afraid the shots would only make the situation worse... maybe that's wrong.
Anyway.
When the tofranil stopped working, the neurologist (whom I didn't much like) prescribed a blood pressure medication, which promptly made me so sick I couldn't take it at all. She was out of town that week, so I went to my regular doctor, who said a newer, time released version of the drug would solve the problem, but it didn't.
I understand all about adjusting to medicines -- but I knew that something that made me this sick was all wrong for me.
Then a friend emailed me a link to an NPR story about a doctor who had written a book about migraines.
He had compiled a list of all the foods that could trigger migraine, and it was way beyond the usual red wine, chocolate, MSG, etc. migraine sufferers are told to avoid.
He also explained about rebound headaches -- which taking Relpax too often could cause.
So at this point, I realized my gut feeling had probably been right all along.

But instead of just stopping cold turkey, I decided to go to another doctor in search of a cure.
He told me there was no cure for headaches and I left his office with two new prescriptions -- one of them another anti-depressant.
Maybe I needed it, 'cause I drove home totally depressed.
After giving it some serious thought, I decided to get off prescriptions meds.
I did not do it in a smart way.
I stopped taking the tofranil, and after a few days when this didn't seem to be too rough, I thought I'd stop the Relpax.
Well. The reason stopping the tofranil didn't seem too rough at first was possilby because my body didn't realize I'd stopped right away or something.
But about the same day I decided to stop the Relpax, everything hit at once.
I had possibly the worst migraine of my entire life.
I was up half the night and vomited three times.
I lay on the cool tiles of my bathroom floor most of the night moaning, feeling like someone had hit me in the head with an axe.
I wished someone would hit me in the head with an axe.
There's a line from a Joan Didion essay on migraines that comes to mind at moments like these: “That no one dies of migraine seems, to someone deep into an attack, an ambiguous blessing.”
Well. I lived through that night.
And I somehow got through most of the next year free of prescription meds (though not free of headaches, unfortunately)
I tried the NPR doctor's diet, cutting out quite ordinary foods like cheese, nuts, onions and bananas, among other things.
I tried this for about three months, I think.
As far as I can tell, my triggers aren't food-related (however, the one thing I remain skittish about, avoiding like the plague, is MSG -- I always ask if they use it at restaurants)
I've explored many possible explanations for my headaches: allergies, hormones, sinusitis. I've traveled down many a treatment avenue: acupuncture, chiropractors, herbs, progesterone creams, nasal washes, reiki.
There are still others I haven't tried: biofeedback, massage, botox (don't laugh -- I've heard it helps some sufferers).
Sometimes it seemed like something was working for a month or two, but then they would get bad again -- so I never really know if something works or if the headaches just naturally ebb and flow.
This past year, I returned to occasionally using Relpax, keeping it down to two or three times per month, to avoid rebounds.
I had first thought about doing this blog a couple years ago -- just after I quit prescription meds. I thought perhaps it could help me and other sufferers find ways to cope with the misery of chronic headaches.
I never got around to it till now. Maybe because I had a pretty bad December. Eight headaches, five of them that pretty much put me out of commission for the better part of a day, another that likely would have, except I took Relpax.
And I had one yesterday. Not unexpected, as it was the first day of my period.
It wasn't even close to the worse one I'd ever had, so I tried to just tough it out. But when I woke at 5 a.m. and it was still hanging around, I caved in and took the drug.
As I'm writing this, I still have a nagging pain behind my eyes.
Perhaps the worst effect of my headaches is the self-pity, the way they make me hate my life sometimes, the fear that they will get even worse and more frequent...
I'm not the most cheerful person you'll ever meet, and headaches don't help much with that.
I'm sorry this was such a long entry. I don't know that it's of any earthly use to anyone, but I felt I needed to show the road I'd been down, some of the things I've tried.

Welcome to my head...

And a frightening place it can be at time. Mind you, I'm not claiming that the bats in my belfry are anything more than run of the mill bats -- my metaphoric demons are nothing more than your fairly ordinary, garden variety spleen-devouring imps o' Satan.

No.

What I'm talking about here is the chemistry of the place. Of which I really have only a rudimentary understand -- although I can describe the effects in all their glorious technicolor gore. And likely will, at length, if this goes as I plan it to.

But I don't just want it only to be me whining about the pain.

What I want is to proceed in a methodical direction toward answers, solutions, even a cure, tho doctors tell me there isn't one.

The demon I'm here to exorcise is called Migraine, and as anyone who's tangled with her knows, she's one mean, scary bitch.