The Migraine Curse

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Guess what guys, migraines suck. Part of the reason I began my epic weight loss journey was my unrelenting and chronic migraines. I’ve been afflicted with migraines since soon after I hit puberty. Fun fact: being a woman and having hormonal surges also sucks! Migraines affect about 3 million people per year, and 75% of those people are female. Migraines can be difficult to treat and debilitating. 2% of people will have chronic migraines, defined loosely as migraine headaches more days of the month than not.
Historically, migraines have been treated with suspicion and degradation in the medical field. They fall into that nebulous category of diseases that we don’t understand the pathophysiology well and that don’t have a lot of objective findings. Prior migraine theory has postulated that the underlying cause was vasospasm and vascular dysregulation; this theory has not been outright disproven but more current information is leading towards a more neuronal driven model based on abnormal trigeminocervial afferent nerve activation. This obviously is still an area of much research, and hopefully with time we will gain a better understanding of the underlying process.
Treatment for migraines falls into four main categories:
1. Identifying and avoiding triggers
2. Lifestyle changes
3. Abortant medications to stop active migraine
4. Preventative medication to help stop recurrent migraines
In my lifetime I have had hundreds of migraines. Some last a day, some have lasted for more than 2-3 excruciating weeks. On and off I’ve qualified for the diagnosis of chronic migraine over the years. I’ve tried many many different treatments including multiple different abortant medications and preventative ones. At one time I was taking 3 different prescription meds and two herbal supplements to try and prevent migraines.
The thing is, none of it was working well. These medications work well and help many people, but it wasn’t a solution for me. Over time I gradually weaned myself off all my meds and have been using a much more holistic approach. I started to focus more on lifestyle changes and triggers to help manage my headaches. This is not an approach for everyone, and in fact I still get debilitating headaches, but overall the quantify and duration has been improved in the last 18 months.

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So what are the most common migraine triggers?
1. Stress
2. Sleep
3. Caffeine intake
4. Diet: anything from processed food to alcohol to cheese to food additives can be a trigger. Note that chocolate had not been proven to be a trigger food, but cravings for chocolate are a warning sign a migraine is coming your way.
5. Environmental/weather changes
6. Dehydration
7. Over-exertion
8. Drugs
9. Oral contraceptives
10. Teeth grinding
11. Medication overuse
It’s not hard to see how many of us can check nearly every trigger box on here. I set out to work on what I could most easily control and change. Starting with my diet, I eliminated caffeine and cut way back on processed foods. I think this has been the biggest help to me. I now only drink caffeine at the start of a headache, and it helps to reduce my symptoms.
I also cut back on taking medications when I have an acute headache. I rely on more multimodal therapy, using an ice pack, caffeine, sunglasses and dark quiet rooms to help my symptoms. In the past would be chugging ibuprofen all day and night and ducking into the bathroom between patients to give myself toradol injections. I found that didn’t really help things improve any more rapidly. What I really need to get better is sleep and time.
As you can imagine, when you are a busy working physician, those things are hard to come by. I struggle with sleep so often and my stress levels are chronically high due to my line of work. It’s been a battle to try and get more sleep and learn to relax and meditate and stop perseverating on every single little thing.
So if you see me rocking my headache hat ice pack and sunglasses around the hospital, no it’s not an awesome new fashion trend.., just one woman trying to feel better, get through the day, and overcome the migraine curse.

 

2 Comments

  1. Dr J., hope your new approach keeps working for you and those migraines begin to ease off in frequency and severity. My migraines have no traditional triggers – they occur simply because I have a rare neurological disease called CADASIL, in which migraine with aura is often the first presenting symptom. MRI scans will usually show white matter disease and lacunar strokes are also common in those with this disease. Vasodilation is definitely an issue with this disease due to cerebral arteriopathy. This is an autosomal dominant disease and there is often a significant family history of migraine with aura, strokes and early death. I’m not suggesting you have it, bu any means! As you are a physician, though, I thought this might be of interest as a possible cause of migraine in affected patients.

    Like

    • jkhartsock says:

      Hi! I’m sorry it took me so long to read this, due to my health issues I’ve taken a break from my blog and only just now getting back to it. As I type this I have just gotten Botox injections for my migraines last week. I’m hoping it helps!
      I have had CADASIL patients myself that I’ve cared for! Luckily, I do not think I fall into this category, but you are right them are extremely interesting patients!

      Like

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