Free my Brain from Migraine Pain

Boy, that's a Real Migraine!

a. Europe's $1.50 Headache Is Italy's Migraine(Headline in Forbes.com today, article by Vidya Ram – the article is about the rising euro and its effect on Italian exporters.)

b.  SOUTHERN AFRICA: Integration and the migrant migraine (Headline from IRIN, posted by Reuters today - the article is about how the flow of Zimbabwean migrants to neighboring countries is hindering the goal of Southern African regional integration.) 

c. Saturday - slept badly Friday night, migraine by afternoon, pain at level 3 on left, moderate nausea, picked up boys from movies, pain at level 8 on return, both sides now, extreme light sensitivity, took Imitrex 7 pm, lay down, room dark.  Can't read or look at computer screen.  Vomiting on & off 3 hours, pain varied from 8 to 5,  went to sleep around 10.  Pain at a 3 on waking, tired, achy, depressed all day.

Okay, are you ready?  Which one is the real migraine?  You picked c, right?  Good job!  You get a gold star.  a and b are known as frustrations, hassles, problems or perhaps international crises.  They are not migraines.

Am I being too much of a stickler here?  Maybe.  Maybe not.  There's a lot of real news about migraine in the news these days.  Partly thanks to the New York Times Migraine Blog, or maybe our chance for some recognition and understanding has finally come.  But most of us get annoyed by the trivialization of a very real and debilitating illness.

Interestingly, today the first 15 pages of results of a Google search on migraine are actually some kind of content about migraines. This was not so a few months ago, when I tried the same search and came up with many references like the two above, and one about a hockey team's poor performance being a “migraine” for the team manager.

I am willing to ascribe most of this to ignorance, not evil intention.  I think it's become a fashion to refer to a big hassle as a "migraine" instead of just a "headache."  However, it does distract public attention from the fact that this is a disease.  A fact that most people still don't know.

Is it okay to say "what a headache?"  If you've ever had a headache, you know what that means.  Most people have had a headache, and know that tension can lead to one.  So we call things that make us tense or upset "a headache."  People also say "I just about had a stroke!" or "I just about had a heart attack!" I've been guilty of that myself.  After a stroke hit someone very near and dear to me, I didn't feel like joking around about it any more.

This is in the category of being responsible for what comes out of our mouths.  We create our world through language.  We shape what is possible for ourselves and others.  You only have to listen to political double-speak to understand that.  Whoever gets to frame the issues tends to win the debate.

And so, maybe we can call a hassle a hassle and a crisis a crisis?  It seems like in our culture we always have to go one better, to make things more extreme.  If 10 years ago we called a hassle a headache, today we have to call it a migraine.  What will we call it 10 years from now?  A brain tumor?

- Megan Oltman
Somebody stop me before my head explodes!

                                                cave waterfall courtesy of subflux; brain courtesy of Gaetan Lee

Snow and Hope

Our kids are out of school for a snow day today. It’s the first all year, and I don’t think we had even one last year. I wonder why a snow day makes me feel so hopeful?

   Maybe it's something visual - take a look at the view off my icy deck.   

Snow is not as much fun as it was when I was a kid. I still have to worry about getting my work done to earn a living. I have to cope with clearing it off the walks and driveway. I have to cope with driving in it.  But I have always loved snow, and I still do, despite all the adult hassles it brings. Especially when it’s a novelty. I love waking up in the muted bluish light of a snowy morning, from the deep soft sleep the snow always brings. It must be the extra negative ions that make me sleep so well. But rational explanations aside, it just feels like snow magic.

One snowfall does not herald the end of global warming, but it makes the winter feel right, instead of off. If it’s going to be cold, it might as well snow. My overburdened migraine mind appreciates the peace and quiet, the way the day is simplified. (Shovel, cancel appointments, shovel, get warm, take kid to sledding hill, throw snowballs at dog.) I like the exercise of the shoveling. A good workout. I didn’t get enough sleep and may need a nap to ward off a migraine – lack of sleep is one of my surest triggers. But I know I’ll nap well on a snowy day!

I notice that the aches and pains index on weather.com seems to be low when it's snowing.  Barometric pressure changes trigger migraines for many of us - so I wonder if the pressure is very steady while it's snowing. I remember learning in Earth Science in high school that low pressure makes us hurt - because the pressure inside our bodies isn't balanced by the pressure outside!  Are snowy days high pressure days?  Any meteorologists out there want to chime in?

Here is the big yellow doofus in the big white snow. Isn’t she cute?

Wherever you are, whatever your weather, I hope it’s treating you well.

- Megan

How can I do serious work on a snow day?

Calming down the migraine brain

Several people have asked me lately about relaxation techniques. If stress is our enemy, we need to relax, yes? But if we strive and worry about whether we’re relaxing, we tense up. Raise your hand if this applies to you. My hand is up. Luckily there are some very simple techniques you can use to begin to practice relaxation. 

Relaxing is not the same as doing fun things – fun things may or may not be relaxing. When I had my first job out of college I used to go to the video parlor on my lunch hour and play PacMan (yes, I am that old). I would return to work with my wrists and hands asleep, so stressed out I could barely cope. I learned eventually that video games are not relaxing for me!

Our nervous systems have two components – the sympathetic and the parasympathetic. The sympathetic nervous system controls stress – this is where our flight or fight response comes from. The parasympathetic nervous system controls relaxation, which is often neglected in a busy twenty-first century life. We can build the tone of our parasympathetic nervous system in many ways, including through deep breathing, meditation, moderate exercise, yoga and movement, stretching, reading a good book, having an enjoyable conversation, playing with children or animals, being out in nature, loving touch or sexual contact. If we take some time to strengthen our relaxation “muscles” daily, we improve our ability to handle stress. According to Dr. Ian Livingstone, studies showed a 40% reduction in migraines in those practicing regular relaxation.

So here are a few ways to get started:

1. Sit comfortably with your back supported, legs uncrossed, hands on your knees. Close your eyes. Breathe in deeply through your nose, for a slow count of three. As you inhale, allow your abdomen to inflate like a balloon. Then breathe out through your mouth for a count of five, gently pulling in your abdominal muscles as you exhale. Gently concentrate on your breathing. If you find yourself thinking of other things, don’t get upset with yourself. Gently remind yourself to focus on your breathing. Try doing this for five minutes at first. Each day you can increase the time.

2. Lie on your back, legs uncrossed, arms resting comfortably at your sides. Bring your awareness to your feet. Notice how they feel, any discomfort. As you breathe in, imagine silver light being pulled with your breath into the soles of your feet. If there is any pain or discomfort in your feet, imagine that you are exhaling it out as you breathe. Next notice your ankles. Breathe in and pull the silver light up into your ankles. Breathe out any pain or discomfort. Continue to gently pull the silver light up through your body, being aware of each part of the body in turn and blowing pain or discomfort out with your breath. If pain still remains, don’t fight it or worry about it. Just keep breathing the light into your body and exhaling out the pain. Continue until your body is glowing from head to toe. You may want to do this in bed to help you fall asleep. 

3. Take a walk and practice keeping your awareness in your body as you walk – the way your muscles feel when they move, the way your feet hit the ground. Be aware of the rhythm of your breath and the rhythm of your walking. Look at any trees or plants, any living things or natural features you pass – fully observe them as you pass. If you find your mind getting busy, working or worrying at anything, gently return your attention to your body and to the trees, ground, plants, rocks or sky. If you are walking in the city be aware of the sky, the wind, any elements of the natural world.    

Give these techniques a try and let me know what you think!

- Megan Oltman

Not trying to be stressless, but to stress less!

 

The Migraine Life – Waking up into it

My eyes are not open yet. The alarm is calling with its insistent “nature sounds.” Supposed to be a spring breeze; it sounds like a blistering gale. I crack an eyelid, reach and press the snooze. Do I still have a migraine? Not sure yet but I know I don’t want to wake up.

Danny rolls over. “Needa lilmor sleep,” I mumble. Opening my mouth and enunciating would be a mistake. I catch the elusive tails of my dream – something about books and a cat. Drift into vagueness. Ten minutes passes like no time. More roaring wind. I reach to turn it off, eyes still closed. Danny gets up. I roll onto my back, checking. Crick in the neck. Roll the head gently on the neck. Body is okay. Little point of pain lodged over the left temple. Tiny. Like a bad little seed. “You should have taken the Imitrex last night,” I chide myself. But I don’t know. There is no absolute answer.

Sun is pouring in around the edges of the blinds. The covers are warm. My husband is cheerful. He is wishing me good morning. I am stretching gently, still unsure. If I move will the seed grow? I have slept enough, but should I be getting up? Should my responsibilities be pulling me into the day? Should my fear of the next migraine pull me back to bed? Where do good sense and balance lie?  I don’t know the answer. But I know I want to get up, I want to get to my good work, I want to live my life. I stand and start my stretches. Pain seed does not go away, but neither does it grow. Still dormant. I move into my day.

Will I have to reset the migraine ticker? What will I write in my migraine diary? Maybe the pain will leave entirely. It may stay; it may or may not grow. I will get down on the floor and stretch. I will take all my supplements and medications. I will try very hard to eat right. I will meditate before work. I will plan my day and stick as best I can to my plan. I will take a walk, pray and let go of fear and anxiety. Ten minutes at a time, or an hour, or a day. Let me appreciate each moment without pain.

- Megan Oltman

"How are you feeling?" "Okay." "Just okay?" "Okay is not bad, I'll take it."

 

"Breaking the Headache Cycle"

Breaking the Headache Cycle by Ian Livingstone, M.D. and Donna Novak, R.N.

When my migraine pattern suddenly shifted from once month or less to three to four times per week, I went to see Dr. Livingstone. When I first saw him in August of 2004, it was six months after I had two episodes of anaphylactic shock, caused by ibuprofen. I was a little gun-shy of trying new medications. I did agree to try Imitrex – I needed to be able to abort my attacks. But instead of preventive medications, Dr. Livingstone suggested that I get into a regular relaxation routine – using deep breathing, meditation and guided imagery to strengthen my nervous system’s relaxation response.

I first read the book at that time: Breaking the Headache Cycle: A Proven Program for Treating and Preventing Recurring Headaches.  I took on practicing meditation daily, and after about six months I found my migraines reduced to 2 or 3 per month. The methods outlined in the book were very effective for me, in combination with the migraine abortive, to reduce my migraines to a manageable level.

The authors say migraineurs' nervous systems are “very reactive to any change, even good change. This sensitivity is the hallmark of the migraine condition. Unless it is understood and recognized, the migraine disorder cannot be adequately treated.”

If our nervous systems are over-responsive, it makes sense that relaxation and meditation will calm down the responsiveness of the nervous system. Dr. Livingstone cites studies showing that preventive medications reduce migraine about 40% on average (the book was published in 2003 - there may be more up to date statistics on this); and other studies showing that a regular relaxation practice reduces migraines 40% on average. Is it a safe bet to say if doing both, we might reduce migraine 80%? That's a number I could be very happy with!

Many times I pause and do deep breathing when I first feel pain in my head, or even just when I feel my tension mount.  This often down-shifts me from a budding migraine back to a state of no head pain.  I have come to be able to notice when I am getting too excited or too engaged - it's not just negative stress that can trigger me! Not surprisingly, when I got out of the habit of practicing regular relaxation, my migraines increased again. As tricky as it is to remember to take a variety of medications, in the right amounts, at the right times, I think it is even more challenging to establish and keep a routine of putting the busy concerns of life aside and take time out to look inward, breathe deep, become aware of the body, calm oneself, and relax.

I came to these methods already convinced – I was not a stranger to yoga, meditation and relaxation. I had practiced yoga in many periods in my life, starting in my teens, and meditation and guided imagery from my early twenties. Later, as a life and business coach, I have used meditation and guided imagery with my clients to help them get clear about issues that were stopping them, and to visualize what they wanted in their lives. So I wasn’t surprised that this practice would aid with migraine disease as well. The challenge is keeping it in my life as all the demands of life crowd in. The reward is getting to know my own system really well, and gaining at least a little bit of control over it.

By the way, I think preventive medication is a great thing, and many migraineurs find a lot of success with it. I may be headed down that path myself, as my migraine pattern has changed and my treatment will need to change too. But I’ll always keep relaxation as part of my routine.  It makes me feel good!

- Megan Oltman

Nothing to gain from pain!

Vitamin Therapy for Migraine Prevention

This is not News in the capital N sense but news in my life.  I had my first neurologist consult in 4 years today, since Dr. Livingstone moved to Arizona.  I am, like many of us, a complicated case.  In my case the complications include my anaphylactic allergies to (apparently) most NSAIDs (non-steroidal anti-inflammatories, a.k.a. most OTC pain meds and quite a few prescription ones).  My new doctor wants to go very slowly in adding medications because of these allergies, and the fact that I tend to get a lot of medication side-effects.  So for the moment he added another form of Imitrex as an abortive (now I will be able to give myself injections, oh lovely) and prescribed vitamin therapy for prevention. 

In a startling piece of non-news, I am sensitive to medications.  He shrugged - "sure you're sensitive - you get migraines."  This vicious circle is familiar to most migraineurs.  Sensitive nervous system - gets migraines.  Sensitive nervous system - gets side effects.  Sensitive immune system (I guess) - develops medication allergies.  So for the next three months, I am to try 400 mg per day of magnesium and 200 mg per day of B2 (riboflavin). 

I am certainly in favor of using nutritional means to deal with illness.  That fits with my holistic philosophies on life!  So I am crossing my fingers.  I know a number of people who have had success with magnesium, though many of them take preventive medications as well.  I have to admit I'm not 100% happy, though.  My recent increase in migraine frequency is taking its toll on my life.  I guess I'm ready to be a bit more aggressive about my treatment.  So we shall see... my new doctor search may not be over.

Read more about magnesium for migraines in The Magnesium Solution for Migraine Headaches.  Let me know what you think!

- Megan

So many pills, so little time!

                                                              newspaper image courtesy of Matt Callow

It’s Not Me, it’s the Migraine Talking

I have been back on track with practicing my relaxation routine this past week and I was going to write you a nice inspiring post about that. I was on a 13 day migraine free run and feeling pretty good about it. Yesterday the beast sank its claws in again and hasn’t let go yet. I feel like all the inspiration has been sucked right out of me. But that’s just the migraine talking.

I resent the arrival of a migraine on the weekend, stealing my weekend time away. On the other had there’s less anxiety with a weekend migraine as I am not missing work – not missing things crucial to my livelihood. Just missing my down time, my marriage time, my family time, my fun time, my get the house in order time. Well, I guess I’m not missing down time, actually, because I am down!

Lying around. Watching tv, reading when I can stand the light, hanging out on line, drinking lots of cups of tea my sweetie brings, enjoying the comfort of my bed, receiving periodic visits from the family, with hugs and snippets of conversation. It’s not really all that bad, for down time.  That was me talking.

Then I can’t stand the inactivity any more. I decide to sit up and be okay, and I start folding laundry or some such ridiculously strenuous task. The pounding returns and the nausea starts back up. Danny comes in to watch a movie with me and we try to talk about plans for next weekend, and it strikes me what I am missing, how uncertain my life is. And I start to cry. Knowing that crying can make the migraine worse, I try to stop myself.  I remember how accepting I have been in the past month, and I start beating myself up for not being accepting right now. That’s the migraine talking!

Serotonin levels drop during migraine attack. I imagine the migraine slurping up my serotonin. So of course I’m going to feel unhappy. Aside from the pain itself, which is not happiness inducing, it’s hard to feel happy without serotonin. So I use what I can to comfort myself – hugs and tea and toast with honey, dark chocolate (when the stomach can stand it) and gentle movies, puzzles and pillows and good books. If I can concentrate at all, I come and write to you here, and that helps me remember who I am, that I am not the migraine, that it is what it is, that this too shall pass.

- Megan Oltman
Moderate migraine, day 2, hoping for relief soon

Oh, yes that's Arizona again - Spider Woman Rock in Canyon de Chelly.  I didn't have a migraine for that part.  Down below is New Mexico - the sunset over Albuquerque from Sandia Peak.

This is snot about migraine...

Okay, I just had to share this.  I'm up past my bed time, getting punchy.  In the continuing quest for relief from my recurrent sinus infections we are considering whether surgery to remove nasal polyps might be helpful.  Apparently there is a frequent correlation between seasonal allergies or asthma (I've got the allergies, not the asthma), aspirin allergy (which I have) and nasal polyps.  My doctor wants me to research this connection, known as Samter's Triad. 

So I'm on pubmed.gov reading these medical studies all written in medical jargon and all very serious... So here's one about "Medical and surgical considerations in patients with Samter's triad" and they're going on about doing "functional endoscopic sinus surgery (FESS)" and then the patients were CT scanned and they measured the FESS results by a test called (I kid you not) the "Sino-Nasal Outcome Test (SNOT-20)."

So if I go through with this - you can ask me "hey, how'd your SNOT test come out?"  "We were hoping for a better outcome - but all we got was the same old SNOT..."
 
Who said doctors have no sense of humor?

- Megan

Gotta laugh, otherwise we'd cry.

Migraine Management - My Other (other, other, other) Full Time Job

A week or two ago I posted about living healthy - a few comments there got me thinking (again) about just how challenging this is.  Getting it all right really does feel like a full-time job.  It's time-consuming-picky-detail-oriented, and doesn't fit with the way most "normal" people live their lives.  (By the way, I'm still interested in finding one of those "normal" people - if you spot one, let me know!)

This morning I am off to the doctor for a general health consult.  I have a lot of questions for him and wanted to go in when I wasn't feeling awful, for once, and would be more able to pay attention.  I'm feeling okay today - not great but okay.  Okay is good, I can live with it.   So I have been preparing for the appointment: printing out the last 9 months of my "wellness calendar."  Here's what January looked like:  I color in days when I feel great as pink (when "I'm in the pink") - I only had one of those.  Days when I am sick but functioning are orange; when I am functioning about half-way are red; totally out for the count are brown.  I had a very red and orange January, luckily no brown days.

So then I printed out the narrative part for the last month, that shows how much I slept, what changes I made to my diet, details of my migraines and sinus infections.  I printed my checklists for caring for myself when I have a sinus infection or migraine, so the doctor can review them.   I wrote out my questions.  Here's what my desk looks like right now.  The yellow book in the pile is Breaking the Headache Cycle by Ian Livingstone, M.D.  I don't think messy desks are identified in there as a migraine trigger, but it still seems ironic!

I got up at 6:10 to get the kids' breakfast and get the younger one off on the bus (the older gets herself off on the bus - let's be clear about that).  I dealt with dishes and then went back to sleep for 45 minutes since I'd had only 6 1/2 hours of sleep which is a pretty reliable migraine trigger for me.  But when I got up again there was only time to prepare for the doctor and write to you here.  So I have not done my meditation/relaxation practice for the day or gotten my exercise, both of which are important to keep myself healthy and resistant to migraine triggers.  I'm going to have to fit them in this afternoon, when I will also be worrying about getting all my work done for the day.  Stress alert!

I so want to be perfect at my treatment plan and know perfectly (!) well I've never been perfect at much of anything.  It reminds me of one of those annoying parabolas (or was it a hyperbola?) from Trigonometry - approaching zero but never reaching it.  The ridiculous emotional see-saw of trying to do it all but without stressing about it.  Time for the Serenity Prayer again.  Time for the rainbow picture again - the perfect rainbow over the field outside my window - reminding me of the return of hope.  What would we do without it?

- Megan Oltman
Hurrying up without Being in a Hurry!