Free my Brain from Migraine Pain

Coping with Migraine: Claims of a "Cure"

I was recently presented with a dilemma here on Free my Brain. I want to encourage dialog and exchange of ideas, but I don't intend to provide an open marketplace for sale of migraine "cures."  (Though I will gladly support and even promote helpful products and services.)  Migraine is a complex, genetically based, neurological disease.  The frequency and severity of migraines vary enormously from person to person; so do the number and complexity of triggers and other contributing factors.  What we know now is that this is a neurological disorder, a differently ordered nervous system, if you will, which has existed throughout human history.  Like many congenital conditions, there may have been a valid evolutionary reason for this mutation at one point.  Maybe migraineurs were the human barometers, predicting disastrous weather changes for primitive societies.  I had fun speculating on the evolutionary basis of migraine in the post Our Ancestress: A Fable.

I have heard from many people who have done just one thing and their migraines have gone away.  To them I can only say mazel tov!   (Congratulations!)  Here is a bouquet of flowers to celebrate!   For some it is eliminating just one trigger.  For others it is a particular nutritional supplement, a practice of meditation, regular exercise, a medication, a surgery, pregnancy, menopause, a life or lifestyle change.   I don't know if there are statistics on how many migraineurs find relief from just one thing.  I do know there are large numbers of us out here who need to find a combination of factors to manage and control our migraines.  Here is a bouquet of flowers to console us!  There is no "cure" for a genetically based neurological condition, any more than there is a "cure" for my red hair and green eyes.   (Well, another 15 - 20 years may pretty well eliminate the red hair.)

A great place for some very basic facts and information about Migraine is the recent quiz at My Migraine Connection: Dispelling Migraine Myths.   The two books on migraine featured in the left side-bar on this page are both great resources for learning about migraine and how to manage it.  There is much we can do.  For most of us, we can reduce our migraines significantly.  You have probably heard me say before that I have reduced my own migraine frequency by about 50% through use of abortive medications, supplements, trigger avoidance, relaxation and meditation, and lifestyle changes.

Someone submitted a comment to one of my posts stating that 1) Migraine isn't a disease; 2) there is a cure for Migraine "within us;" 3) he had over 20 years of migraines which are now gone; and 4) you can "retrain" yourself so you have no more migraines; he then went on to promote his methods.  I am genuinely happy for the commenter that his migraines are gone.  I am certainly curious about his methods, and glad that he wants to help others.  I don't mean to suggest he had any but the best motives.  But I am wary of anyone's claim to have a cure.  After some deliberation, I decided not to publish the comment and link.  

There are two ways to look at "retraining."  A nervous system which can be easily triggered into a Migraine attack can be viewed as an over-excitable or hyper-reactive nervous system.  Regular practice of meditation and relaxation can help us reduce the excitability of our nervous systems.  Note that this is not a "cure;" it is a supportive exercise or practice which can strengthen our system's ability to resist triggers.  You could call this "retraining."

But there is another view of retraining which comes from an idea that Migraine disease is psychologically generated.  It is not.  It is a real, physical condition.  It is no more psychological than epilepsy or scoliosis.  I view with rage books like Louise Hay's "You Can Heal Your Life" which suggest that right thinking can solve all our medical problems.  She suggests that "Migraine headaches are created by people who want to be perfect and who create a lot of pressure on themselves. A lot of suppressed anger is involved..."  

And so, if we work like crazy in therapy, meditate, recite mantras and do whatever highly subjective steps Hay seems to think will enable us to let go of the anger and pressure, if we do all that and we still have Migraines, then what?  We failed?  It's like telling someone the devil is causing their Migraines and they just have to really believe in God.  "I do believe!"  "If you really believed the devil would leave you and your Migraines would be gone!"  "But I really do believe..."  It's just a very sneaky way of blaming the victim!

I wish we could do a scientific study of people who want to be perfect and who put pressure on themselves.  In the first place I bet you that's at least 75% of the population.  And I bet you dollars to donuts that 12% of all the perfectionists would turn out to have Migraine disease.  And I bet that 12% of all the non-perfectionists would have Migraine disease too.  What's the incidence of Migraine disease in the general population?  12%!  I think you get my point.

I have been told that if I only distinguished the beliefs from my past that were making me have Migraines, they would disappear.  I will admit I tried to do that.  Like anyone else, I have a past and beliefs were formed in it!  Some of those beliefs are limiting to me.  In a life of nearly half a century, with plenty of self-help, support groups, personal development courses, and therapy, I think I've managed to identify most of those beliefs.  So why am I not cured of Migraines?  Is it my fault?  Or, wait, could it be that I have a genetically based, incurable neurological condition?  Hmmm...  Which is the more logical conclusion?  And which is more empowering? 

For me, the answer is clear.  I am 49, a woman, 5'2", a redhead, a migraineur.  These are facts.  I get choices about what I do with those facts.  I am choosing to vigorously pursue better and better Migraine management.  I am not wasting my mental or emotional energy on "cures."  Or at least I won't, once I'm done with this rant!

- Megan Oltman            

Curing is good for meats, cheeses, wines, paints... Maybe our heads don't need it?

                         Hammer image courtesy of Darren Hester

Feverish Thoughts

I am slowly recovering from the bronchitis that has had me out of action for nearly two weeks now.  The first week was characterized by a fever ranging from 100.5 to 102.2 F (38 - 39 C).  The common medical wisdom these days, as I have heard it from a number of doctors, is that fever is a positive reaction of the immune system to an infection. To put it in lay terms, the body seeks to kill the infection by burning it up.  Therefore many doctors now recommend taking nothing for a fever, unless the patient is uncomfortable, or of course, unless the temperature rises dangerously high.  So if you can't stand the body aches, or the head ache, or the heat itself, go ahead and take an analgesic, otherwise, let the fever burn. 

I've been wondering how many people, given a choice and with analgesics available, actually just let the fever burn.  I am allergic to analgesics.  Incredibly, this was my first episode of fever since I developed the allergies five years ago.  My doctor recommended a homeopathic Belladonna preparation if needed for fever reduction, but I couldn't find any to buy.  So I had a week of letting the fever burn.  It was an interesting experience, to say the least!  While my eyes were open I was fairly cogent, but had occasional visual and auditory hallucinations.  Nothing too exciting, a repeated mechanical banging sound in one ear, and a teddy bear face in the neighbor's pear tree across the street that grinned and winked at me through the window.  I did not feel like myself at all; it was hard to even remember who "myself" was.  I felt like an alien from the planet Febrile!

It was very weird living on another planet. My body size was all over the map - at one point I was convinced that the pillow I was touching on the other side of the bed was part of my body. Other times I felt very tiny, like a little fold in the bed-covers. Whenever I shut my eyes the fever dreams moved right in, with always a committee of six or seven people in my head furiously making plans and fixing things. I'm sure if I just could have somehow recorded what went on my brain I would have written 16 volumes of great literature, solved global warming and created world peace too, while "we" were at it.  You've heard of doing things at a fever-pitch?  My thoughts were like that.

The worst thing was the head pain.  Headaches go along with fevers; for a near-chronic migraineur like me any headache has a high likelihood of morphing into a Migraine.  The persistent coughing of the bronchitis also banged my head around.  I woke every morning with a headache and developed a Migraine every day by afternoon.

I had one really funny fever dream where I closed my eyes and there were 7 of me around a conference table and one of us had this really searing disgusting hideous head pain, and the other 6 of us voted her off the show!  She had to go - and my goodness I woke up and my head pain was gone!  I don't know but I may have to see if I can tap into the power of the fever dream committee other times too.

Everything is relative and I have been profoundly grateful that I am not that sick all the time, or even often.  I've been thinking about acute versus chronic illness.  I live with frequent Migraines, frequent fatigue, fairly frequent infections.  I know there are others of you whose chronic illnesses are more debilitating, and more progressive.  But mine pale in comparison to a high fever and racking cough, aches, shakes, dizziness and passing out.   Being that sick for an extended period of time could kill you!   I guess that's why we read in 19th century literature of a "dangerous fever."  I sit in awe of my body's ability to fight off an infection like this one, largely unaided by modern medicine.   I'm giving it lots of rest and fluid and letting it do its thing.  It's getting the job done, slowly. 

- Megan Oltman

Back on good old planet Earth.

                        

Heart of fire image courtesy of Marcus Vegas; pointing finger image courtesy of Lisamarie Babik.

Face, meet Floor!

Fall down go boom!

Well I had an exciting night! I passed out and fell on my face in the bathroom! The good news is that though my nose is very bruised and I'm getting a bit of a shiner on my right eye, nothing is broken, there's not much pain this morning.  I have succumbed to the nasty virus with fever and coughing that my son had for ten days.  Danny came down with it after Adam was back on his feet for a few days, and I bit the dust (so to speak) a couple of days after Danny.

What makes this all the more exciting is that I have anaphylactic allergies to most analgesics.  So there's nothing I can take for fever.  Luckily I'm not very prone to fevers; I often get the same virus as everyone else but minus the fever.  Not this time.   I've been lying around now for two days with a fever and a nasty painful cough.  The coughing hurts  my whole body and jars my head enough to wake the migraine monsters.

Around midnight my head pain was resolving into a migraine so I went into the bathroom with the Imitrex package. I was very feverish and not thinking too straight. I thought I'd first take my temp and then read the Imitrex packaging to see if there was some reason not to take it with a fever - there isn't, and that doesn't really even make sense, but anyway... I didn't want to wake Danny up because he was sick too.

So I sat on the toilet lid and put the thermometer in my mouth. I was very woozy and could hardly sit up. So I put my feet up on a little stool, put my elbows on my knees, and started putting my head down on my hands. The next thing I knew I was on the floor in excruciating pain with bright lights flashing in my right eye. Someone was making this horrible wailing noise and it turned out it was me. The whole family came running in. I was so disoriented, I had no idea where I was or how I got there, I just knew my eye and nose hurt and my glasses were pressing into my eye. I don't know if the glasses saved me from getting more hurt or if they made it worse. They didn't break. There's a big bruise and cut on the bridge of my nose.

The kids got me ice packs and Danny helped me up - he was going to support me back to bed. Next thing I know I'm very peacefully and comfortably asleep on the floor and he's saying, Megan, Megan, can you hear me? Apparently I just kind of slumped and slid out of his arms back onto the floor. So weird. He got me back to bed and I slept the rest of the night. I'm still coughing and feverish and weak and I'm staying in bed!

I don't know if it was the fever or the migraine or maybe both that made me pass out. What a mess!!!  Just to make this all the more dramatic and interesting, my long-awaited headache specialist appointment is on Tuesday.  I will call first thing tomorrow to get in to see the internist, and find out if the Headache Center wants me to come in.  I "only" had to wait 4 months for this appointment - I really don't want to give it up!  I'm perfectly willing to go in not feeling well, but if I'm in danger of passing out it may not be a good idea.

Never a dull moment!

- Megan

                               Blue tile floor image courtesy of Jason Meredith

Stress is not a Migraine Trigger

At least, that's the latest thinking - last year the International Headache Society moved stress from its list of Migraine triggers to a list of exacerbating factors.  In other words, stress makes us more vulnerable to the things that trigger our Migraines.  In other words, pains in the ... do not trigger the pain in our heads - directly.

So here's a list of things that do not trigger my Migraines:

• Passive-aggressive people who don't listen and make me want to pull my hair out. (Note: pulling hair out could well trigger a migraine.)
• Days and days of mysterious computer malfunctions that cannot be solved without spending money I can ill afford. (Note: running out of money and therefore missing meals could well trigger a migraine.)
• Worrying... need I say more?  You name it, I can worry about it.  I think it's a genetic predisposition.  Kind of like... Migraine disease!  (Note: losing sleep while worrying?  Bingo!  Migraine trigger!)
• Not getting my work done due to computer problems, and worrying.  Chasing tail around in vicious circle. (See Worrying.)

And so, I am trying a mantra: "stress is not a migraine trigger, stress is not a migraine trigger, God grant me the serenity, stress is not a migraine trigger."  I'm not entirely sure this is working.  My head hurts!

Actually since striking a note of hope is clearly needed here - I have better mantras.  Some deep breathing - in Hummm - out Saaa... I'm going to go try that.  And please pray to the computer gods for me.  And maybe tomorrow I can write a better, more useful post.  With pretty pictures. 

- Megan Oltman

What are you complaining For?

Hi there - Happy Easter to all who celebrate it. I am up and walking around on a beautiful, chilly, early spring day, with bulbs poking their green noses out of the dirt (and a few, their bright flowers.) I am headache free for the first time in 5 days and enjoying a lovely family visit. I really don't feel in the least like complaining. But I thought about it a lot while I lay in bed this past week with sinus Martians and Migraine beasts fighting for control of my head. (They both won.)

Some folks just don't like to complain. That preference is generally seen as virtuous, stoical (for which read, a good thing) and considerate. Hazel Reese's autobiography, a tale of a life with chronic illness, is entitled I Will not Complain. I don't intend to take anything away from the non-complainers, they have my reluctant admiration. You may have guessed that I myself do not often rank among their numbers. I do think there are several ways to look at, and use, the practice of complaining, or not complaining.

What are you complaining for? I mean what is the point of complaining? Actually there can be several points. The complaining we don't like, the kind we, well, complain about, is the complaining that has no purpose other than to make us feel sorry for the complainer. Whining. Whinging. We don't want to go visit Aunt Sue or we're hardly friends with Bill anymore because all she/he does is whine. Taking it down a level, what we're really objecting to is an evasion of responsibility. If only you knew how bad it was for me, you wouldn't expect so much of me. If only you understood, you would take all these burdens from my shoulders.

There are several other reasons to complain, though, which are perfectly responsible, even virtuous. We can complain to get it off our chests, what we coaches sometimes call clearing. When I sit down to a coaching session with a client we usually spend a few minutes noticing if anything is getting in the way of our ability to be fully focused in the present - and if something is, we name it so we can put it aside. "I'm feeling sad about..., I'm upset by..., I've been angry about..." Those emotions keep on operating in the background and color the way we think and what we see as possible, if we don't give them voice, whether we write them down or share them with someone who will help us clear our minds.

And then there's complaining to get results, to make change, to change history. Most of us have seen the bumper sticker "Well-behaved women rarely make history." Any social change worth mentioning has happened with a great deal of powerful committed complaining. Public opinion does not change without an awakening of empathy. You can awaken empathy by complaining, by making sure someone else really  gets it, really understands your world. I'm thinking about the ADA (Americans with Disabilities Act), which took a great deal of powerful committed complaining. For those of us with invisible illness, with Migraine Disease and the other chronic icks that have people saying "but you don't look sick...", it might not be a bad idea to complain more. Not like Bill and Aunt Sue, like the ADA advocates.

Try these: "I don't look sick, but I feel like there's a squirrel with a chain-saw in my head" (thanks Migraine Chick!); "Oh yes, I'd be fine, if only they'd stop trying to remove my brain with a grapefruit spoon" (that was me for the last week). Or a more sincere heart to heart with the non-migraineur of your choice, asking him/her to support the AHDA (Alliance for Headache Disorders Advocacy) efforts to get a fair share of NIH funding for headache disorders!

"Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has." Margaret Mead

- Megan Oltman

Gripe, gripe, gripe!

                                                     easter egg photo courtesy of adobemac

                                                     spring bulbs photo courtesy of view of the world

                                                     hyacinth photo courtesy of B~

Not a Happy Camper

I'm not really even up to a rant.  The nasty sinus infection has spawned several days of set my teeth on edge migraines.  Then today my computer died, taking several power cords down with it.  Conspiracy?  You could only call me a grumpy camper right about now.  I will write you all a nice juicy post as soon as things clear up in my brain and my world.  Can't be long now!  Right?

- Megan

Please feel well - someone has to!

Take at first sign of Migraine

If you are among those lucky enough to be able to use drugs in the triptan class, Migraine abortives, you've seen this advice "Take at first sign of Migraine."  Most of us find them quite effective when we follow this advice.  But like many things in real life, following the advice isn't easy.

Triptans were the first, and are so far the only, class of drugs specifically designed to abort a Migraine attack.  When they were first introduced in the 1990's, they revolutionized the treatment of Migraines.  Rather than simply treating pain, or reducing the inflamation of blood vessels, they work directly to end the neurological process which is Migraine.

As described by Dr. Gary L'Europa in his excellent article last June in the Providence (RI) Journal, Stop Limiting Migraine Medicine , the migraine process includes these phases:

     "Prodrome consists of fatigue, neck pain, hunger, thirst, and other physical symptoms that occur up to 24 hours before the headache.

     "Aura occurs up to 60 minutes before the headache and produces a sensation of seeing sparkling lights or feeling numbness or tingling in the face and hand.

     "Headache, lasting as long as 72 hours, consists of severe throbbing pain similar to that associated with meningitis. This pain is often associated with nausea, vomiting, light and sound sensitivity.

     "Postdrome consists of fatigue, neck pain and lethargy that lasts 24 to 48 hours after the headache."

So what's the first sign of Migraine?  Most migraineurs report that triptans are not particularly effective in the prodrome phase; they wait to take them at the first sign of headache.  I can attest to the fact that my triptans are most effective if taken at the very first sign of head pain.  I haven't tried them in prodrome, since fatigue, neck pain, hunger, thirst (and irritability) can have other causes.  Also because I am afraid to waste one of my precious triptans.  Which brings us to my main point.

Triptans tend to be very expensive.  Imitrex, which I take, retails at around $20 to $30 per pill.  It often takes two doses to end a Migraine attack.  Given the cost of triptans, many insurance companies began in 2007 to set lower limits on the number of doses per month they would cover.  My coverage went from 9 per month to 4.  This was based on some math they had done on what the "average" migraineur needed.  I guess I can take pride in being, once again, "above average!"  I have 4 - 5 migraine attacks per month.  Migraine researchers estimate that 46% of migraineurs have more than 3 attacks per month.  Do they limit the doses of insulin a diabetic can have to the amount an "average" diabetic would need?  (Maybe they do... someone fill me in... either way, it's a scandal!)  Seems to me the reason our doctors prescribe for us, not our insurance companies, is because they treat the actual patient, not the average patient!

My insurance company politely suggests I look at having another triptan prescribed for me, as Imitrex is one of the most expensive.  I'd be happy to, but becasue of my multiple drug allergies, the neurologist I saw recently wasn't willing to prescribe a different one at this point. 

As Teri Robert pointed out in her article Doctor speaks out about insurance limiting triptan Migraine medications,

     "Limiting triptans is beyond absurd. It's counter productive, inane, and cruel. Many Migraineurs, when faced with a Migraine and no triptans, end up in the emergency room. Ever pay an emergency room bill? The cost of a reasonable month's supply of triptans costs far less than a single ER visit. Duh! Maybe part of the problem is that many insurance plans have two parts -- medical care and prescription coverage. The people managing the prescription coverage don't care about ER payments because that's a different budget."

After many calls, 4 months, over $350 out of my pocket for medication (and several seemingly stress triggered Migraine attacks following calls to the insurance company,) they have now told me they will cover 9 pills per 23 days.  This comes out to almost 12 doses per month.  Which ought to be enough for my average month, but...

Can I take the Imitrex at the first sign of Migraine?  Certainly not.  I have moments, or sometimes hours, of mild migraine pain up to 8 times per month.  That's on top of my 4 - 5 "full blown" migraines.  This may be the sign of a transforming migraine pattern.  I have an appointment with a bona fide migraine specialist in early June - we'll have to talk on this blog about the lack of qualified headache specialists another time.  For now, my attitude seems to be that the pain isn't bad - many of you have it worse - so I save the Imitrex for when I feel a "real one" coming on.

Is this a good strategy?  Probably not.  My other alternative, I suppose is to pay out of pocket for additional Imitrex (at $26 per pill at my local pharmacy.)  I do get what samples my doctor can spare me when I see him.  But I have to say, when it comes to aborting Migraine, most of us are between a rock and a hard place.

- Megan Oltman

It's a paradox wrapped in an enigma!

                                                              Signs of Spring photo courtesy of Just-Us-3 

                                                              Hammer photo courtesy of Darren Hester

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

It's all in your head

Gotta rant today. I've been hearing too much about blaming the victims lately. And when we start down the road of "it's all in our heads"there's danger ahead.

What migraineur has not heard that as a put down? "It's all in your head!"  What people mean by that is, it's psychosomatic, or it's psychological, or snap out of it - you can control this.  Migraines are in our heads - and in other parts of our bodies as well. They are a series of rapid firings of a bunch of overexcited neurons - in our brains, which happen to be in our heads, not our elbows or our spleens. So what? Just because something is taking place inside our head, doesn't mean we have control over it. Try snapping out of it! Try snapping out of depression, or anxiety, or worse yet seizures, or a stroke. Try not thinking of an elephant while you're at it. We can't even do that!   

Is that a statement straight out of the mind/body fallacy or what? The brain is a bodily organ.  It controls the rest of the body, to a large extent, but that doesn't mean it's not part of the body. Just because we use it to think thoughts, doesn't mean we can control its processes or malfunctions. We like to think we are completely independent in producing thoughts, but our thoughts are strongly influenced, if not controlled, by our emotions, and emotions are produced by biochemical secretions. You can't think your way out of an illness. Or maybe you can, who knows, but I can't, I've tried!

On the other hand, our bodies influence our brains. We put chemical substances in - foods, nutritional supplements, medications, that help or hinder our recovery, relieve or trigger our migraines. We walk and exercise and that affects our moods and our thoughts.  And keeping a positive attitude, doing things to take care of ourselves, reaching out for support and helping others - all these things can influence our moods, and our health. They should be part of our migraine treatment plan. But they won't take away the underlying condition. I cannot think or emote or eat or exercise my way to a redesign of my neurons.

This kind of thinking is particularly damaging when it feeds into our own perfectionism and guilt about being ill. The next person who says that, you might say, "I can't think myself well, but you can think yourself tolerant!"  After all, their prejudices against migraine are all in their heads!

- Megan
Laying low with a headache - keeping migraine at bay

brain photo courtesy of Gaetan Lee