Treatment Options

A friend of mine, who I haven't spoken to in years, emailed me about my migraines today. Her husband had chronic migraines for years, and his pain was dramatically improved by getting a spinal cord stimulator (http://www.poweroveryourpain.com/sb/learn_about).

Another friend of mine, another whom I haven't spoken to in years, asked me if I had heard about neurostimulators (http://nomigrainepain.com/).

So, of course, I started looking into all sorts of different things online. There's so much information about spinal cord stimulation, occipital nerve stimulation, neurostimulators, etc...

There are sooo many different options. Does anyone have any insight into any of these (or other) treatment options for chronic migraines???

Rant and Rave

Better understanding of the phases typically involved in a migraine attack seem pretty useless to me, at this point... Prodrome... Aura... Headache... Postdrome... I have symptoms of all of these phases all of the time. I don't know where one migraine ends and another begins!

© 2009 David Madden Photography.

This is (and has been) taking a huge toll on me, as well as my husband. I am truly blessed to have a wonderful husband. He doesn't understand any of what I'm experiencing (he doesn't even get headaches, much less migraines); and, yet, he's there by my side to take care of me. It breaks my heart that this disease affects my moods (we're talking big-time irritability) and weight (a lot of weight loss, which I can't afford to lose), and causes him to worry about me. But I'm so grateful that he loves me, and that he tries to help me in any way that he can. I thank God every day for my husband.

Phases of a Migraine

There are 4 distinct phases in classic migraine:

1)  Prodrome
The symptoms of the prodrome phase typically occurs hours or days prior to the actual onset of headache pain. Prodrome symptoms can include:

• Fatigue or excessive sleepiness
• Frequent yawning
• Altered mood
• Irritability
• Depression or euphoria
• Muscle stiffness (especially in the neck, back and face)
• Food cravings
• Difficulty concentrating

2)  Aura
Not all migraineurs experience an aura preceding or accompanying the actual headache pain. The aura phase typically begins minutes or hours prior to the onset of headache pain. Aura can be visual, sensory, or motor in nature. Visual symptoms include:

• Blurred vision
• Appearance of floaters (tiny specks that float before the eyes)
• Flashes of light or color
• A blind spot or even complete blindness in one eye
• Double vision

Sensory and motor symptoms include:

• Numbness or tingling of the hands, feet, and/or face
• Stiff neck
• Weakness
• Vertigo or Dizziness
• Loss of balance
• Ringing in the ears
• Difficulty talking
• Slow thinking or confusion
• Problems with concentration
• Changes in mood and activity level
• Hypersensitivity to touch

3)  Headache
This phase is the experience of the headache pain. For some, the pain is a one-sided,  throbbing or pounding pain. For others, the pain is all over the head. The migraine pain typically lasts between 4 to 72 hours. "Status migrainosus" are headaches that last longer than 72 hours, and require immediate medical attention. This is the most disruptive of the phases, and migraineurs often stop all activity and remove themselves from certain triggers (light, sound, odors). The headache phase often includes the pulsing / throbbing head pain, as well as some other symptoms, including:

• Extreme sensitivity to light, sound, and smell (photophobia, phonophobia, osmosphobia)
• Nausea
• Vomiting
• Increased pain with physical activity (such as walking or going up or down stairs)
• Blurred vision
• Scalp tenderness
• Stiffness and tenderness of the neck
• Problems with concentration
• Mood changes
• Vertigo, hotheadedness, and/or faintness
• Extremities feel cold and moist

4)  Postdrome
Some migraineurs experience symptoms after the headache pain has subsided. The postdrome symptoms may continue for several hours or even days. Symptoms of this phase can include:

• Fatigue
• Weakness
• Irritability
• Anxiety
• Depression
• Scalp tenderness
• Cognitive difficulties (difficulty concentrating)
• Mood changes
• Feeling "hungover"
• Head pain

Headache Care Center

This video is very informative about migraine and its treatment. I believe that a interdisciplinary approach to treating chronic pain is the best possible option. Migraine is a very complex disease that is very misunderstood and under-treated.

Premonitory Symptoms (continued)

I continue to think about the premonitory symptoms that many migraineurs experience. These symptoms preclude a migraine attack and include fatigue; muscle stiffness (especially in the neck, back, face); change in appetite / food cravings; changes in mood (including depression, irritability); difficulty concentrating; feeling cold; and sensitivity to light or sound.

What's going on in our heads that causes these changes? And, what causes these changes to take place up to several days before a migraine attack? It should come to no surprise to me that there is no answer to my question, since there is still no clear answer as to the cause of migraines. But, it still makes me wonder...

Premonitory Symptoms

As I finally ended one horrible week-long migraine, had a day of "relief" (still bad headache, just not debilitating), and began to have another migraine attack... I got to thinking. Around the times that I have my worst migraines (both before and after), I tend to get extremely irritable, snappy, and on edge. And, sometimes I get a burst of energy before...and then a migraine hits and stops me in my tracks.

So, I did some research online to see if other migraine sufferers experience extreme mood changes around the time of a migraine attack. I came across an article in the New York Times (August 4, 2010), where Dr. Dodick responds to this very question:

"Migraine is too often “bookmarked” by the start and stop of the headache, but migraine is frequently associated with symptoms other than headache before, during and after the onset of head pain. About 75 percent of migraine sufferers will experience non-headache premonitory symptoms prior to the headache pain. Patients experience a range of cognitive, emotional and physical symptoms in this phase; the most common include feeling tired and weary, difficulty concentrating, stiff neck, dizziness, light and noise sensitivity, yawning, and depression or irritability.

These non-headache symptoms usually occur within six hours before and resolve within six hours after the headache. But in a sizable minority of people, the symptoms can start within 24 hours of the pain and take more than 24 hours to resolve.

This range is important to recognize for a few reasons. First, it reflects the fact that the changes associated with a migraine attack are occurring in the brain up to three days before and one day after the headache pain begins, and therefore, the disability associated with attacks cannot be measured by the duration of the pain alone..."

You can read the entire article in Consults.

It is unfortunate that many of these premonitory symptoms are so subtle that we may not notice until the migraine has already struck. Even those that have migraine with aura (as I do) cannot always count on the "warning." I don't always get an aura, or at least not the same type of aura (usually visual or auditory, though there are many different experiences that fall under the term "aura").

Glimmer of Hope

I have finally "broken" the week-long migraine, so now I am just trying to recover from the aftermath of that storm.

I have been looking online at a lot of different websites and blogs about migraines and chronic pain. I came across a wonderful blog, Chronic Warrior. I was touched by many of the things posted on the site. Perhaps God's purpose in my chronic illness/disability is to bring me closer to Him... to work through me to glorify Him.

I have definintely not yet come to terms with (or accepted) having chronic pain or the changes and limitations that I now have in my life, but this site brought me 1) a new perspective of chronic pain, and 2) hope that this can actually bring me closer to God.

"You will seek me and find me when you seek me with all your heart." (Jeremiah 29:13)

The Dream Giver

A few weeks ago, I decided to sit down and start reading The Dream Giver, by Bruce Wilkinson (with David and Heather Kopp). I never expected to become so captivated by the book that I would complete the entire thing in one afternoon/evening.

This book was EXACTLY what I needed to read/hear right now. I feel like I'm at such crossroads in my life... feeling lost, confused, and scared... and the Lord used this book to speak to my heart.

Wilkinson's book is in two parts. In Part I, he tells "The Parable of the Dream Giver" -- this is a wonderful parable. Part II is "The Journey to Your Big Dream." He posits that every person has a Big Dream that God places in his/her heart (often referred to as one's calling). He speaks to the various stages (including the different types of obstacles) of the journey toward fulfilling that Dream. The book has A LOT in it. It is filled with deep meaning, but is structured in a simple manner.

While I still have much to think about and consider after reading this book, I feel like I already have a better understanding of my journey. I still cannot clearly state what my Big Dream is, but it is beginning to come into better focus.

We must first recognize what our Big Dream is. Once we decide to pursue it, we are faced with a struggle (with ourselves) to move out of our Comfort Zone. However, there are plenty of other obstacles that we will face along the journey.

One of the parts of the book that really touched me was that it is often the people that are closest to us that may question or oppose our decision to pursue our Dream. I have definitely experienced this. But I now have a different perspective and better understanding about where this opposition is coming from.

The part of the book that really touched me was about the WasteLand, where "we encounter a series of unexpected trials that never seem to end. No one prepared us for this. Delays and setbacks drag on. Soon, disappointment sets in. Eventually we begin to think we should abandon our Dream" (p. 116). However, the "WasteLand happens for a good and important reason: It is an invaluable season of preparation. It is the place where God transforms you into the person who can do your Dream" (p. 117). The WasteLand is a place where your faith is tested. "When God seems absent and everything is going wrong, will you still trust God enough to patiently allow Him to prepare you for what's ahead?" (p. 119). This bold question pierced my soul. I have often prayed that God make me into the person I am meant to be, so that I can do what He calls me to do. I guess I never imagined that such tests and suffering could result from such a prayer.

In the book, there are Giants that will stand in your way and try to prevent you from fulfilling your Big Dream. "A Giant is a very real and completely overwhelming obstacle you encounter on the road to your Dream. Overcoming a Giant requires you to use everything you've learned so far on the journey to your Dream...[and] you will need God's power ot overcome a Giant" (p. 139). I know that Migraine is one of my Giants, and that it will take my complete trust in the Lord to overcome - and I'm working on that.

I still do not know what the Lord has in store for me, and I do not know what He will use these current trials and suffering for. But I trust that He has something wonderful in store for me, and that gives me some peace.

Wilkinson, B. (2003). The dream giver. Oregon: Multnomah Publishers.

Status Migrainosus

So, I'm getting pretty scared right now. I've been having meltdowns every day lately, due to the intense and never ceasing migraine pain. I can't get rid of this migraine, and it's been a solid week now. My headache specialist is in a different state than me, so communication is over the phone. He put me on a 2-day steroid pill regimen, but I've already completed day 1 with absolutely no relief. If this doesn't help, I might go to the E.R. I don't know if/what they can do to help, but I don't know what else to do. My husband works at nights, which has been when my migraines are normally at their worst. I saw something on someone's blog about 'status migrainousus' (basically, a severe migraine that lasts more than 72 hours with less than 4 hours of relief). I'm going to try to go to sleep... it has been pretty rough, so I'm hoping tonight will be different.

The Battle Begins

I experienced migraines on and off throughout my teenage years. However, by my current standards, those would barely rank as headaches.

I had a car accident in October 2008, which has resulted in chronic, debilitating migraines; neck and shoulder pain; insomnia; and extreme weight loss. It has been a nightmare dealing with the different insurance companies, doctors’ offices, and so forth; while trying to heal and continue on with my life.

I never imagined that so much pain could result from a single moment in time. I have tried more medication than anyone should take in an entire lifetime! I have been to neurologists, physical therapists, massage therapists, counselors, etc... but the pain persists...

Migraine has affected my entire life: flipped it upside-down. I was only 23 years old, when I had the accident. I was at the top of my game at work, my long-time boyfriend had proposed a few months before, and I had just presented part of my senior thesis at a national conference. I was looking forward to going to graduate school the following fall.

I felt that my health had improved enough to begin graduate school in the Fall 2009. Unfortunately, my migraines worsened as the semester(s) progressed. I struggled through my first semester, which resulted in me being placed on academic probation. I was able to improve my grades during the spring semester, which resulted in me being taken off of academic probation. It definitely took a toll on my health, though. I took the summer off from school, and I am taking a leave of absence for at least this semester.

How could all of this be happening?! I went to a great liberal arts university and did well during my undergraduate years (i.e., before the accident), taking 15-17 credits per semester and working 20-25 hours per week. And, now, here I am... unable to keep up with school work (even with accommodations), unable to fulfill the 20 hours of work required for my graduate assistantship... unable to live my life in any sense of the word "normal."

Thus, the past (almost) 2 years of my life have been spent searching... I have done A LOT of research about migraines, as well as generally living with chronic pain. My search is definitely not over. There are many wounds that need healed - this accident and disease have affected my life physically, emotionally, spiritually, financially, and so forth.
 
It makes my heart ache to know that there are others out there that are struggling with chronic, debilitating pain and just trying to hang on. I hope that I can help, even just one other person, by sharing my story and what I have learned, as well as by being here to listen to other people's stories. If you have a story that longs to be told, feel free to tell it, even if anonymously. I know that it can be difficult to put your experience(s) into words, but perhaps telling your story will provide a sense of release.