Tag: migraine

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Another Day Gone

This is My Brain on Migraine
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I wake up; the pounding in my head forces me to. I drag my sandy eyelids up and try to focus on the clock. 4:45 a.m. My mouth tastes like dirty socks and my stomach wants to heave. I make myself sit up and the room reels. The telltale rush of saliva into my dry mouth warns me that I don’t have much time. When the room stops moving I put my legs over the side of the bed. Somehow I’m vertical and staggering toward the bathroom.

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I keep the shots of Imitrex ready to go. Finding the injector in the dark is not a problem. The container is on the bottom shelf of the bathroom cabinet, right where it’s supposed to be. My fingers fumble and pry up the lid on one of the twin ampules. The only reason I can do this now is years of practice. When my doctor first gave me the shots I was slower. The novelty meant I sometimes couldn’t prime the injection device properly and a spray of precious triptan would shoot across the room instead of into my flesh. When the headaches are really bad, sometimes that still happens. Migraines steal fine motor coordination. Gross motor skills are pretty much out the window, too, but it’s the fine motor I need now. And the dismay of seeing an injection that costs over a hundred dollars wasted into thin air has no equal. This morning I manage to load the syringe and press it to my flesh. My thumb hits the button on the end of the device and I can’t help but hiss as the sting of the medication hits my intramuscular tissue. It takes a couple of tries, but I manage to cram the injector into its holder and prime it for the next shot. Then I stagger a couple of steps to the sink.

Surely I will feel better if I get those nasty gym socks off my teeth. My hands tremble as I load my toothbrush. Applying toothpaste to my toothbrush takes extra time and effort. It’s hard. I turn the water on and wet the brush, then bring it to my objecting mouth. No sensation is good, because every sensation is amplified with a migraine. The sharp taste of minty-fresh explodes in my mouth and I rinse the brush again. I just want to peel off the cotton that coats my mouth, not breathe on anyone. I don’t want to sanitize myself yet. I just need to get rid of the grimness of first waking up.

Afterward, I grip the sink with both hands. The Imitrex still isn’t working, and even the slightest head movement is agony. Maybe if I lean here for a moment the drug will kick in. But not yet. The jack hammer in my skull subsides with stillness. When I think I can bear it, I move tentatively toward the toilet. Whether or not I really need to go, I need to sit down, and, at a distance of twenty feet, my bed is too far away. I miss the three-foot-tall stacked cube shelf that I used to have in my bathroom. I could sit on the toilet, pull it close, and rest on it, my head lying on my folded arms. Sometimes I would drift into unconsciousness that way and my husband would call to me, asking me if I was all right. If I had assumed that position, I was never all right. Now, though, the shelf lives at his house and the twelve-inch distance to the tiled wall is to far to lean, no matter how good the cold tiles might feel on my skin. I sway as I sit there.

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My eyes are closed. I lose track of the minutes. I beg the drug to start working. I wait for the sensation at the back of my neck that signals its effectiveness. Nothing happens.

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Eventually, I think I can make it back to bed. The nausea is a reminder that the meds aren’t working, and I know that on my way I need to get the Phenergan. Dr. Archer has prescribed it in a cream. Philip at the Drug Store compounds it and puts one dose into a syringe without a needle. A plastic cap at the tip of the syringe keeps the cream from drying out. It’s hard to get those caps off. I dread the effort, but I know it is necessary. If I start throwing up, I won’t stop. Vomiting with a migraine doesn’t make anything better.

I stand before the door of the medicine cabinet again, reach into the Ziplock bag that contains the Phenergan cream syringes, pull out a syringe, and start wrestling with the cap. Not only do I lose coordination with migraines, I lose strength. It takes me more than a minute to pry the cap off. With a grateful sigh I push the plunger and spread the cool cream on my wrists. I aim the syringe at the trash can and let it go. Of course I miss. I’ll pick it up later. Now it’s time to stagger back to bed and hope that the combination of drugs will stave off the nausea.

Too late, I forget that I have a bead of blood on my skin from the Imitrex injection. I know I smear the sheets with red as I lie down. I hope it has dried and I can brush off the crumbs of blood easily. I washed and changed the sheets just yesterday, using strong spot remover on the blood stains from last week’s migraines. They never seem to come out completely unless I use bleach. I care, but not enough to do anything but pull myself into a fetal position. My pillow is too hard. There’s nothing I can do about it except keep very, very still. My body is covered in a sheen of sweat from the nausea. I don’t want under covers yet. Warmth amplifies the pain. When the Phenergan kicks in, the sweat turns clammy, then evaporates, leaving a salty residue. Once my skin is dry, I find the coolest spot on the smooth sheets. I tug the top sheet over me, and a few minutes later pull up the quilt, too. The Imitrex still isn’t working. I am grateful for Phenergan’s fortunate side effect of drowsiness. I lie there, waiting for the Imitrex, and waiting for sleep.

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Sleep evidently came. I am wake again. It’s 7:40 now, and the Imitrex has only dented the migraine pain. The nausea is mercifully gone, but even though every shift of my head doesn’t bring waves of agony, a full-blown migraine still actively assaults my head. I try to sleep again, lying still and letting my mind drift hypnotically. It’s no use. I’m awake and alert, pain and all.

I can dose myself with Imitrex again. After two hours, if I don’t have relief I can take one of the tablets. I carefully leave my bed and make for the bathroom. The blackout curtains in my bedroom don’t close completely, and the shaft of daylight stabs my eyes as I pass through it. I need a ladder to reattach the last drapery hook to the rod.  Not now, though. I can barely walk steadily. Climbing a ladder is out of the question.

Imitrex’s packaging is intended to be impossible to open. Insurance only pays for nine pills a month, and they come in paper and foil-backed blister packs. Normally I take all the pills out of the blister packs and transfer them to a pill case as soon as I get home from the pharmacy. Stupidly, I neglected to do so this time. It’s a new box of pills, and I fumble even to tear away the box top to get at the blister pack. I still have no fine motor coordination, and tearing away the paper and foil backing is beyond me. Finally I stab the back of the pack with tweezers to get it open. The pill breaks as I extract it. It will leave a horrible taste in my mouth because of that. I swallow it anyway, and take a long drink of water to wash away as much of the residue as I can. Now for the other weapon in my migraine arsenal.

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Hydrocodone. I hate it. I love it. I hoard it. Dr. Archer allows me twenty pills a month, but I rarely use them all. It scares me. The last thing I need is an opiate addiction. My tolerance to it is high. For all I know, I’m already addicted. I don’t know. What I do know is that hydrocodone is an extra lifeline for when the triptans don’t work. Today, I need it. Maybe I can go back to sleep. It will be an hour before either it or the Imitrex tablet will take effect. I shake the fat tablet into my palm and wash it down with water. I go back to bed.

I doze, but I don’t go back to sleep completely. After an hour, there is no change. I am tired of my bed. The cats have been anxiously head-butting the door and crying. They’re hungry. Their water dish is probably empty, too. I debate taking another hydrocodone tablet, but decide to wait. I want to see how the effort of climbing the stairs affects me, and if I take one now it will make me itch. Of course, I can always take Benedryl with it. The antihistamine will help with the itching and make me drowsy again. No, I’ll wait.

I should have taken the second pill. In my kitchen, I sink onto a stool at the breakfast bar and lay by head on my arms. The cool granite of the counter feels wonderful. The pounding in my skull does not. When it subsides, I reach for the bottle of hydrocodone I keep on my lazy Susan. The cats are sitting next to their empty food bowls, expectant. “Just a minute, guys,” I whisper. I run water into a dirty glass sitting in the sink and swallow the pill. I stand at the sink for a moment, waiting for the pounding to start again because of the movement. Thankfully, it does not.

The cats’ food dishes are on the floor. I squat slowly, not wanting to bend or even tilt my head for fear that blood will rush into it and the throbbing will begin again in earnest. I nearly lose my balance, but I’ve thought to hold the edge of the counter to ease myself down, so I have a lifeline. I’m shaky as I rise. The three steps to the bin of cat food in the pantry go well. I scoop food into one of the bowls. No wet food this morning, kitties. Sorry. I can’t bend over to get the can, and the smell of it would destroy me. I can smell the litter box across the room, and I know it needs attention, too. There’s no way. Not now. Not yet. Please understand and don’t do your business in the house plants, I beg them silently.

I sit on the stool again to recover from this round of activity. I need to eat something. Lack of food will only make things worse in the long run. I keep coffee in the fridge. Caffeine sometimes helps, sometimes hurts. As bad as this headache is, I decide to give it a try. Iced coffee with a bit of hazelnut-flavored sweetener and a dollop of milk. It isn’t as sweet as Starbucks, but then nothing really needs to be. My sister says those sweet coffee drinks from Starbucks are “a candy bar in a cup.” She’s not far wrong. I sit and drink. It tastes good. I feel stronger after sustenance. I mix myself another iced coffee, and munch on a few strawberries. The carbs will give me strength and energy.

It’s 8:25 now. I move to my computer, which sits in an alcove off the kitchen. I bring my coffee with me. I can sit relatively still, reading blogs and news, and wait for the hydrocodone to do its magic. Eventually, the itching starts. I keep a back scratcher next to the computer because my perpetually dry skin always itches. Itching from too much opioid  is not satisfied as easily. I read. I sit. When I get up to forage for more food, my head reminds me that I need to stay still. I return to my computer chair with a small chunk of Havarti cheese and rice crackers.

A little after eleven, my phone rings. It’s Jan, wanting to go to The Full Monty at the Weekend Theater. She’s not sure we can get tickets. Tonight is the last night. Even though I tell her I am not up for it, she is determined to go. She will have to drive in from Hot Springs, so if the show is sold out then she’ll have a wasted trip and an hour’s drive home. I turn down the volume on the phone, because the conversation is unnaturally loud. I tell her I’m not feeling well, but that she is welcome to come by if she can’t get a ticket. I hope the show is not sold out. I hope she can go. I realize I need to go back to my bed. We hang up, and I take a deep, slow breath to steady myself. The phone call has brought back the raging throb.

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I get a glass of ice water before descending the stairs to my bedroom again. I climb into bed. The sheets are smooth and cool, and I think again that I need to rehang that drapery hook so the curtains close completely. The shaft of midday sun coming through the opening stabs my eyes. My head hurts too much for me to turn my back to the windows. Besides, the light bounces off the wall; it doesn’t really go away if my back is to it. I close my eyes and hope for sleep.

I haven’t yet started to doze when I hear the garage door open. Jack is home. Lora is with him. They’re going to hang out in the basement. He brings me an icepack. I’m glad he’s come home, because I can really use that icepack. I drape it over my forehead, pressing its ends to my temples. The kids go to the basement. They know to be quiet when I have a migraine. Poor Jack. His whole life, his mother has been sick. Sometimes, she’s sicker. Like today. He has told me that by the time he was eight, he could read the labels on my meds and even spell hydrocodone. I don’t doubt it. I sent him to get them from the cabinet often enough.

I doze, and finally I sleep. It’s almost 5:00. The migraine has receded to the back of my brain. It’s still there, but right now it’s not attacking me. It doesn’t hurt. I go upstairs again. If I don’t eat a meal, I’ll suffer for it. I need protein, vegetables. I make a sandwich and chew it slowly. I don’t really want it. I’m not hungry. The consequences of not eating will be worse than forcing myself to eat now. I sit at the kitchen counter and read a  magazine while I take unenthusiastic bites. I hear the kids come upstairs. They’re leaving. They chat cheerfully. Their good moods and the sandwich have combined to lift me up. Lora tells me she’s reading The Princess Bride, and I am delighted. It has been my favorite book since I was sixteen. I refused for years to see the movie, because I was so afraid that Hollywood would ruin it. I shouldn’t have worried. William Goldman wrote the screenplay for his own great book, so everything was as it should have been. Miracle Max and Valerie. Fezzik and Inigo Montoya. The Man in Black. Buttercup. Prince Humperdink. The Six-Fingered Count. Talking about it with Lora, I feel animated for the first time today.

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The kids leave and I return to the computer. I need to sit still. If Jan comes tonight, I need to be functional. I’m functional now, but I don’t know how long it will last. I start writing this blog post. I feel myself tiring, but Jan calls at 7:30 to say she could not get a ticket to the play. For the last hour I have been checking the clock, wondering if she will call. About fifteen minutes ago I had decided that she must have gotten in, or I would have heard from her. “No, no, it’s fine,” I tell her. “Come on by.” I go downstairs to get the skirts I need to alter for my niece’s school uniform. They are hand-me-downs from her sister, who is shaped differently. As Jan and I visit, I rip out the hems. By 9:30, she says she’s tired and is going to get back on the road. I’m glad, because I’m fading, too. The headache isn’t back, but it’s skulking in the recesses of my skull, waiting to strike. And all those meds exhaust me. I’m happy to have seen Jan, though.

After Jan leaves, I rip the hem out of the last skirt, and I head downstairs with a fresh glass of ice water.

I read a little in Sacré Bleu, the newest book by Christopher Moore. I’ve had it since its greatly anticipated release, and I keep getting distracted from it. I love Chris Moore’s books. I wish I had his wild imagination. I want to keep reading, but my brain won’t let me. I’m too tired.

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Another day sacrificed to migraine. Another day, gone.

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Migraines

I have chronic daily headaches.

My migraines were diagnosed when I was 9 years old.  I don’t remember the first one I had.  I have always had what we called “sick headaches.”   My head would pound to the point where I couldn’t speak or think, and my stomach would lurch.  Then I’d lose everything I’d eaten in the last 24 hours. It might last a few hours, or it might last 3 days. However long it lasted, the hours and days were simply written out of my life.

My migraines came at irregular intervals.  I would get three, four, or perhaps five a year. They were manageable with pain medications, which would help me to sleep despite the pain.  Without the meds I would lie curled up and moan.  Tears, unbidden, would leak from my eyes, which were screwed tightly shut to ward off light.  I was prescribed codeine.

When I was in boarding school no drugs were allowed in our rooms.  Even aspirin had to be deposited with the school nurse, who was there only from 7 a.m. to 5 p.m. The nurse didn’t believe my headaches were real.  She thought I was a druggie teenager seeking narcotics when I asked for my medication, so I kept a bottle of pills in my room and another in my purse.  Had they been discovered, I would have been suspended or maybe even expelled.  They were the only way I could even partly function when the headaches were their worst, and sometimes even then I couldn’t. I hoarded and guarded those pills.  There was no way they were going to be used recreationally.  Those pills were more precious than diamonds.

The world often seems brighter, louder, more active, and more intense just before a migraine hits.  Sometimes before the pain begins colors suddenly take on an energetic quality, smells become more pungent,  and sounds seem louder. Activity around me makes my heart beat faster.  I don’t perceive it as a threat, just as too much energy that makes me uncomfortable or edgy.  I get irritable. This is my “aura.” I don’t hallucinate. I don’t see anything that isn’t really there, unless the increasing intensity of my senses counts.

Sometimes a migraine hits with no warning at all. I may be calmly walking to my car and be slammed with a 2×4 to the brain. I fumble in my purse for the triptans – drugs that are designed to abort a migraine – knowing that it may be an hour or more before the pills begin to work. Another slam, and I wonder if I can drive my car home.  I have to.  That’s the only way I can get there.  Digging back into my purse I come up with the Vicodin ES my doctor prescribed for pain that isn’t alleviated with the non-narcotic triptans. It still takes an hour before I can drive, and I am thankful I don’t have to drive far.  It’s not just for my sake, either.

I call these headaches “Mike Tysons.”  With the first sudden blow I am reeling; with the second I am almost unable to move, talk, walk, or look at anything.  I curl into a fetal position in a small, dark, cool place and wait out the pain. I am oblivious to my surroundings except for the sounds and lights that assault my senses.

A car accident a decade ago made them worse.  The headaches I got perhaps five times a year suddenly became several times a month, then several times a week, and now are almost daily.

My triggers include physical stress to my cervical spine (sleeping wrong on my pillow), soy, corn, preservatives, artificial sweeteners, the weather, seasonal allergies, irregular sleep, stress, irregular meals, alcohol, and aerobic exercise. Being in a crowd where I can’t hear well causes a headache, too – I’m talking about football games, crowded parties, and noisy restaurants.

Emotional surges can induce a migraine.  When I was told my father died, one hit me immediately.  Great joy can induce one, too.  Winning a tough case makes me feel wonderful, and is always followed in just a couple of hours by a splittng headache.  The shouts of boys playing inside on a rainy day, the birth of my favorite oldest niece and both of her siblings, a favorite song cranked to top volume, the satisfaction of a difficult job done well, the pleasure of a story completed after wrestling with the plot and characters for so long – all of these things make me feel wonderful, and all leave me with a hatchet striking my frontal lobe repeatedly.

In college, I would always get a migraine after the exam or after the term paper was turned in.  I call it my neurological let-down.  Once the period of stressful high productivity was over, my body and brain knew they could rest.  Before I embarked on another project,  a migraine would force that rest on me.  The same thing happens still.  I finish a brief, I’m through with a settlement conference, I leave a hearing and my head throbs.  The stress is over; the migraine is just beginning.

I lose the ability to speak coherently.  My brain fumbles for the right words.  My fingers fumble with the Imitrex packaging.  What sociopath at Glaxo-Welcome designed that packaging, anyway?  It’s hard enough for someone without a migraine to open it, but someone with a migraine, who suddenly has the strength of a kitten and the coordination of a newborn has an extremely difficult time getting to the stupid pill!

Migraineurs know exactly what the ice pick in the eye feels like.  We have experienced a head that literally feels about to explode, and we pull our hair in an effort to force the explosion to completion or we squeeze to hold it in.  Other time we feel the vise tightening around our skulls, squeezing until we think the bones must shatter… but there’s nothing there.

Migraineurs have experienced soft pillows that are too hard. Walking up or down stairs is excruciating. Any movement causes a swell in the degree of pain, a giant THROB that suppresses all reason.  Each footstep across a room creates those throbs, as does turning over in bed and sitting up to accept the glass of water and pill from someone kind enough to bring it to me. Turning one’s head during a migraine can be agony. Every migraineur understands exactly why decapitation would be a relief.

I’ve tried biofeedback, meditation, acupuncture, chiropractors, cupping, Chinese herbs, oregano, and magnesium supplements. I’ve tried several drugs that work for others, including Neurontin, Topamax (the gastro side effects of this drug were horrific), Verapamil, and Atenolol (Beta Blockers).

I’ve stopped working full time to reduce my stress levels, and moved my law office home so that I can take a nap when I need to. My bedroom is painted a dark mossy green and I have blackout curtains. I am careful to take cases that will not cause undue stress. I got out of a stressful marriage. I don’t drive more than an hour at a time because even on cloudy days the glare gets to me.  Forget driving in the rain, too – windshield wipers are like strobe lights to me.  They induce a headache in a very short time.  Even the long shadows falling on the road through the trees in the late afternoon are enough of a strobe effect to set me off, and it only takes a few minutes.

In an effort to avoid soy and corn additives to food , I am now make almost everything I eat from scratch – I can’t eat any of the prepared meals from the frozen foods section of the grocery store, and practically no canned or packaged foods other than fruit or vegetables.  My bread machine gets a great workout.  I read food labels religiously.

My migraines are manageable with my current regimen of drugs, which includes an anti-seizure medication.  Triptans like Imitrex, Maxalt, Zomig, and Relpax usually break off the headache.  I use Vicodin ES for extra help in reducing the pain. I use Phenergan suppositories to quell the nausea. I take a mild muscle relaxer before bed to help keep my neck supple. I use ice packs, heating pads, and naps.  I listen to cool jazz even though I really want to hear Foo Fighters.  I never go anywhere without my medications. The pain killer, the triptans, the anti-nausea… I am a traveling pharmucopia.

I have also discovered a fantastic massage technique.  It’s expensive, and my insurance doesn’t cover it, but once a month I go to a masseur who does myofascial release.  I follow that appointment with a deep muscle massage.  I have found that the massages not only help relieve muscle tension, but they help relieve stress.

Learning to live with chronic daily headache doesn’t mean giving up the fight against it. I go to my neurologist every three months, and I am always up for trying new procedures, drugs, supplements, and techniques to alleviate the pain and prevent the headaches from happening.

I am realistic about what I can do, though.  Because I can’t be relied upon to be at functions (crowds stress me, and a headache is guaranteed), I do the behind-the-scenes stuff at my son’s school and for two historical societies I belong to. I wish I could do more, but I have learned the hard way that I usually have to say “no.”

Even the things I want to do will be torpedoed by a migraine. A coffee date with girlfriends, a dinner out, plans for the theater – all of these get derailed by migraines occasionally. My friends don’t understand. It’s just a headache, after all.

I’ve had people tell me, “Oh, you have a magnesium deficiency.” Nope, sorry.  I tried magnesium and saw no appreciable difference in the frequency or severity of the attacks.

“Oh, you need to relax more,” I’m told.  I have eliminated all possible stress from my life. It’s not just stress.

If I could tell you the number of times someone has told me about Topamax, or fever few, or acupuncture, or some other remedy! And even friends who suffer common migraine with aura don’t seem to get it. Mine occur almost every day, not once a month with my period (that stopped at 32 when the plumbing got yanked for cervical cancer). Hearing that this treatment or that treatment will “definitely” work amounts to a platitude. I want to say to them, “Don’t condescend to me.  You have no idea what I’ve tried and what I’ve gone through.”

I live life one day at a time.  The rare day without a migraine – today! – is a treat.  I accept it with cautious pleasure. Tomorrow the drugs may work, and I’ll be able to function.  The next day I may be in bed, wishing the Red Queen’s executioner would hurry up.

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