April 8th, 2012
Well, not literally. Not that it would be unheard of in the Migraine world, many of us have banged our heads at times when the beast has settled down upon us. It’s a kind of counter-irritant, I guess. Something, anything, to try to break the repetitive throbbing. Or a distraction, some surface pain to focus on instead of the hideous rending inside the head. I’m really glad I don’t have many Migraines that get that bad any more.
Last Monday I woke up after a rough night, sleepy and with a mild ache on the left side of my forehead. Technically I’m sure it was a Migraine already, but I thought of it, as I often do, as more of a maybe-migraine, a migraine wannabe. My first impulse (so often the right one) was to call in to work, take my sumatriptan and go back to bed. And then the thought entered my mind of the budget for the month, and of the sick leave hours I try to budget too, and how since my Migraines have become less frequent I sometimes have a little headache that doesn’t turn into a full-blown Migraine. So my little headache and I went off to work, and chose to focus on the less mentally taxing of the tasks on my desk, and did most of my thinking out loud to help me focus, and took a walk at lunch, and did all I could to keep the beast at bay.
But I was talking about head-banging. Which I wanted to do before the night was out. I got home and tried to focus on all the stuff I try to focus on after work, like visiting my on-line world, Migraine related and otherwise, and helping Adam manage his homework, and imposing some kind of order on the chaos that is my home, and trying to build up and work on some of my free-lance work, and I found all I could do was go take a sumatriptan and lie down.
I set the alarm for about an hour and a half, rolled a pillow under my aching neck and dosed off, hoping the pill would do its job. And woke up groggy when the alarm went off, groggy and in pain. Groggy and nauseous and hungry and in pain. It was not yet two hours from the time I took the triptan, so I couldn’t do another dose, and the pill had had no noticeable effect. So I had to wait 15 minutes or so, and I needed to eat something for my blood sugar which was dropping (contributing to the Migraine). The head had started throbbing, one of those times when I imagined I could specifically feel each dilated vein around my brain pulsing and stretching and shoving against my skull.
So did I hit myself upside the head? In a sense. I didn’t actually feel like head-banging this time, though it was the worst Migraine I’ve had for a few months. Probably about an 8 out of 10 this time, the kind that makes me cry. I knew I had to bring out the big guns this time. I had to give myself a sumatriptan injection. A highly effective way to abort the Migraine, but which I put off and avoid as long as I possibly can. Why on earth would that be, you ask? If you have to ask you have never had one of these injections, or you are lucky enough not to experience them the way I do. First of all the injection itself hurts. It’s a spring-loaded injector; you shove it hard against your arm and hold it there, pressing until it injects. It’s not a jab, it’s a SLAM-STAB, and you have to keep pushing that thing in for 30 seconds to make sure all the medicine goes in, I do it while breathing hard through my gritted teeth.
Then you need to take your sore and aching arm and get yourself prone as quickly and smoothly as you can, so you can be lying down as still as can be when the real head slam comes. For me, and I understand for many others, the injection causes a “surge” of increased head pain before it begins to work. So the only thing, sometimes, that will make the pain go away, is a short-term, extreme increase in the pain. When I say short-term, it’s not an agonizing 30 seconds like the injection torture. It’s a good five to ten minutes of the front of my head feeling like it’s being hit with a tire iron, from the inside.
The only thing that gets me through to the other side is lying on my back as still as I can, doing my relaxation breathing. I have to go into the pain, be with the pain, and visualize my breath carrying the pain away, out with each exhale. And eventually I fall asleep, and usually in that sleep the pain goes away.
This time it took a long time, almost until morning, before the pain lifted. If I’d followed my original impulse and taken a pill in the morning before the pain was much of anything, I probably wouldn’t have needed the injection. If I’d taken the injection right away when I got home I probably would have been pain free in two hours. But I couldn’t bring myself to hit myself upside the head. Until there was no alternative. If you’ve been there, you know what I mean.
- Megan Oltman
April 20th, 2010
On Tuesdays there are staff meetings at my new office, at 8:30 a.m. That may not be ridiculously early, but it means I have to be up at 7 and racing through my morning to get there on time. The nortriptyline I take as a Migraine preventive makes me good and sleepy, and it’s hard to wake up and move on less than 9 hours of sleep. Today I not only had to be awake but to give a little presentation at the meeting on using Facebook and Twitter for business. I am relearning some things I used to know, like how to get up and go even when I don’t feel up to it. How to push myself through times when my focus isn’t there, or I’m a bit fatigued, or to work with a triptan in my system.
Don’t get me wrong, this new job wouldn’t even be happening if my Migraine prevention regimen weren’t working quite well. My Migraines went down by about 60% in the months before I started the job. The challenges of the work routine have them back up a little again, but it’s still significant progress. If I had tried to take on the challenges of this job a year ago, I doubt I could have done it.
I also work an 8 1/2 hour day on Tuesdays and Thursdays because Monday and Friday are my short days and Wednesdays are a day off. That’s just the way we worked out for me to work a 25 hour week. It makes those long days challenging, though. If I don’t sleep well the night before (like last night) and I still go put in a full day, it can lead to an evening Migraine. Right now I am lying down with the laptop, writing to you all after dinner, with a bit of a headache. Trying to see if I can contain it by resting. That works sometimes.
One of the difficulties for me is that I can’t seem to go to sleep and get up at the same time every day the way my Migraine brain demands. I need plenty of sleep, and if I went to bed early enough to make the Tuesday wake-up hour my standard, I’d never get to see my teenage kids or night-owl husband. I’d be best off if I could take a nap to even things out, I think, but short of napping in my car that’s not an option right now.
All in all, I am very grateful to have a job, to be doing professional work and helping people, to be getting some respect and recognition, and earning a living. I am grateful that I still have Wednesdays to keep working at my Migraine coaching. I had forgotten, as a self-employed person for many years, how satisfying it is to leave at the end of a work-day, knowing I had filled the day with doing my best, and that I am done for the day. I am enjoying my evenings more, and allowing myself to relax. Except that these Tuesdays are hitting me hard!
Sleepy law student image courtesy of umjanedoan.
December 3rd, 2009
Teri Robert at My Migraine Connection reports today on a study on use of sumatriptan (Imitrex and generics) and naratriptan (Amerge) to abort Migraines during pregnancy. The article is well worth a read. Migraines, Triptan Safety, and Pregnancy. The study is preliminary, but indicates that the overall risk of birth defects is not raised significantly (from 4% general risk to 4.6% risk in the study) with use of sumatriptan. There was not enough data to draw a conclusion as to use of naratriptan. This is potentially good news for pregnant Migraineurs. Although the results are preliminary, it’s well worth discussing with your doctor if you are experiencing Migraines during pregnancy.
October 1st, 2009
So I stayed in and didn’t take the triptan – and about 10 my head was pounding and I felt nauseous. At that point I took the triptan, and some anti-nausea meds, and tried to go to sleep. I slept badly, with pain in my head nearly all night. I kept waking and checking the clock to see if 2 hours had gone by so I could take another triptan. Then I slept a bit longer and woke after 2, still in lots of pain, and took the second dose. Slept fitfully and around 5 noticed that the pain had let up a good bit. Woke with the alarm at 7.
So I called the court and told them I was ill and could not come in. I went back to sleep and woke up a few hours later, to this:
I’m not sure they ever shut up, those voices in our heads. But here I am, several hours later, head still hurting, trying to make what I can of the day. Just a Migraineur, intermittently impaired, working around it the best I can.
November 24th, 2008
Imitrex – the trade name of the drug sumatriptan by GlaxoSmithkline – is at long last out in generic form. Imitrex was the first of the triptan class of drugs to be released, and is therefore the first to be coming off patent. When Imitrex came out about 15 years ago it revolutionized treatment of acute Migraine attacks. Triptans work not as pain-killers but work directly to abort the neurological process involved in a Migraine attack. Although they are contra-indicated for some Migraineurs, particularly those with cardiac-related problems, they are tolerated by most, and make it possible to greatly limit the impact of a Migraine attack.
Kerrie at the Daily Headache reported last week that injectable sumatriptan is now available in a generic form, and the Wall Street Journal announced today that Dr. Reddys Laboratories has launched the generic version of sumatriptan tablets. This is great news for Migraineurs – Imitrex has been one of the more expensive triptans on the market, retailing for anywhere from $15 – $25 per pill. Many Migraineurs, myself included, have found ourselves in ongoing struggles with our insurance companies, which limit us to 4 (or 2, or 6) pills per month, forcing us to choose which Migraines to treat and which to suffer through. I am still fighting for reimbursement of over $200 for Imitrex that was prescribed, and which the insurance company said they would pay for and didn’t. But that’s just another health insurance headache story.
March 5th, 2008
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
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