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Archive for the ‘Managing’ Category

Update on my Headache Specialist Visit

July 13th, 2008


If you’ve been wondering, I do think all the preparation I did paid off.  I met with my new headache specialist for over an hour on Tuesday, and I liked him.  He seems knowledgeable, up on current research, is respectful, takes his time, listens, answers questions.

He took a little over an hour with me. He is starting up the headache center for UMDMJ (University of Medicine & Dentistry of NJ) and RWJ (Robert Wood Johnson) University Hospital. The center has been open
less than a year. Right now he spends half his time with general neurology patients while they build the headache & Migraine practice. He plans to do headache medicine exclusively and wants to have an iv center here eventually. He said about 80% of his HA patients have chronic daily headache or transformed migraine. He is very concerned about preventing chronic pain in someone like me who hasn’t developed it yet.

Some very good news for me – when I talked about an emergency plan, he said to come to the ER at RWJ. They will contact him or the neurologist on call and will have my chart and a protocol for me. It’s about 15 minutes further to this ER as opposed to 20 to my nearest one, but I can cope with that. It’s a huge load off my mind to have an emergency plan.

We talked about preventives – he gave me the choice of starting them now or giving it a few months to see if my current success holds (2 mild migraines last month – see my post on Recent Success). I decided
to wait. He wants me to continue exercising every day, get 8 – 10 hours of sleep per night, and he wants me to add physical therapy for neck-strengthening exercises and get neck massages. If the headaches

increase again I can call him and he will start me on preventives. I will be seeing him again in mid-September.  I’m planning to do a lot of reading up on medication options before that time. Other issues – he wants me to get an ENG to test whether my vertigo is positional vertigo or Migraine related (MAV). He thinks from my description it is probably positional and they can correct that in the office. If it’s MAV
triptans could be a problem so I hope I don’t have it. My medication options are so limited already I sure don’t want them limited further!

He would also like me to do a challenge test with aspirin – I’ve talked to my primary physician about doing that in his office. (For those of you not familiar with my saga, I have a life-threatening allergy to ibuprofen, and that is in the same drug family as aspirin, naprosyn, all the other nsaids.) This is an allergy challenge test – to see if I react to the drug. The
staff would be standing by to save me if I have a reaction. The idea makes me very nervous. But if I am not allergic to aspirin it expands medication choices quite a lot. I need to think hard about whether I am willing to take that risk. He’d like to be able to give me naprosyn for when I can’t use a triptan – he also says because it’s longer acting
it’s less likely to cause rebound headaches than the triptans.

I left his office and developed a 2 day migraine – I think the drive and parking in the blazing hot sun did me in.  But I’m happy to have a good doctor on my team!  Since the appointment I have scheduled physical therapy, called to schedule an ENG, and ordered prescription sunglasses to deal with the summer sun.  I hope I’m on a roll!

– Megan

Hospital image ©2008 Robert Wood Johnson University Hospital, aspirin image courtesy of Ritcharnd Moskow.

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God Grant me the Serenity to Accept the Migraines I Cannot Change

July 11th, 2008

I try to live by the serenity prayer:

God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

This simple prayer has seen me through family issues, recovery from major illness, life crisis and transitions, grief, job loss, financial difficulty.  It is the mantra I repeat as the pain takes over my head, as I wait for my meds to work, as I practice deep breathing to relax my mind and body.  It keeps me focussed where I need to be, in knowing what I can change and what I can’t, not wasting my energy where I cannot change something, not sitting in useless despair when there is something I can do.  It also keeps me in the moment.  I cannot change anything in the past.  I can only change the future by taking the next right action to lead me where I want to go, not by wishing, hoping, fantasizing or sitting immobilized in fear.

There’s no way for me to write a post about spirituality without talking about what I believe, which is deeply personal and which I rarely discuss.  I grew up with a Jewish mother (from a not very religious family) and a father who was the son of Presbyterian missionaries, celebrated holidays from both religions but was raised pretty much as an atheist, and then became a Quaker (along with most of my family) as a teenager.  Spirituality and faith may never be a simple matter for me.  I don’t consider myself a religious person, but I am a spiritual person.

There’s no way to write a post about spirituality, I think, without turning some of you off.  Some may already be turned off by the use of the word “God.”  Some were turned off by my description of my unusual religious background.  Some will be excited by it and see it as an opportunity to convert me.  Please resist that temptation!  Some will be turned off in a moment when I tell you that I consider myself to be a faithful agnostic.  What does that mean?   I have faith in a power greater than myself, in a power for good, the power of love, a power that unites people, incites altruism, brings us to care for more than our own selfish interests, “that of God in every man.”  I believe there is more out there than we can see, perceive or know in any scientific sense.  But I’m… blessed if I know what it is!  I don’t even think it’s important for me to know what it is!
How does this help me with Migraine disease?  I don’t go down the road of “God gave me Migraines for a reason.”  Whatever else I believe, I can’t get behind the idea of a God who causes suffering, for any reason.  I think more that we live in this gloriously complex world where we have sunsets and earthquakes, roses and poison ivy, kittens and sharks, senses of humor and migraines.   It’s a complex system that somehow all works together, and we are part of it, warts and all.  Migraines and all.

I do believe, though, in my God, my higher power, as a comforter.  As the force of love, of good.  To help me through pain, to help me remember that I am not the pain, that I am more than the disease, that I am here to help others, to make the world better.  Sometimes in the midst of a migraine, I have a moment of feeling like this is all there is, no world exists outside the pain.  I say the serenity prayer.  It reminds me that there is more.  That I am more.  That another day will dawn when I am without pain and can get on with living.  That the beauty of the world is still there waiting.  I do think it takes faith to live with Migraine disease.  Ridiculous faith and unconquerable hope.  I am amazed by the ridiculous faith and unconquerable hope I see in my fellow migraineurs.  And I find serenity there too.

– Megan
Wishing you serenity and freedom from pain

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Exercise and Migraine Prevention: Take Two

July 10th, 2008

I promised to get you some more evidence to answer the question: Does exercise aid in Migraine prevention?  And in the interim, this news cropped up:  The Journal Headache recently published a review of eight studies and four case reports of exercise as migraine therapy.  Dr. Volker Busch of the University of Regensburg, Germany, reviewed the studies, and found that

“most studies did not find a significant reduction of headache attacks or duration due to regular exercise. Six of the studies demonstrated a reduction of pain intensity during the intervention.”

Read full coverage at My Migraine Connection.  Please note, though, that the answer is not “No.”  The answer Dr. Busch’s review provides is that: 1) in the studies reviewed, there was not a significant reduction in number or duration of migraines; and 2) there is not yet sufficient evidence to state with certainty whether or not exercise helps.

Does this mean we give up on exercise?  No!  I gave you my little piece of anecdotal evidence a few weeks ago in the post Exercise for Migraine Prevention.  My update since that time?  I have exercised 27 of the last 30 days.  I have had 3 migraines in that time.  Contrast that with an average of 6.5 migraines per month for the last 7 months, with sporadic exercise.  It’s not scientific evidence of anything, mind you.  All I can tell you is that exercise is making me feel good!

What does exercise do for us?

Read more on the benefits of exercise from migraine blogger James Cottrill at Relieve-Migraine-Headache.

It stands to reason, I believe, that exercise might reduce migraine frequency or severity.  I can’t promise you, of course, that it will do that for you.  Migraine is, among other things, an outcome of a sensitive, highly reactive nervous system.  Whatever we can do that makes us stronger, healthier, more relaxed, more stress-hardy, ought to make our systems less reactive.

Most of us are also aware of the problem of exercise-generated migraines.  The key is to take it slow and gentle.  A couple of great articles on how to work in some exercise without setting off migraine are Teri Robert’s 10 Ways for Migraineurs to Sneak in Some Exercise, and Ellen Schnakenburg’s Moving and Exercising and Migraine.  Also remember to drink lots of water and avoid hot sun if it’s a problem for you.

I don’t have medical studies to back me up here!  But medicine is art as well as science, and I’ll tell you that all my doctors are telling me I need to get regular exercise!  So don’t let “it’s not proven” mean “why bother?”

– Megan
Breezy, clear, sun getting lower – time for a walk!

What does that sailboat image have to do with it?  That was my daughter’s first solo sail – she was getting some great exercise!

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Coping with Migraine: Claims of a “Cure”

June 27th, 2008

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

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Managing my Migraines: Recent Success

June 25th, 2008

All my hidden superstition comes out and I hesitate to say this for fear of jinxing myself, but I have only had one very mild Migraine in the past 19 days.  It is too soon to tell if this is a trend or a fluke.   It’s quite a contrast to the last 6 months though, when I’ve had an average of 5 Migraines per month and my Migraines have generally lasted 36 hours.  I promise not to be embarrassed if this trend doesn’t continue.  I believe I am doing a lot of right stuff – just sometimes we need even more right stuff to add to our toolkits.

I have yet to try preventive medications; I missed my long-awaited headache specialist appointment when I was sick with bronchitis.  But I will give you my current regimen, and list the things that I think are making a difference.  Please note that this is my list; the same factors might not work for you.

  1. 400 mg of Magnesium (see studies done by USDA linking magnesium deficiency and migraine)
  2. 200 mg of B2 (riboflavin)
  3. a high potency multi-vitamin
  4. 60 mg Armour Thyroid*
  5. an iodine supplement*
  6. 3000 mg phosphorylated serine per day, 1000 mg each at lunch, dinner and bedtime*
  7. 10 mg DHEA*
  8. the Wiley Protocol – bio-mimetic hormone replacement therapy
  9. not drinking caffeinated beverages more than 2 -3 times per week – and the ones I drink are mild!
  10. 30 – 45 minutes aerobic exercise daily
  11. sleeping 8 hours per night
  12. daily meditation
  13. basing my work schedule on the idea that I have about 30 productive hours in me per week, and not trying to do more than that!
  14. taking frequent breaks throughout the day and gardening or doing housework
  15. napping if I need to
  16. switching overhead lights in the house back from CFLs to incandescents
  17. banning my son’s stinky cologne from the house
  18. Summer – long days, warmth

I have Migraine disease, early stage chronic fatigue syndrome (CFS), low thyroid and, I believe, seasonal affective disorder.  I also have allergies, and frequent, sometimes chronic, sinus infections, and am very prone to catching whatever illnesses are around to catch.  The factors that I marked with an asterix (*) above are not there to prevent Migraine; they are there to balance my hormones, strengthen my adrenal glands, and manage my CFS.  All the research shows that CFS and low thyroid are co-morbid conditions with Migraine – they occur at the same time, without a causal relationship.  I can only speak to my own experience, but when I am fatigued, and I push myself beyond my limits, I often get a Migraine.   Low thyroid also contributes to my fatigue, which contributes to my Migraine frequency.  Unless someone can prove to me otherwise, I will maintain that taking care of my thyroid and CFS also takes care of my Migraines.

I began the Wiley Protocol about a year ago to address menopausal symptoms.  The Wiley Protocol replaces a woman’s hormones with the identical hormones her body makes (rather than the synthetic hormones found in traditional HRT), and doses them in the way that mimics her natural cycle when she is young.  It is not specifically designed to combat Migraine, but for those of us whose Migraines increased in peri-menopause, it makes sense that returning to a younger hormonal state would help!  I found initially that while my Migraine frequency didn’t improve, the severity went way down.  My doctor started me on an adjusted dose of the hormones about 3 weeks ago, with estrogen levels raised slightly in the beginning of my cycle and lowered slightly later on.  Since that’s the same time period where I’ve been having so few Migraines, I can only guess it’s helping.

I am usually healthier in the warm weather months, and sluggish and illness-prone over the Winter.  I feel like I come alive again in the Spring.  Short of moving far south, I think I will have to get a light-box for next Winter to address this.

The CFLs are funny for me.  They are on a list of things that I “just don’t like” – and haven’t liked most of my life (baking in the hot sun, strong men’s colognes, crowded rooms full of noisy people, fluorescent lights).  Lo and behold, these things that I never liked are actually triggers for me.  When I began blogging about CFLs a month or two ago it occurred to me to get them out of my own house and see what happened.  My husband had started replacing incandescents with CFLs in our overhead lights about six months ago.  My Migraine frequency went way up when?  About six months ago!  Coincidence?  We’ve been taking them out again and… fewer Migraines?

A conclusion here?  As you all know who deal with this disease, there are many factors involved.  If you are one of those people who only has to avoid one trigger, or take one herb, or use one particular drug, to eliminate Migraines, then God bless you!  You have my undying jealousy!  If you are one of those complicated cases who have to manage multiple triggers and multiple treatments, I know how tired you are of managing it all.  I just want to hold out some hope – that the detective work is worth doing, and can make a difference.  Keep on trying!

– Megan Oltman
Managing Migraines one day at a time.

Crossed fingers image courtesy of Meisje van de Sliterij.

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Migraine? Where do I Start?

June 20th, 2008

Do you have migraines? Severe, disabling head pain, sometimes accompanied by flashing lights and other visual disturbances, usually accompanied by nausea, light and sound sensitivity? If you do, you know how Migraine disease can impact your life.

And while dealing with all of this, you struggle to remember that you are more than just your migraines.
You are not just a patient, or a chronically ill person.  You are a unique human being with things to contribute, people who love you, talents and strengths.

If you fit these characteristics, the first thing I have to tell you is, there is hope.  While there is no cure for Migraine disease, there are many proven strategies and treatments that can reduce your migraines
and enable you to take back your life.

Many of us struggle along for years, either with or without the diagnosis of “Migraine,” taking pain killers and coping with the migraines when they come, and then something happens. The pain gets worse, the attacks get more frequent, the symptoms change; suddenly what we always did to cope doesn’t work any more. We need answers. We pick up a book, talk to a doctor, search the internet. And we discover there is a lot of information, a lot of misinformation, and loads of people trying to sell us “cures!”

I wrote the free e-course “The Six Keys to Manage Your Migraines and Take Back your Life” to help people in that situation – people who are trying to get the information and support they need to cope with, manage, and recover from debilitating migraines. I wrote it to help people start down the path to managing their migraines and taking back their lives.

In the The Six Keys to Manage Your Migraines and Take Back your Life we discuss:


I would love to have you use the course as a resource for yourself as you work on managing your migraine disease. If you’d like to register for The Six Keys to Manage Your Migraines and Take Back your Life just fill out the box at the upper left corner of this page. The e-course will be delivered to you by email every two days over approximately two weeks.  As you receive each lesson, take some time to think about how it applies in your life, and follow the action steps included in each lesson.  I will be available by email for help and feedback as you work your way through the course.

For over ten years I have worked to help my clients live healthier, more productive lives.  I am certified as a life and business coach; I am also a migraineur.  I have succeeded in reducing my migraine frequency and severity by over 50% through a combination of medication and lifestyle approaches.  I have run my own business for fifteen years while managing Migraine and several other chronic illnesses.  I am committed to helping people live healthy and productive lives, creating a thriving world we all want
to live in. For those of us with Migraine disease, that means more than relief from pain – it also means living the best lives we can, using our talents, and knowing our strengths.
This is the game I love to play. You can play it with me!

– Megan Oltman

Please come out to play!

Cave exit photo courtesy of David Wilmot; Smoo cave waterfall photo courtesy of Subflux

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Exercise for Migraine Prevention

June 19th, 2008

When the wonderful May Migraine and Headache Blog Carnival came out on the topic, “How to integrate exercise into a life filled with migraines,” I was in the midst of my month and a half of viruses, flu and bronchitis, and having several migraines a week, and I couldn’t bring myself to write about exercise, let alone do it.  So I submitted a post on Calming Down the Migraine Brain, with relaxation exercises, which are also a good thing!

Don’t get me wrong, I believe in regular exercise and I know I’m better off when I do it.  There’s just a nasty chicken and egg dilemma when you are too sick to get moving.  Another familiar dilemma for me is when I’m too stressed and worried to allow myself to drop everything and exercise, even though I know the exercise will reduce my stress and make me more effective at doing the stuff I’m worried about!

Sorry if the title was a bit of a come-on, I am not going to write a post today full of science on why exercise helps prevent migraines.  I promise to pull the research together and write that post soon.  Today I will give you an anecdotal, personal short-term success story.

It’s probably too soon to say this, but I have exercised every day for the last eight, and in that time I have had only one very mild migraine. Lately, this is big success for me as I have been having 5 –
8 migraines per month. Since I started recovering from the bronchitis, I’ve been walking every day, and stretching most days.   Look at where I have to walk – right outside my door!  The beautiful field does make it somewhat easier.

I know there are other factors: the weather has been mostly good; I have been taking it very easy as I have been recovering from being sick.  I have really put my worries on hold and the stress level has been pretty low.  How did I do that?  I was too sick to even think, let alone worry, and I just gave myself over to recovering.  I prayed a lot.  I did my relaxation exercises when I had enough brain to focus on them.  It probably didn’t hurt at all that Danny and I had just decided to let go of a business that was giving us enormous stress with very little return. I also have been almost entirely without caffeine – I didn’t want it
when I was sick and so I broke the habit and see no need to go back.  I also know it has only been eight days – not a statistically significant sample!

Despite all of those factors, which surely contributed to calming my migraine brain, and the short time period, I think the exercise has been preventing migraines.  It’s hard to describe, but I just have a sense of my system being calmer.  I feel good!  I started on the first day I felt well enough to even sit up out of bed – on that day I walked 7 minutes, at a geriatric pace.  I have increased it every day.   Eight days later I’m walking 45 minutes at a brisk pace.

While there’s not much evidence showing that exercise has a direct bearing on Migraine prevention, doctors remind us that regular exercise raises our endorphin levels, which makes us more resistant to pain.

Doctors tell us again and again we need to exercise and there’s tons of science behind it. But it’s hard to
remember that when my head hurts, or I’m exhausted or stressed out, or it’s blistering hot out.   I’m planning to get the elliptical machine fixed for rainy or blistering hot days.  I’m also planning to get up and out early before the heat settles in, or go out around sun-down.  If you all would remind me, it would help over-ride my built-in forgetters.

– Megan
Let’s go for a walk!

Race Walk image courtesy of Kris Krug

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Sit up and Read Blogs! Blog Carnival Time!

June 10th, 2008

Hello dear, readers, I’ve missed you.  Since I was scraped off the bathroom floor last week I have been sick in bed with the worst case of bronchitis I’ve seen in many a long year.  More about that later.  (Is that a threat or a promise?)  Today I’m sitting up to read blog carnivals!  There are tons of good reading!

Posted yesterday, June 9th, there’s:

The June Migraine and Headache Blog Carnival.  At The Migraine Girl,
where host Janet Geddis treats us to a range of great posts on “How to have a Happy, Healthy Vacation” despite Migraine or headache disease.   Some are practical tips with checklists on being prepared; some are personal experiences of vacations that worked, and vacations that didn’t.  There are also  a number of posts on controlling stress, triggers, and emphasizing relaxation, which will serve us well whether we’re on vacation or not.   Janet has done a great job of cataloging and describing the posts, and I for one am looking forward to some great reading.

And posted today, June 10th, there’s:

The June Living with Pain Blog Carnival. Hosted by Marijke Durning at Help My Hurt, the scope of the articles is wide, from practical and alternative treatment strategies, to communicating with doctors, discussing the world of health web sites, to meditation and spiritual stories.   Something for everyone who’s living with pain.

Wishing you pain free days and nights,

– Megan

Carnival Lights image courtesy of Gilberto Santa Rosa

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More Time Management for Migraineurs: Managing the Time we Have

May 28th, 2008

100_0515
Do try this at home.  And at work.  I wrote a post a while back on How do you Manage Life with Migraine?, about managing our time when migraines interrupt us all the time.  Those of you receiving the newsletter got an expanded version of that post in the article “Time Management for Migraineurs (or, how can you get everything done when you can’t get anything done?).” 

The gist of those pieces was that 1) whatever is on your list, you must learn to accept that you will never get it all done; 2) you need to choose what is most important to you and put those things in your schedule first; and 3) if you keep detailed lists of what you are working on, next steps, what you need to handle if you get sick, and what you need to care for yourself, you will best be able to pick up where you left off.  I  recommend Time Management from the Inside Out by Julie Morgenstern, as the best system I have come across for managing your time to make sure that you spend it on what is most important to you.  And as I mentioned last week, Teri Robert has taken this idea of list-making and planning for Migraines much further in the helpful article MAPP Your Migraine!

All of that said, it occurred to me last week that I had left an important piece out.  This may look like a blinding flash of the obvious, but it hit me that a key piece to making this all work is that we can only manage the time we have.  Please don’t say “Duh” yet.  Take a moment to let this sink in.

I read an intriguing post on How to Cope with Pain earlier this month, called Time Management and Pain.  What intrigued me was that rather than laying out any nitty-gritty on scheduling and managing time, the article focused on “pacing ourselves and keeping stress to a minimum.”  In other words, to manage time, we need to manage our own, often over-achieving and denial-ridden, selves! 

We can only manage the time we have.  I looked back over my Migraine and Wellness calendars for theJan last 5 years.  I’m happy to say that my time spent incapacitated by Migraine and my other illnesses decreased over those 5 years from 27% of the time to 22% of the time.  I have focused on increasing that
trend, with mixed results.  I go up and down; there are months where I’m down more than I’m up.  What I have not always remembered is that, however you slice it, I will be down for the count about 25% of the time. 

When I look at a beautiful, clear, blank work week in my calendar, I can’t say, “Oh, goody, 50-60 working hours to schedule into!”  Into that week I need to put all of the things that allow me to maintain my health, to pace myself and keep stress to a minimum.  For me that includes exercise every day that I am capable of doing it.  It includes 20 minutes of meditation or relaxation practice every day.  It includes eating lunch away from my desk – taking breaks that are real breaks.  And once I have put all those things in, that help me keep stress down and stay well, I still only have about 75% of the remaining time available for my work! 

This means if I set deadlines for myself, I set them taking that
percentage of time into consideration.  It means when I block out my
week, I leave blocks of “not working” time.  It means when I come right
down to it, I have about 27 hours of productive working time that I can
count on in a week.   Now I’m not a workplace productivity expert, but
I have worked in a lot of places, for others and for myself, and I
don’t think many people are really productive much more of their time
than that. 

I have felt such freedom since I have been scheduling this way!   My
productive100_0510 time tends to be really productive; I stay focused on what
I’ve set out to accomplish in that time, knowing that I have a
reasonable 
break coming.  I can use my “not-working” time for those
water-cooler type conversations we tend to have at work, or for actual
work if I choose.  Of course I can’t control that I will schedule my
migraines into the hours I have allotted, but there’s room in the
schedule to rearrange things when I do get sick.  And when I am sick I
don’t worry about what’s not getting done.  Without the added stress of
that worry, I can recover faster.

Since I am self-employed, I know I have more freedom around these issues than some of you who hold down “regular” jobs.  But you can find ways to use these ideas.  It may be about how you approach your time away from work.  It may be about how you pace yourself at work.  Please share your thoughts on managing the time you actually have!

– Megan

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Taking Care of Myself

May 23rd, 2008

That’s what I’m doing today.  It’s 5:00 and I think I’ve missed status migrainous by about 4 hours.  Status migrainous is a condition where a migraine has continued for 72 hours without a 4 hour complete break in 
pain while awake.  It is a serious condition which carries an increased risk of stroke due to long-term dilation of the blood vessels around the brain.  I am lying in bed with my fingers crossed because my migraine seems to have finally broken after about 68 hours. 

The pPillowsain started Tuesday evening and has varied from about a level 2 on a 1 – 10 scale to about a level 8 or 8.5.  It has varied from itchy nagging pain all over my head to furious pounding pain in both temples.  It has been a particularly sneaky persistent presence, sending me strange nightmares.  I have woken up two mornings in a row with the sense of something awful sitting on top of my brain, waiting to pounce.  I have used 4 doses of Imitrex on it.  Finally today, after all of today in bed, most of yesterday, and half the day before; and after 4 expensive, befuddling and nauseating doses of Imitrex, I think the pain is gone.  I’m afraid to move in case it’s just asleep and I wake it up again.  For many of you, this will sound quite familiar.

Nearly all of my plans for the last few days have gone out the window.  What have I accomplished?  I did have an important business conversation with my husband.  I did gather up a list of all the homework my son has missed while he’s been out of school with the flu.  I did wash a few dishes here and there.  I did about 20% of the business work I had on the agenda for the last few days.  I helped my daughter find her uniform for work.  I’m about to be really ambitious and dig up some pretty pictures to illustrate this post.  Other than that, I have been taking care of myself.

What does that look like?  Today, and the past few days, it has looked like sleeping late, staying in bed in my pajamas for much of the day.  Today it involved not even taking a shower so as to keep my head quiet.  Anyone who knows me will tell you how much I hate not taking a shower!  It has looked like saying no to even talking to my family when the pain level was high.  It has looked like keeping track of how long this migraine has gone on, diarying about it, and calling the doctor for help.   I spoke to the nurse this afternoon and now have a plan in place for what to do if the migraine doesn’t break, or recurs, over this holiday weekend.  I’m happy to say the Emergency Room is not the first line of defense in the plan!

I went on the My Migraine Connection forum to connect with my buddies over there and gripe about this long migraine.  One of my friends told me she was proud of me for taking care of myself.  It was a revelation to me, a welcome one, to realize that I have been doing that – taking care of myself! 

After 30+ years of migraines, coaching others to accept their disease and build the best life they can around it, I still struggle with acceptance.  After basing my self care on meditation and relaxation exercises100_0411 and building my life around my illnesses, I still fight tooth and nail.  I didn’t take an Imitrex Tuesday night because I wasn’t positive it was a migraine.  Maybe I could have prevented the following days of pain if I
hadn’t been in denial then.  Regret is pointless.  Great thanks to Gret for reminding me of what I am accomplishing today.  I am taking care of myself.  The shower will still be there tomorrow.  Chances are, so will the dirty dishes.  And the newsletter I owe to you, my subscribers.  And the garden beds to weed.

Wherever you are, whatever you’re doing tonight, remember to take care of yourselves.  I hope for all of us a pain-free tomorrow.

– Megan

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