a.k.a. "What I've learned about migraines through far too extensive experience..."
Migraines suck. Those of us who have them know all too well the difference between a good day and a migraine day. If you're "lucky" enough to only have 1 or so a month, then you can possibly take the day off. If you have a ton of them, then you have probably been desperate to manage them, like me. Overall, I feel better than 10 years ago - I have a handle on some things that cause them, and a drug combination that usually beats one when I've got it. If ANY of this can help you manage yours, then I didn't write this in vain. Please comment if you have anything to add.
Personal headache history:
I’ve had headaches my whole life. I remember days as a kid when my head just killed. Around age 27, they morphed from whole-head events to a more classic migraine. I used to get by with 800 mg of ibuprofen, but that started to upset my stomach and lost its effectiveness at killing the headache as well. In early 2007, I was at an untenable peak of 15-18 migraines per month. Since then, a lot has changed – my meds, my diet, and my ability to “suck it up” and just work through it (though not without some griping, sorry). I’ve learned a LOT about headaches and triggers and fixes in the last 4 years, though some months are still better than others.
What I tested (***indicates that it is a trigger for me)
Wheat
“New” cheese (anything that can be store brand would qualify)
Aged cheese (hard grated fresh Parmesan, for example)
“Smoked” things
***Some barbeque sauces/spice rubs
Citrus
Pomegranate
Berries (blueberries, strawberries, cherries, raspberries)
Milk chocolate
***Cocoa
Splenda
***Aspartame
Magnesium
Daily vitamin supplements
***Caffeine imbalance
***Pork (even the organic, non-preservative laden stuff)
***Alcohol (one drink)
***Dehydration
***A dry room at night
***Too much salt
***Regular soy sauce
Low sodium soy sauce
***Chewing gum for too long (jaw muscles)
***Massages
***Hormonal fluctuations
***Subway subs (might just be the turkey, but I’m not willing to check)
Some things change over time. Alcohol was not initially a trigger of mine. It’s only in the last year or so that it suddenly seems to have become an allergen – I get super stuffy after drinking even one drink of any sort, and a headache will follow immediately. Some are about quantity – I can have pork in small quantities, like a slice of pepperoni pizza, but two days in a row that has repeatedly triggered a headache (mushroom is fine!). [Note: see 1/14/12 update below]
Caffeine was a big one, too. I had to give up Diet Coke when aspartame turned out to be incredibly evil, and I tried Diet Rite because it was a Splenda pop. Well, Diet Rite has no caffeine. I thought the Splenda was killer for a while, but as it turns out, Pepsi One is fine as are all other Splenda products. When I started drinking coffee, I’d fill a travel mug daily and take it to work. My headaches spiked. I went back to pop, they decreased… I tried half-caffeinated coffee, and they’re fine. My head is Goldilocks.
Hormones can be held steady. Ask your OB. No hormone changes, no spikes in headaches once a month (hmm... I feel like I should not punctuate this sentence...haha). One thing my doctor mentioned, though, is that if you have a migraine with aura, then you definitely do not want to be on an estrogen-based hormone for birth control (or any other reason!). It doubles your risk of stroke - plenty of medical research behind this, google it and see the journal articles.
ADDED 4/27: How could I forget dust? Sweeping the garage, pouring in new cat litter, or even extensive house cleaning (with emptying the vacuum canister repeatedly) can be a huge trigger for me. A dust mask is silly looking but helps 100% of the time - that's not hyperbole, that's the actual figure for me with multiple trials with and without something to filter the dust out of the air I breathe through my nose.
ADDED 4/27: How could I forget dust? Sweeping the garage, pouring in new cat litter, or even extensive house cleaning (with emptying the vacuum canister repeatedly) can be a huge trigger for me. A dust mask is silly looking but helps 100% of the time - that's not hyperbole, that's the actual figure for me with multiple trials with and without something to filter the dust out of the air I breathe through my nose.
With respect to testing, the only way to be sure about things is to go on a radical “migraine diet” and cut out everything that may possibly offend, then add things back in one at a time, with a 2 or so week period in between (depending on how frequent your headaches are). Removing things one by one may not be telling. If I were to remove cocoa from my diet but not aspartame, I’d not know that cocoa is a trigger because I’d still be having headaches from the aspartame. If I remove everything, but then add things in one by one, then when the headaches re-appear, then it’s clear what the culprit is. Of course, not all headaches are diet related, so lengthy periods of testing are typically best to be sure it’s not weather/allergies/etc. that’s causing the pain. Honestly, I was never able to eliminate mine to get a baseline, but I saw spikes that were associated with these triggers often observed over months of observation.
Other patterns:
- Weather seems to play a big role, totally uncontrollable
- Seasonal allergies trigger my sinuses which give me... migraines. I take a bevy of allergy medications which help a LOT.
- SLEEP is critical. When my doctor heard that I really don’t sleep at night after about 2 hours, she prescribed Ambien. I was very apprehensive at first, but now love it. I sleep at night for 6 hours or so! I've heard horror stories, too, but I'm pretty lucky. (See 1/14/12 update below)
- I need to keep the thermostat cold! My head seems unable to properly thermoregulate me and if I’m sedentary, my head will overheat in a warm room. It’s oddly ok if I’m gardening in 90 degree heat and sweating. It’s got to be the sweat…
- Clenching my teeth at night gives me a migraine! I have a little device to bite on that was molded for my front teeth that keeps the back ones from coming in contact. I don’t grind, I just clench them and the jaw muscles are tense.
- Stress – what can you do, eh? Many days in a row of working 6am-11pm will cause a headache by the middle of day 4. That’s not really a surprise. I think it’s jaw clenching and exhaustion, actually.
- Weight - As it turns out, losing all the weight seems to have helped my immune system a lot, but not my headaches. I guess I won one game but another is not yet over...
- Splashing my face with cold water
- Hot compresses on my sinuses or running them under the hot shower, though my scalp has to stay cool.
- A slathering of Vicks VapoRub under my nose (this also helps with the humidity level in the room at night, though I think the smell is tied in, too)
- Taking the time to completely relax the muscles in my head/face for a few minutes
Drugs
Some are just not stoppable, I find Imitrex + 1 Aleve the best relief. The addition of the Aleve has increased the length of the relief for me and increased the “kill rate.” My migraines used to always come back and last for 3-5 days, but now they often go away on day 1. They make a combo pill now (Treximet) but it’s still brand-name only, and I can get the Imitrex as a generic and buy store brand Aleve – a much cheaper combination. Unfortunately, I find I cannot take migraine meds until I’m 100% sure it’s going to “launch” into a full blown migraine. Doctors always say “take this at the first sign” but I am pretty sure that if I take the pills prematurely for something that would have gone away, then I end up with terrible side effects. I’m best off with the pills and a nap, but if I can’t nap then a bit of movement about 20-30 minutes after taking them seems to help.
I’ve also been prescribed Topamax and Amlodipine for migraines as preventatives. The Topamax dosage has gone up over time and the side effects have gone away (I thankfully never had aphasia). The Amlodipine is to help “relax” my blood vessels and keep them from “spasmodic episodes,” I don’t think I’ve noticed a headache difference, but my lowered blood pressure (which was low-normal) is now VERY low. I should probably drop that one. An antihistamine and Flonase keep my sinuses at bay (+real Sudafed as needed), and Ambien makes me sleep. I wonder sometimes what life off drugs would be like, but then I remember how many headaches I used to have ALL THE TIME.
I’ve identified a lot and yet a lot is still a mystery. As of right now, though, after a foul March (weather?), I’m having a great April – only 2 days of headache! The 21 day stretch without one was the longest in 10 or so years.
Got anything to add, please share!
1/14/12 Update
Life has changed, and so have my headaches. After making the incredibly difficult decision to end my marriage, I've been on my own for 5 months now and have seen marked improvements in my headaches. I have been able to incorporate pork and moderate amounts of alcohol back into my diet without repercussions. The line of "how much alcohol is too much" is a fine one to tread. Certain wines can still get me with a half-glass, but others I can have 2 glasses with no problems. Same goes for beer and liquor. I can drink my favorite beers again, though, without the pain that they had caused. Diet pop with aspartame is still a no-go. Dust is still evil. Small amounts of barbeque are ok. I still don't regulate my head temperature well and I prefer cool conditions - unless I'm active.
I can only conclude that the constant stress brought on by an unhappy relationship was exacerbating the impact of other triggers. I'm constantly testing the boundaries with thing I'd like to incorporate back into my life, and I've definitely found my limits (and paid for it sometimes). The toll of the daily stress was also likely responsible for my problems sleeping every night. I no longer require the assistance of Ambien more than once or twice a week! I've also stepped down off of the preventative migraine medication (Topamax) and not had trouble. It's liberating.
