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April 22, 2011 10:32 PM   Subscribe

I've had brain surgery that involved cutting out a quarter-size hole in my skull and peeling back the dura-matter and layers of other tissues, drilling through bones connected to my ear, then putting everything back with a titanium plate. The surgeon forgot to order pain meds. and I was in misery for two hours before the first shot. This was NOTHING compared to the migraine I barely endured two days ago. Had we a gun in the house I would most certainly not be here.

The worst of it lasted about eight hours with no sleep for relief because everywhere I placed my head was where the pick-axe like stabbing planted itself. (I can’t lie on the other side because pressure there triggers the condition I had brain surgery for). So I had to prop myself up on the couch, praying for death. The nausea was terrible, too, and I wasn’t able to throw-up for relief because they no longer make epicac (sp?) and I haven’t figured out the finger down-the-throat technique. I’ve learned a lot from other post re migraine, and I thought I’d plumb the knowledge-base for anything new. The only brief respites were when I managed to meditate/pray to a place deep inside, which does suggest spiritual implications I will not ignore. Here is what else I've tried and a few questions.

Imitres works in the months when I can feel my period coming and take it early and long enough. Increasingly, though, my period surprises with migraine as the first sign. I’m no longer regular and probably entering perimenopause.

What’s going on when the stabbing sensation moves to wherever my head touches something, even a pillow? I fell and hurt my head a few months ago and the migraines are definitely worse since, though they were headed that way anyway. We did not do any scans of my head because I’ve already had multiple CTs and an MRI wasn’t offered. I can’t have one now for insurance reasons. Anyway, has anyone had any luck with diet or supplements? What about the continuous pill? Is it worth the side effects of that? Other posts suggest induced vomiting, which I’m willing to try. I live in fear of another like the last one, or worse.
posted by Mertonian to Health & Fitness (33 answers total) 5 users marked this as a favorite
 
Imitrex never worked well for me for aborting migraines (and I always woke up with them already raging). I switched to Relpax, another triptan, and had much better results. There's also Maxalt.

A few times when it didn't work, I had a prescription for Compazine (prochlorperazine) which really helps with nausea. It's also a bit sedating so it would help me fall asleep. I think they make it in a suppository form (I know, ew) in case you wouldn't be able to keep it down. I only took it once or twice but it was comforting to know that I had it as a safety net, you know?

Marijuana never helped me but some people find relief that way.

Induced vomiting...well, I learned at some point that the trick to induce vomiting via the finger-down-the-throat method is to be sure to touch your uvula (the little hanging part).

What really helped for me was going off hormonal BC altogether, but if your estrogen levels are swinging wildly then the continuous pill might help you.
posted by cabingirl at 10:49 PM on April 22, 2011


First, talk to your hospital/workplace about medicaid, disability insurance, or any other programs they might have to supplement or replace your current insurance.

And it may or may not help, but I also recently started getting similar brainbending pickaxe headaches which no amount of medication would cure (I even tried my leftover post-surgery prescription meds). I, too, initially thought it had something to do with menstruation - the migraines were worse during PMS. As it turned out, it was a wheat-sensitivity migraine.

I don't know if looking into food allergies will help you at all, and I still think it would be your best course of action to push your medical team to see what kinds of discounts and/or treatment assistance they can offer you. Considering your previous problems, this sounds really serious.
posted by lesli212 at 10:53 PM on April 22, 2011


I get terrible migraines.

I have tried Imitrex, Treximet, Midrin, Replax, Roxicet, and various other medications all prescribed by doctors and neurologists. Then one day, while living with a roomate who was a pothead, I tried marijuana when I had a migraine. It worked. To this day the only thing I have found that will alleviate both the pain and the nausea of a migraine, while also putting me to sleep, is weed.

I understand this can be a controversial topic, but my experience with weed really has been that it is a "miracle drug" when specifically used for migraine headaches. And this is coming from someone who smokes it recreationally about 2-3 times per year.

If you don't want to try that route...I have read that capsaicin cream applied inside the nostril on the same side as the attack *may* quell the pain. I have not tried this but I do know sufferers of cluster headaches who use this approach and have said it offers some relief.

Good luck, I wouldn't wish a migraine on my worst enemy. Awful things.
posted by jnnla at 10:58 PM on April 22, 2011


I don't know about migraines, but I have been on the continuous pill since 2001 with no side effects. I hope you find relief.
posted by TochterAusElysium at 11:01 PM on April 22, 2011 [1 favorite]


I am not a physician or a medical expert, but I am a migraine sufferer and two women in my family also suffer from migraines.

Important note: triptans (the class of medications that maxalt and imitrex fall into) more so than other classes of drugs induce different reactions in different individuals. If your pal from work tells you that she prefers Imitrex, it may, or may not necessarily work for you. Anecdotally, I have noticed that there is some familial relationship in what works for different people. My Mother and I both use the same triptan (maxalt).

Also, be aware that there are numerous types of formulations. If taking a pill inspires nausea, Imitrex also comes in a nasal spray. If that doesn't work, Maxalt comes as a dissolvable wafer (mint taste) called Maxalt-MLT. Another triptan has a dissolving formulation as well but it has a disgusting (and vomit-inducing, in my experience) orange flavor to it.

Be prepared to try everything out. Keep records of what you take and how your respond. Again, speaking from personal experience, I know migraineurs who get NO relief from Imitrex capsules, but extraordinary relief from the nasal spray, so plan to try out each drug, in each formulation, until you find something that works for you.

You mentioned that you lack insurance: triptans tend to be pricy. Many physicians have loads of triptan samples in their office, I would suggest asking for a couple of each kind they have on hand next time you go in, if you can afford to go in for a regular check up. Tell them candidly that you don't have RX coverage right now AND you want to try all the formulations to determine what works best for you.

(I'm not going to get into the lifestyle elements or the non-triptans pharmacological options for migraines because I have a paper due but those are also highly worth exploring)
posted by arnicae at 11:47 PM on April 22, 2011


I've been on the continuous pill for over 2 years specifically to treat migraines, and it has been damn near miraculous. For me there are side effects (the worst being unpredictable spotting), but the relief it's given me is totally worth it. I still have the occasional migraine, but I take Imitrex at the onset and it usually knocks it right out.
posted by pupperduck at 12:00 AM on April 23, 2011


A doctor may be willing to prescribe better pain meds. A friend was recently surprised when I told her what I had - she said she got the same thing for symptoms associated with her cancer. It's awesome, but I only use it rarely.

Advil makes a migraine formulation that's surprisingly effective; worth a try, but probably not up to your needs.

Finally, see a doctor for nausea medication. Totally worth it.

If you do want to induce vomiting, sometimes just drinking water does it for me. Warm water does it even better. Warm salt water might be gentler, but if you keep the salt down it might increase the pressure, I guess.
posted by amtho at 12:31 AM on April 23, 2011


You may need to upgrade to the heavy artillery--prescription pain medication. Don't take this step without consulting an MD, and be sure to educate yourself in the risks involved.

For me, Fioricet--a blend of butalbital, acetominophen, and caffeine--is about the only product that works on nearly every migraine. Butalbital is a mid-acting barbituate, which means it's similar to the chemical that executes criminals, puts down animals, and destroys the lives of mid-20th century Hollywood starlets. It's nasty, dangerous stuff. But the strong dose of caffeine makes it effectively impossible to take more than one or two pills at a setting without experiencing extreme caffeine jitters (in my case). Caffeine is added to the pill to relieve the migraine, but in my case, it's an addiction inhibitor. In combination with cannabis (to relieve nausea), it's a silver-bullet medication.

Most migraine specialists are down on Fioricet, because of its addictive nature, and also because of a bad propensity to cause "rebound migraines" if taken more than twice a week. But in my case, it's a lifesaver. A similar "heavy artillery" pain med may be the same for you.
posted by Gordion Knott at 2:58 AM on April 23, 2011


I've never had a migraine but I have taken the progesterone-only pill, which is different from Lybrel. It stopped my periods and had some minimal side effects, including weight gain and oily skin. I also find ginger helpful for nausea sometimes. Ginger ale or ginger biscuits depending on what I think I can keep down.

I'm really sorry you're going through this and I hope you find something that helps.
posted by teraspawn at 3:44 AM on April 23, 2011


Dealing with migraines is different for everyone. All advice you're going to get will have a hefty dose of YMMV.

This is what I've found to help me.

Laying down horizontally hurts worse than sitting down. Now when I have a migraine, I put myself to bed propped up with pillows, much as you did with the couch.

Cold compresses can help.

The meditation you describe can also be helpful - I've always found that if I imagined my "self "in the center of the pain, the pain abated somewhat. Some people have found relief using relaxation techniques, I've been mixed on that. I find the relaxation techniques useful for getting to sleep while my head feels like someone is slicing through it with a light sabre made out of extremely dry cotton balls.

The simple technique of ibuprofen plus caffeine works for me; I take a couple of ibuprofens and chug a coke.

Imitrex worked like a charm for me for about 5-10 migraines and then stopped working. I was sad when it stopped working.

Birth control + migraines isn't always the best idea. You want to talk to an MD with some experience of this - ie, going to a random GP might not be great. I'd expect a GYN to know the risk factors fairly well, but you might need to bring the issue up and make sure it gets discussed.

There are dietary supplements - vitamins and minerals - that may decrease the incidence of migraines. I've heard Mg supplements as well as others.

I've also heard that marijuana is effective, but I've not tried it myself.

Personally, my migraines have gotten better since my teen years, both in incidence and in pain level - I had one yesterday which I was able to tame with ibuprofen and caffeine and was able to get back to work within an hour. Hearing about yours reminded me of the bad years - the pain is really hard to handle. I'm sorry. I really hope you find a way to stop the headaches or at least decrease the pain.
posted by sciencegeek at 4:14 AM on April 23, 2011


I cannot imagine going through migraines as a teen! You must have truly been wise beyond your years. Thanks to you and everyone for your compassion and ideas. I'm seeing my doc next week and taking all of these with.
posted by Mertonian at 4:23 AM on April 23, 2011


the fact that the migraines are worse since you fell indicates to me the possibility of some structural shift. i don't know what your relationship to alternative approaches is, but if you would consider seeing an osteopath, they could possibly help to correct the shift, rather than simply dealing with the pain. it's very non-invasive and they can often help by working on things like - dura mater tension, structural adjustments, releasing tension around the base of your skull so blood can drain out of your head (in a good way) etc. if you're interested you can message me for details.

good luck, this sounds like no fun.
posted by andreapandrea at 4:37 AM on April 23, 2011


I've had episodic cluster headaches (kind of a pickaxe headache on one side of the face) on and off for twenty years. They're actually nicknamed 'suicide headaches,' because the pain is intense. During the last spell, a neurologist recommended indomethacin, an arthritis drug, and this actually worked, if I caught them early enough. This is the first med that has had any effect at all for me.

Also, some deep tissue massage for the upper back and shoulders and neck seems to help in the long run.
posted by carter at 5:19 AM on April 23, 2011


Seconding Compazine suppositories. It's a pretty heavy duty sedative/ ant- nausea drug that lets you sleep for 8 hours. A family member used it for migraines and it was pretty effective. 95% of the time they'd wake up with nothing worse than a mild headache hangover.

A co-worker took it though and it caused him to move like a robot for a bit. Fortunately it was temporary.

Given your past history with brain surgery you might want to fight with them for more coverage of MRI's etc., it that would lead to a clear diagnosis. In my experience they might say no for a "normal" customer but be willing to foot the bill for someone with a history who can get a doctor to approve the test.

Good luck. Migraines are tough.
posted by JohntheContrarian at 5:56 AM on April 23, 2011


I used to have absolutely horrific migraines. Acupuncture cured them.
I'm generally not a big believer in earthy crunchy remedies, but when the pain and stress of dealing with migraines drove me to the point of trying ANYTHING (exorcism was next on the list) I found a good practitioner and had several visits.
posted by pentagoet at 6:41 AM on April 23, 2011 [1 favorite]


I take the pill continuously for PCOS, but also because of menstrual migraines (which are nowhere near as severe as yours.)

Side effects are minimal.
posted by sugarfish at 7:28 AM on April 23, 2011


I don't have any personal experience with migraines, but I used to use hormonal birth control continuously just to avoid inconvenient/somewhat uncomfortable and heavy periods, and so if you're asking me "is it worth taking the pill continuously to avoid pain that made me feel like I wanted to die", I'd say most emphatically yes! It's very individual but I barely get any side effects on the combination pill, like teraspawn I had bad skin and a little weight gain on the progesterone-only pill so I prefer regular combination pill.
posted by treehorn+bunny at 7:58 AM on April 23, 2011


You sound like you've already been though the migraine gauntlet, but in case you haven't read it, give Heal Your Headache a quick read. My migraine's aren't as bad as yours, and have an underlying medical reason, but that book changed my life. I didn't do the program, but it gave me an understanding none of my doctors were able to do. But if you were interested in changing your diet, the author has a very effective program for that too in the book.

Oh, and if you haven't thought about it, the Mirena IUD might be worth considering. Very small, continuous localized dose of the hormones, and it has pretty much made my monthly cycle none-existent. Eliminating that particular trigger from my life has definitely made a difference. I love, love love my Mirena so much.
posted by cgg at 8:14 AM on April 23, 2011


Wow! I am a migraine sufferer, but what you are describing sounds more like headaches that my mother has (and that someone upthread mentioned)--cluster headaches. Watching her go through those is painful in itself--I cannot imagine facing them.

I find that the best doctor for a headache sufferer to have is a doctor who also has headache, or who has a close family member with headache. Failing that, one must advocate strongly for oneself.

My mother has been told that she "can't" have clusters, "because women don't get them." Bullshit. My mother has been told that "even if you do get clusters, oxygen won't help you." Bullshit X100. In the literature, oxygen is cited as the first-line treatment for these headaches. Mayo Clinic article. Oxygen is the only thing that has helped my mother with hers, and is relatively side-effect free as a bonus.

Good luck. Do not stop advocating for yourself, even if it means schooling some docs.
posted by thebrokedown at 8:23 AM on April 23, 2011


I believe psilocybin has shown some miraculous effects at preventing/aborting certain types of migraines/cluster headaches. You might want to give it a try
posted by crayz at 10:22 AM on April 23, 2011


By the way, Imitrex and other anti-migraine drugs are very very chemically similar to psilocybin, and from past research do not work as well
posted by crayz at 10:26 AM on April 23, 2011


Do you get an anticipatory aura with your migraines? I get migraines which, thank all the Gods above and below, are merely bad enough to wish that someone else would kill me. I don't get them very frequently, but I've been continuously pregnant or breastfeeding for over five years now, and that takes a lot of the heavy drugs off the table. My doctor recommended that at the first sign of aura (or at the first point I realize I am actually getting a migraine) that I take 800 mg of ibuprofen, a gram of acetaminophen, and 400 mg of caffeine (2 Vivarin). I was like "Oh, doctor, you don't understand, these are SO BAD there is no way that OTC drugs will help," and if I take them after the pain starts, they really are useless. . . but if I take them during the aura, the headache either never comes or is fairly toothless. My father gets horrific migraines, and he's found that this same combination of drugs substantially lessens the pain, too.

You need to be evaluated by a neurologist or headache specialist, to be sure, because this is not OK and a doctor will be able to offer you more treatment options. But this OTC cocktail has the advantage that you can pick it up right now at any pharmacy, and it might help.

As for the meditation and prayer, I had my second child at home with only self-hypnosis for labor management, and the hypnosis helped a LOT. Not as much as it helps some people, but a lot more than I thought it would. There are lots and lots of available hypnosis courses for labor management, but I am sure there must also be courses for headache management. Given that it helped you a little just on your own, a structured course might be really effective.
posted by KathrynT at 10:30 AM on April 23, 2011 [1 favorite]


I can't express well enough how much all of these suggestions are helping. I wish I could select them all as "Best Answers." Now I feel armed with an arsenal against the next one rather than living in dread and fear. This means so much in my quality of life. Thanks so much everyone who took the time to help.
posted by Mertonian at 12:56 PM on April 23, 2011 [2 favorites]


Whoa there. Is there ANY possibility that fluid is building up in your brain post-surgery? Why did you have it and could there be a more organic reason for this pain? If you are sure it's a migraine, I second the sufferers above with using a combo of caffeine and pain killer. I get the flashing light aura, and as soon as that happens I drink two very strong cups of coffee and take a Vicodin (allergic to NSAIDS) or Tylenol. Lie down and meditate in the dark. Nausea can be controlled by Phenergan and/or candied ginger. You have my deepest sympathy for your suffering, please ask your doctors if your symptoms are related to your surgery. Good luck to you.
posted by ~Sushma~ at 4:29 PM on April 23, 2011 [1 favorite]


OH! Another thing: sedating antihistamines are often effective anti-nausea drugs. Unisom (doxylamine succinate) is the best, but even plain old Benadryl works. Plus they help increase the possibility that you'll fall unconscious and sleep the nightmare away. I took Unisom for morning sickness, and it was really quite effective.
posted by KathrynT at 4:55 PM on April 23, 2011 [2 favorites]


Topomax taken daily has helped decrease the intensity and frequency of my hormonal migraines. Also, I tried all of the new migraine meds - Imitrex, Maxalt, etc., and the ONLY ones that work for me are Axert (which none of the prescription formularies seem to cover) and the Imitrex shots. So if you have bad luck with one type, try another the next time, especially if you can find a sympathetic doctor who will give you samples to try. Just don't try more than one type within 24 hours.

For breakthrough pain that won't be tamed by anything, ask for a good old fashioned painkiller to have on hand.
posted by Addlepated at 8:22 PM on April 23, 2011


Hey ~Sushma~, I did have a cerebrospinal fluid leak from the surgery and still get awful head pain when I exert myself. The surgery was almost two years ago. The surgeon is so specialized that he knows nothing of these things and my family physician naturally wants to refer me to the surgeon, or to a neurologist who would likely see a very complicated clinical picture. Actually the suggestions here make way more sense than anything I've heard from the surgeons. My family physician's office no longer accepts samples so that's out, but I'll have a good talk with my doc. and get some hardware to have on hand. Btw, they give me very powerful anti-convulsants and the pain meds they give cancer patients daily. My condition is Trigeminal Neuralgia, considered the most painful known to medicine. Yet I can say that my worst flare-up was a tenth of the pain of my last migraine, probably because they are brief and the 'graine was so sustained.

I've already been offered marijuana, may give it a try if I can take it without smoking.
posted by Mertonian at 10:53 PM on April 23, 2011


Oof - that's a horrible combination - Trigeminal Neuralgia and migraines. Yikes. Birth Control pills have been linked to a somewhat higher risk of stroke in migraine with aura so that's something to consider if it's a factor for you. I'm another peri-menopausal woman whose migraines have become more frequent although mine aren't as bad as they were in my teens and 20s. Have you kept a headache log to try to identify your triggers? Red wine, cheese and chocolate are very common ones that you can avoid, especially at key times of the month. Triggers like menstrual cycle and weather are obviously less avoidable. Wheat is a significant trigger for some people so exploring a gluten free diet might make sense. Taking the herb feverfew helps some people as a preventative - didn't do much for me.

I learned to do biofeedback through the Michigan Headache & Neurological Institute about 25 years ago and it helps - it's more than just mediating but also learning to relax muscles in neck and jaw and changing one's circulation to direct bloodflow to the extremities away from one's brain by thinking one's hands and feet warm. I find that biofeedback +an icepack at the nape of my neck + 2 Excedrin or espresso+ibuprofin really take the edge off for me although don't entirely eliminate the headache unless I start as soon as an aura begins, which is a point I'm usually too spaced out to realize what I need to be doing.
posted by leslies at 6:10 AM on April 24, 2011


I've already been offered marijuana, may give it a try if I can take it without smoking.

Yes, you can take it without smoking! I'd suggest making green dragon -- it's essentially old-fashioned tincture of marijuana. You can follow the recipe at the top of that page to make it on the stove, or you can simply dry and grind marijuana, put it in a sealed Mason jar with some high-proof alcohol (Bacardi 151 or Everclear, see the thread I linked to above for alcohol/weed ratio suggestions), and leave the bottle in a dark cupboard for a while (one to two months works). Then strain out the plant matter and throw it away, retaining the marijuana-infused alcohol. The stove method is supposedly best, but a friend of mine had good results with the lazy way, too.

Either way, be careful with it until you've experimented to find out how much you need to take. It takes a while (up to an hour and a half) for the high to come on, and it tends to be more intense than smoked marijuana, so it's fairly easy to get "too stoned" (harmless, but unpleasant!) if you take too much. I'd suggest trying it long before you need it, because you don't want to have to figure out dosage while you have a killer headache -- set a weekend evening aside, and start with 1/4 to 1/2 of an eyedropper to see how it goes. If you don't feel it's enough, increase the dose the next weekend, etc. Then you'll know how much to take the next time a migraine comes on.

Feel free to me-mail me if you have questions. Good luck!
posted by vorfeed at 12:02 PM on April 24, 2011


Oh, yeah, and it's important to go through the same dosing experiment every time you make a new batch! Marijuana potency varies wildly, so the dosage for batch #2 may or may not be the same as batch #1.
posted by vorfeed at 12:51 PM on April 24, 2011


How come I can't find any tea recipes for it? Seems like a good way to get just enough to curb the nausea and maybe relieve some of the pain.
posted by Mertonian at 9:16 PM on April 24, 2011


Tea recipes are few and far between because marijuana isn't very water-soluble. However, you can make cannabutter, and then you can make a tea by simmering milk with a dollop of cannabutter and your favorite tea leaves or teabag.
posted by vorfeed at 11:21 PM on April 24, 2011


For any who might be checking back or just finding this my doctor gave me a number of things to help: Loestrin 1/20 for three months on, with a patch to ease quarterly period symptoms, Phenergan 25mg for nausea, and Sumavel DosePro in case a migraine does strike. It's an injectable to keep around kind of like an epi-pen, for peace of mind.

I printed this thread and took it with and that made all the difference!
posted by Mertonian at 6:08 PM on April 27, 2011 [1 favorite]


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