Fellow Migraineurs: How did you kick the quick fix?

January 29, 2013 2:05 PM

Help me figure out specific techniques, distractions, etc. to employ while I stop taking pain medication for migraines.

I've had lifelong migraines but they've been a daily occurrence for the past two years. This weekend I finished "Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain" (thanks to someone's recommendation here on Ask). Step 1 in the book is to avoid the "quick fix", i.e., painkillers, since they can lead to rebound headaches. The problem here is that I have been entirely reliant on a low but daily dose of a doctor-prescribed painkiller to keep functioning in life at all - and I really have no idea how I can keep doing work (I freelance write/edit/project manage for a living) while feeling like there's a spike through my head all day long for who knows how many weeks. The author's estimates for cessation/withdrawal duration range from a few days to a couple of months. Headaches can also increase in frequency/intensity during this time - not just remain at the status quo. However, this book's approach makes a ton of sense to me so I'm committed to making it happen - but I need help.

I am looking for specific advice/anecdotes/techniques/strategies to help me stay sane and functional through this process. My fear is that I will have a big project/deadline and the only way I'll feel like I can actually do the work is by medicating myself to stop the pain. If you've ever been in this situation what have you done? How did you cope? How did you continue to think while your primary thinking organ was in unrelenting pain?

(Please know that I am under the care of a physician and a neurologist and they are both aware and supportive of my attempts at making this work. Neither have any issues with me stopping the medication cold turkey - the dosage I take, while effective, is not high enough to warrant any sort of step down or detox. I also get Botox shots in my shoulders, neck and head every three months to help reduce the headache frequency and once I make it through Steps 1 and 2 - trigger food identification - of this process, I and my doctors will assess if any other preventative medications may help. At this time I'm also not looking for help in identifying triggers or reducing migraine frequency - this question is specifically about how to keep functioning while in pain.)

Thanks for any advice/suggestions.

posted by hapax_legomenon to health & fitness (32 answers total)

Does caffeine alleviate your symptoms at all? Since I can't have any of my usual meds while I'm pregnant, I've found an occasional Diet Coke or strong black tea can help when I get a headache. Step two after that for me is Tylenol. If those don't work, honestly, it's nap time. Sleep seems to help but can be very inconvenient, especially at work or away from home.
posted by Kitty Stardust at 2:11 PM on January 29 [3 favorites]

...what's the medication?
posted by kmennie at 2:11 PM on January 29

Cold temperatures and mint tea help a bit. Darkness and lying down are even better, but might not help much with productivity.
posted by oinopaponton at 2:13 PM on January 29

Are non-pain relieving prophylactic drugs an option? i.e. Calcium Channel Blockers, Beta Blockers, etc.? Lots of prophylactics are incredibly useful for migraines, and they can be used as a bridge in your situation -- ease you off pain killers, then see if you can get off the prophylactics.
posted by barnone at 2:17 PM on January 29 [1 favorite]

Oh - and this ice head wrap. It has a velcro buckle, so you can cinch it tight, and the pressure of the ice on the throbbing arteries is really helpful. There are other head wraps out there, but not all of them can be tightened.
posted by barnone at 2:20 PM on January 29

I promise I won't threadsit and realize should have put this in my original question: meds that contain anything with caffeine, naproxen, and decongestants are verboten since they cause rebounds. Anything that doesn't cause rebounds (acetaminophen, ibuprofen, etc.) does not work for me. So different kinds of medications are really out altogether (and I've tried all the jillion that are available over the past 35+ years anyway.) I'd rather not say explicitly which medication I take now since this is public.
posted by hapax_legomenon at 2:21 PM on January 29

It sounds totally crazy and woo, but I swear it works for me: lavender aromatherapy. I dab a little behind my ears and at my wrists. It doesn't always eliminate the pain, but it reduces it I think.
posted by mchorn at 2:21 PM on January 29 [1 favorite]

Massaging your head can help, wearing dark glasses if you find light even a little painful, relaxation exercises where you tense each part of your body then relax then all at once, distracting yourself by looking at relaxing scenery (a garden is good), listening to a radio or TV show with your eyes closed for a while. You can also try to abuse the placebo effect by taking sugar pills, it can work even if you know it really doesn't.
posted by meepmeow at 2:22 PM on January 29

Have you ever tried biofeedback or meditation? You're not a ton of use while you're actually doing them, but as you practice them you can get to where you do it for 10 minutes, get 20 minutes to an hour of relief (and often, for me, it creeps back rather than roaring back full-force so I get an additional hour or so of productivity before I have to cave).

Full-on Bio Feedback is something you'll have to see a practitioner for, they hook you up to machines and use the machines to teach you. But I can share my focused pain meditation technique with you and you can see if it helps. If you master this, it will help you master bio feedback more quickly should you choose to pursue that route.

Focused pain meditation. (actual imagery doesn't matter so much, you can sub whatever images make sense to you)

1. Locate the pain. My migraines invade the entire top of my skull.
2. Visualize the pain "laid over" your actual head in a color, my pain is red
3. Taking calm, deep yoga breaths try and "contract" the pain in from the edges
4. When you get it to be a little smaller picture it kind of curving in on itself
5. Continue with deep breaths and squeeze as much as you can, try and get it to make a ball. It does not matter how "big" the ball is for right now
6. As you breath squeeze the ball in, it might pulse some, that is expand back out, but just keep tucking it into itself
7. To help you squeeze the ball start wrapping the ball in tissue paper (my paper's pink) keep squeezing the the ball and wrapping it in tissue. The ball is tough, it keeps bursting through the tissue, but as you keep breathing and squeezing and wrapping it will get smaller and smaller and smaller.
8. Eventually you get it to about the size of a pea, usually by this point the pain has subsided enough that it's not actively bursting out of shape, you should be focused enough by this point that you can "move" it around a bit (kind of like shifting your weight when your leg gets tired) I'll move it to the back of my head for a bit, then over to one side.
9. Slowly open your eyes, keep breathing, it should take you a minute or so to "come out of it" but if you come up slowly the pain should be manageable and ignorable for a decent amount of time as long as you're relatively still.

Anyway, don't know if that will work for other people, but I've been doing it for about 15 years and I've continued to have good results. I don't take migraine medicine more than 2-4 times a year at this point.
posted by dadici at 2:29 PM on January 29 [2 favorites]

Heh - the book could have been my recommendation ;). It's really rough going without, I'll will totally admit. I had to avoid screens as much as possible (TV, computer, phone), spend time in dark rooms with little noise - the usual. I'll also fully admit that although the book changed my life, I didn't actually go though with all the steps; the knowledge I gained however was immensely helpful.

For me, the biggest thing was finding the right preventative (I went though TONS before ending up on a calcium channel blocker) instead of relying on pain killers - and when I finally did find the right one, it was like I got my life back. I still take more ibuprofen than I'd like, and am completely dependent on caffeine, but at least those are OTC and relatively cheap. Finding out my other triggers (for me, changes in barometric pressure is a huge one) was a help - it gave me some understanding of why I had a headache, which for some reason seemed to make it (a little) more tolerable.

Sorry I don't have more helpful advice... :(
posted by cgg at 2:35 PM on January 29

I highly recommend full on bio-feedback training. I did several months of twice weekly sessions when I was a teenager and it was the only thing that helped me control my headache pain. Even now, some twenty-five years later, I use the techniques for all sorts of things (mainly staying calm in the face of toddler chaos). If you're able to get some sessions, DO IT.
posted by PorcineWithMe at 2:43 PM on January 29

Caffeine, ice pack at nape of neck or forehead, holding something hot in hands (changing your circulation away from your head in other words). I also found biofeedback very helpful - not an instant fix but that kind of relaxation and circulation change can really help. My technique is different than dadici's - combination of learning to relax muscles in neck and head and warming hands to change circulation. Misery - I hope some of this helps while you go through the process.

I'll add that my migraines stopped when I stopped eating gluten - 35+ years of fairly frequent headaches to none except when I've eaten gluten by accident - it's been 2 years. It was not a trigger ever suggested to me when I was working with migraine focused neurology practice or by my gp which is part of why I mention it.
posted by leslies at 2:45 PM on January 29 [1 favorite]

I feel ya, most pain meds don't work for me either, so I when I have a migraine, and I've had them for a for nearly 30 years, I just grin and bear it when I need be productive until I can get to a dark room, etc... People say it's not possible, but I say that when you need to be productive then anything is possible.

Anyway, if you find you can't grin and bear it. Dark glasses help a little if you can get away with wearing them wherever you are. I use the wrap around kind so the light can't sneak in the sides. Also, noise cancelling headphones with white noise or low, soothing music on (really really low for me) helps if loud noises bother you.

When I don't have to be productive, dark room, low soothing music and a head massage from a special someone is the ticket for me.
posted by patheral at 2:45 PM on January 29

I understand that you don't want to get into drug specifics so I'll just say that it sounds like you may not have tried Imitrex. It's not a painkiller and does not contain caffeine, and it's specifically for migraines. You can get an epi-pen for it or take the pills; both worked wonders for me.

If you haven't tried this yet I'd definitely bring it up with your doctor. Good luck, I know how horrible it is to live with migraines.
posted by Room 641-A at 3:11 PM on January 29 [1 favorite]

If you currently drink coffee or tea, or otherwise consume caffeine, start tapering off now and treat caffeine as any other drug -- even small quantities. It sounds like your condition is such that it makes sense to be super-careful.

Even though your doctor doesn't think you need to taper off your current medication, you might as well get a pill splitter or half-empty some of your capsules and taper anyway.

Find a good massage provider, and work out the logistics of getting an emergency massage, both near your home and your office.

The cold pack approach can work well. Figure out how you can store one at work or in your car.

If you work in an office, try to scope out places you can take a time out, breathe, and relax your head muscles and massage yourself (or whatever other headache treatment ends up working for you).
posted by amtho at 3:23 PM on January 29

Ice. I like a serious heavy ice pack (you have to buy them online or from a physical therapist, the ones from the drugstore are not heavy/cold enough). The Chattanooga ColPac does it for me.
posted by radioamy at 4:13 PM on January 29

Have you ever tried aspirin? Plain old aspirin? Is it allowed by the book? 1000 mg of aspirin - that's a big dose, but still within guidelines - is what the oldtimers used to use to treat migraines. It fell out of favor when drugs like Imitrex and so on hit the market. When my doctor suggested it to me, I literally laughed at him, but if I take it at the onset of a migraine, it has about a 90% effectiveness rate. If I wait too late, it will not work.
posted by Addlepated at 4:21 PM on January 29

An ice pack on the head helps. And I am about to admit to something weird: I pull my hair in the area where it hurts. When I've disclosed this to other migraine sufferers, they've validated this practice. No idea why it works.
posted by kamikazegopher at 5:37 PM on January 29

Similar to mchorn's solution, I find Tiger Balm to really help. I rub some on my temples, forehead, back of the neck - and if it is really severe a little dab under my nose.
posted by koselig at 5:38 PM on January 29

Most of the drugs you mention are pain killers. There are many types of prophylactics that are NOT pain medicines, and work to prevent migraines before they start. There are also lots of triptan drugs, which are known as 'abortives' which again, are not pain killers, and do not work in the same way as narcotics or naproxen or advil or tylenol or aspirin.

In fact, one of the hallmarks of migraines is that they usually don't respond well to any kind of over-the-counter pain relievers. I'd really urge you to bring up the idea of prophylactics or triptans with your doctors -- it sounds like you haven't tried either, which seems a bit weird, considering a neurologist is overseeing your care. I'd ask about the possibility, even as a bridge to get you off pain meds.

Maybe you don't have migraines, but are experiencing 'rebound' headaches of another sort? In that case, triptans won't be of much help. Try to get a proper diagnosis, because the medicine and path off pain meds will be different for every person.

Acupuncture also helps.

Good luck.
posted by barnone at 6:21 PM on January 29

The 100% natural way to stop a migraine in its tracks: Orgasm.
posted by phytage at 6:32 PM on January 29 [1 favorite]

Somewhat related to the Tiger Balm suggestion- I boil water, take it off the heat & pour into a bowl, and add a ton (like 1/4 to 1/3 of a bottle) of Vicks VapoSteam, then breathe it in. No idea why it helps; my guess is the menthol smell short circuits something and makes the pain more manageable for a while. I do get intense nausea with migraines, and this helps considerably on the nausea front.

Also very basic biofeedback helps immensely. Ask your doctor if he can refer you to someplace to teach it to you. I had surprising luck getting that to work for me, especially when I was a kid & triptan drugs weren't around yet. A word on those- you need to work with your doctor to find the drug that will work for you. A great number of them do nothing for me, and I had to try several kinds before finding any that would help. People's brain chemistries are weird.

And I'll throw this out here again since it's helped me so much - I had to stop wearing contact lenses for my astigmatism to really get my migraines under control. Not a fan of wearing glasses every day, but it means that my migraines are a once-or-twice a year thing instead of weekly. If you're wearing contacts, you might try glasses for a while, and if you wear glasses, make sure that the prescription is current.
posted by lyra4 at 6:36 PM on January 29

If your migraines are ischemic, then try cayenne pepper capsules. My husband gets ischemic migraines and finds that if he takes cayenne pepper the instant he gets the prodrome, it reliably aborts the headache. The capsaicin seems to increase blood flow enough to counteract the ischemia, which fits with what I know of the published scientific and medical literature on capsaicin.
posted by snowmentality at 6:46 PM on January 29

Things that reduce migraine pain for me:
-Avoiding all "screens" (TV, computer, phone) as much as possible. This is the time *not* to procrastinate on the Internet. This is the perfect time, however, to find out how much work you can handwrite.
-Ice pack for the back of the neck and/or where the pain is.
-Benadryl has helped me in the past--it both reduces the pain (my migraines are often in combination with sinus headaches/infections) and can help me take a quick nap.
-Naps really help, but even quiet time in a dark room can help me regain my ability to function.
-Driving and car riding are both hard on me, so working out of my home is immensely helpful. Maybe your boss would be amenable to you working from home on particularly bad days?
posted by epj at 7:25 PM on January 29

Also: brain freeze. See The People's Pharmacy.
posted by amtho at 7:33 PM on January 29

Thanks, everyone. I've marked as "best answer" those responses that are most in line with what I'm looking for. And, just to clarify, I am very familiar with and have tried all kinds of prophylactics (including all of those noted above - and about 50 others) over a lifetime of having headaches, all to no avail. However, one of the things I learned in this book is that this doctor, at least, believes that most people who have tried preventative/abortive medications are either not prescribed or do not take them accurately/adequately, which is why I'll be going through that whole drill again...when I get to Step 3 of this program. Until I get there, however, I need to kick what seems to be the longest-lasting rebound headache ever, which necessitates no more meds.
posted by hapax_legomenon at 7:44 PM on January 29

If you are willing to make major lifestyle changes, I have heard of people having success with an Eat to Live style diet. I tried that sort of diet, not for headaches but other stuff, and it cleared up everything that was ailing me. Literally. Completely 100% worth it.

To get through the rebound headache as you quit painkillers, you might ask your doctor about gabapentin. That helps people who are getting off narcotics. Short term benzodiazepines might also help. You will probably feel like crap for a few weeks though, there is no way of getting around that b/c you will be in withdrawal. The rebound headache you speak of could actually last on the order of weeks if you've been on narcotics for a while. It does pass though.
posted by kellybird at 8:54 PM on January 29

One tip I didn't see above: plunge your hands in ice water for as long as you can stand it. It can act to rush blood to your hands and reduce the flow to the vessels in the head. Dilation of the blood vessels in the head after a time of constriction can cause migraine pain.
posted by thebrokedown at 9:47 PM on January 29 [1 favorite]

A couple slices of toast with margarine/butter to get your blood busy in your stomach rather than your head, a cold damp washcloth on the forehead/neck and a dark room. I usually can relax enough to nap and wake-up without the migraine.

Good luck!
posted by deborah at 10:23 PM on January 29

I doubt you will be able to help yourself unless you find a cause of your migraine, sometimes similar to the triggers. I maintained a headache diary for 4 years but did not find any.

I went through a ton of medications, some of those you mentioned but none helped. So far I did not find any solution to the abortives, I have to take them but one thing I tried has helped. I supplemented myself with Mg-Citrate and Vit B2, each 400mg daily in divided doses. After 3 months of use, I noticed that the ferocity of my migraine has reduced A LOT. At the same time, my lavetor scapula muscle was tight to I got DW (a PT) to massage that muscle and it has relieved me a LOT. Usually, I used to get headahces, at least once a week, now, its been 23 days, no headache.
Noting location of pain was important factor in massaging. At the same time, I am on Verapamil 320mg/day.

My 0.02.

(P.S. - I also gave up gluten, milk, meat, chicken, fish and soy, reduced sugar and salt.)
posted by zaxour at 5:00 AM on January 30

I solved my migraines by breaking up with my boyfriend. I've only had one in the 10 years since. I am not being flip: find the trigger in your life and make it go far, far away.
posted by Capri at 8:15 PM on January 30

FWIW I've got atypical migraines and ice makes them BLINDINGLY worse. If you happen to have the same type, you'd figure that out first try...but the reason I'm chiming back in for the record is that a heat pack (or actually when possible a hot bath) accomplishes the same thing for me.
posted by dadici at 9:52 AM on February 27