Yet another migraine question.
February 12, 2010 8:39 PM   Subscribe

I know what is causing my migraines. I don't know how to make the condition stop.

There was a period of time about 8 years ago where I was getting a migraine every day around 4pm. I had to hop up and leave work immediately so I wouldn't be trapped with no way to get home once I was in the thick of it. After a week of this, I started working with some naturopathic physicians and through a lot of work, we determined that the migraines were being caused by my neck and shoulders tensing up a ridiculous amount. they would relax overnight and the tension would build during the day, triggering the migraine.

This is starting to happen to me again. I believe it started when I bought a new computer bag with a different kind of strap than I am used to. I only carried the bag 2x a week but it was just ridiculously uncomfortable and caused my neck and shoulders to just tense up so they were like concrete. (I am not using that bag any more and pared down my bag drastically to try to help the tension). I visited my acupuncturist and she alleviated the condition somewhat, but then I got a horrible migraine 2 days later, so bad I had to take the next day off work. I visited my western doctor that day, who gave me a prescription for muscle relaxants and told me if they didn't help in a day or two to call the neurologist. I got a massage that night, pared down my bag, and things seemed to be okay after that.

Until today - WHAM. I had a stressful meeting at 1:30 and by 2:30 i started to feel like I was swimming through oatmeal. Luckily I had made another acupuncture appointment for after work, because I could feel my shoulders tensing up again, which helped a lot.

I don't want to go to the neurologist. My doctor didn't seem concerned about the headaches, so I don't believe this is serious. I don't want to keep taking muscle relaxants when I go to sleep. What I want to do is know who I should go see to teach me to stop making my shoulders hunch up. Private yoga lessons? Physical therapy? Massage every week? Am I not breathing enough? I am trying very hard to be very conscious of my body and to breathe and relax but it's still happening. Could it be my pillow or the way I sleep? Do I just need more exercise or something like that? I'm not as physical as I'd like to be.

Basically I have all these ideas but have no idea where to start and don't want to throw money away randomly.

My doctor is not very helpful in suggesting alternate remedies - she is open to them and doesn't frown when I mention them, but hasn't been able to help me think out of the box in terms of what would be appropriate.

I should mention that I also get slightly different migraines under other conditions (lack of sleep, aspartame, just randomly) but not with this frequency. I tried imitrex for those headaches but they didn't help AND i had side effects that were worse than the headache. I drink one cup of coffee a day, maybe a cup of tea in addition sometimes.

I wish I could remember what we did 8 years ago to make it stop but I don't. The odd thing is, I am NOT under the same kind of stress that produced them back then. Getting these now does not make any sense.

I know, YANMD. Thanks.
posted by micawber to Health & Fitness (14 answers total) 5 users marked this as a favorite
and on preview i find that i talked about what worked 8 years ago, which I didn't even remember posting. but my question still stands as I'm sure there's more I can do.
posted by micawber at 8:41 PM on February 12, 2010

You need to go see a neurologist. Many things can present like migraines. You never really explain the buildup to the migraine. Do you get an aura? Do you get nauseous? How about pains and sudden, unexplained aches?

Also, if you are getting them daily, you should consider going on beta blockers. But none of this is going to work if you find out they are cluster headaches or tension headaches.

I always found that it was right after a very stressful situation that the migraines would set in for me. Caffeine also tends to help.
posted by TheBones at 8:59 PM on February 12, 2010

I'm not a doctor, but the pattern of symptoms you describe sounds much more like a tension heache than a migraine. Do you have typical migraine symptoms?

Not every bad headache is a migraine, and treating a non-migraine headache with migraine medication can be counter-productive. Even if you prefer to treat your headaches with alternative medicine, you should still ask your doctor for her opinion on what you're actually dealing with.

Mindfulness meditation may help you learn to relax your muscles. A professional assessment of the ergonomics of your workstation might help. Also, check your caffeine intake. If you're getting headaches every afternoon, maybe your morning coffee is wearing off and you're going into caffeine withdrawal.
posted by embrangled at 9:01 PM on February 12, 2010 [1 favorite]

You should probably be aware that AskMe doesn't do very well with questions involving non-evidence-based medicine, so if you're opposed to seeing a physician, you're unlikely to get the answers you're seeking here.

I guess I'd ask you to look at why you don't want to see the neurologist. It's not as though they can force you to take medication you don't want to take or submit to tests you don't want to undergo. By visiting a neurologist, all you're committing to is talking with a doctor about your symptoms and maybe having him/her examine you. If the doctor proposes a test or treatment you don't want, you're free to turn it down. But at the very least, you can help narrow down possible causes and learn what your options are.
posted by decathecting at 9:05 PM on February 12, 2010 [2 favorites]

Are you clenching your jaw or grinding your teeth? Look and see if your tongue has ridges around the edges. Do your ears hurt? If so, the tensing of the muscles in your neck and shoulders might be secondary or reactionary to the jaw clenching. I went to the dentist, had my bite adjusted, got a special bite guard for jaw clenching, and presto chango, the awful numbing nauseating aura-inducing two year migraine that would bring me to my knees was gone within three days. I also stopped taking a well known antidepressant with a side effect of causing jaw clenching so if you are taking an antidepressant you might investigate side effects.

I literally had this migraine for almost two years to the point of my face going numb, my doctor basically telling me it was "all in my head", numerous tests including an MRI, lots of different drugs, migraine auras, throwing up, the works. I changed doctors. He told me to stop taking everything including the Wellbutrin because it is well known for causing jaw clenching. I had deep scallops on my tongue indicative of this. He sent me to the dentist to have my bit adjusted and order the special bite guard. It is different from the kind you can just get at the drugstore because it keeps your molars from touching. Within three days the headache was gone and has not returned. YMMV but worth investigating.
posted by tamitang at 9:17 PM on February 12, 2010

I am not a doctor of any sort but I get similar repercussions from stress and from using the computer for too long. Mine centers in my neck and makes it impossible to turn my head for ~48 hours unless I take muscle relaxers. Things that have helped:

When I feel it starting as a little prickle or knot I imagine the knot is a fist and I imagine it unclenching and stretching out its fingers. Repeat, Repeat, Repeat.

This is a strange way to explain it but lift your shoulders up to your ears. Now imagine you are tucking your shoulder blades into your back pants pockets. If my explanation comes across you will effectively be repositioning your shoulder blades lower and out a bit from where they regularly sit when you are tense. Keep them there. That's where they belong.

I had someone who knew about ergonomics/alignment etc take a look at my desk setup. Adjustments, although minor, have helped a lot.

I have found that if I am keeping up with yoga, no matter the stress I experience the problems don't occur. Yoga is absolutely integral to any semblance of stress management that I have. If you have the time and a yoga teacher you like what have you got to lose. He/She may also be able to suggest specific poses that will help. Specifically poses that can be done with just arms while at work would be great for your situation.

Are you a woman? I occasionally get extra stressed and experience muscle tension and headaches due to hormones. Bizarrely I am able to mitigate this by drinking an extra large glass of grapefruit juice. Definitely YMMV on that one and if you aren't a woman, never mind.

Good luck! I (literally) feel your pain on this one.
posted by tinamonster at 9:22 PM on February 12, 2010

I'm afraid I don't have any insight to provide on how to address your neck and shoulder problems, but I want to encourage you to seek out a remedy to help you deal with the migraines when they do come. I don't believe muscle relaxants are recognized as a treatment for migraines. Are they meant for your shoulder or your head?

Even though Imitrex didn't work for you, there's a fair chance that another drug from the triptan family can help. I like Axert and hear good things about Maxalt. You might also consider trying Excedrin (an over-the-counter combination of acetaminophen, aspirin and caffeine), which one small study found to be significantly more effective than sumatriptan for the early treatment of migraine. Obviously, these are options you'd be well advised to discuss with a qualified health care professional. A neurologist would be an excellent place to start. Even if you are leery of Western medicine, it may be a consolation to know you have something in your back pocket that will relieve the pain while you seek out a more holistic solution.

And a side note: Watch that caffeine intake. I find that varying my caffeine consumption even slightly is apt to bring on an attack. In the end I had to forswear the stuff almost entirely. A daily cup of coffee and an occasional cup of tea would be disastrous to me. Ironically, one of the few occasions I permit myself to have the stuff is when I take Excedrin for a migraine. For me, caffeine is both cause and cure.
posted by reren at 10:26 PM on February 12, 2010

For a while I was doing a bunch of lab work that involved sitting in the same position and doing a lot of lifting with my arms and lots of repetitive motion (3-6 hours of tissue culture at a time if you really want to know). My neck and back were decidedly against this and would be painful and seize up. I found that doing a series of stretches designed for office workers really helped me.

I have no idea where that particular set of exercises is, but here is a similar set of stretches from the Mayo Clinic that may help you.

I did the stretches every night after I got home from work and at work when I had been in the hood for more than a few hours.

I'd generally consider getting more exercise as well. Not just from a muscular point of view but as a good way to decrease stress. You may not be aware of the stress that is contributing to your headaches and exercise is a good cheap way to destress and be healthy.

I'm also with the people who are recommending talking to your MD about the headaches in more detail. You can think of this as one more alternative. I've had migraines for years and know what my triggers are to avoid them. I don't like taking the meds but I have them available if necessary.

posted by sciencegeek at 9:06 AM on February 13, 2010

Ask your doc to try Maxalt or Axert -- if you take one of these at the first sign of a migraine, you can often abort the whole horrible mess. Just because Imitrex didn't work for you, some people respond better to different remedies.
posted by mmf at 10:08 AM on February 13, 2010

Progressive Muscle Relaxation (PMR) helps you relax and tense muscles in series to help you end up more relaxed overall. If you do this a couple times a day when relaxed (say, when you get up or go to bed) you'll find it easier to do when you're actually tense and need to relax those muscles. Bonus, you should be less tense in general. There are tons of scripts online and some youTube videos that can walk you through learning to do this. Also, Breathing Retraining may help (basically relaxation breathing) you keep you more relaxed in general as well. Good luck, I get migraines too and I wish I knew the triggers!
posted by gilsonal at 10:40 AM on February 13, 2010

25-year migraine sufferer here. I used Maxalt for years, but it became less effective with time. I'd often have to take several over a couple of days because the migraines kept coming back. I didn't have specific triggers, although late nights and alcohol would almost guarantee a headache.

I also saw a neurologist, who prescribed Depakote -- I took it for a short while, but the side effects were horrendous. I was a zombie, and the headaches didn't improve.

I've been on beta blockers (atenolol) for about four years now, and they are nothing less than a wonder drug. I get maybe three migraines a year, compared to one every 10-14 days. The ones I do get can be zapped quickly with Maxalt.

I highly recommend atenolol -- bonus: it's cheap ($10 a month on my insurance) and it also lowers your blood pressure, although you should talk to your doc if you already have low blood pressure.

Good luck -- I know how debilitating migraines can be.
posted by vickyverky at 10:50 AM on February 13, 2010

On another front maybe look at the ergonomics of your work station - sounds like there's something positional in how you sit and work that might be at least exacerbating the problem. Also might be worth looking into a roller bag or a backpack so you're not straining your back and neck going to and from work. Migraines suck - have had them for~30 years - good luck solving it!
posted by leslies at 11:27 AM on February 13, 2010

I don't want to go to the neurologist. My doctor didn't seem concerned about the headaches, so I don't believe this is serious.

Your doctor would be concerned if the migraines were a symptom of something else. As far as she's concerned, your horrible crushing pain isn't causing you any problems.

Go see the neurologist, they are much more knowledgeable about causes of migraines than your GP, and will be willing to act like you have a problem that can be solved.
posted by yohko at 11:33 AM on February 13, 2010

I very much appreciate all of the responses.

Yes, I am sure these are migraines and not tension headaches. The nausea, auras, visual effects, and hangovers the next day make me pretty sure about this.

I'm not opposed to seeing a physician. I just want to consider all options in addition to going to a doctor. I am overcoming deep familial training that you have to have lost a limb and be in danger of bleeding out before going to a doctor (seriously, my father just injured himself badly, and he continued with the task he was performing when it happened because he didn't believe it to be that serious). I realize this is not healthy but I've got years of conditioning to overcome. For me to have taken a day off and called the doctor and demanded an appointment was a big deal. She didn't say "be sure you call the neurologist" so I thought, okay, this isn't anything then.

I do not clench. I had a dentist insist on this for years, and then i left him and went to another dentist who wasn't remodeling his waiting room every six months and guess what? that dentist didn't insist I was clenching and insist I needed very expensive bite molds that would generate very expensive clench guards, and no dentist since then has mentioned it (and I always bring it up just in case). I do not have scallops on my tongue.

I am going to pull up the ergonomics diagram and bring a tape measure to work, I am going to back off coffee (since I don't need it like I used to and I wonder if the inconsistency isn't playing havoc with things), I am going back to yoga, and I am going to call the neurologist. I also like the idea of doing some breathing work, maybe in concert with the yoga.

Thank you again.
posted by micawber at 3:43 PM on February 13, 2010

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