migraine prevention for dream job interview!
January 10, 2018 1:56 AM Subscribe
[potential TMI alert!!] I am on the academic job market. I have a campus interview on Feb 1. I, hm, will probably be ovulating, which is to say the chance of getting a hormonal migraine is high. What can I do to help myself?
I'm super excited about the campus visit.
I've had migraines all my life (female, 33, never had kids). They get noticeably more frequent when I am stressed out or not fit, and less frequent when I am exercising a lot (like 2 hours a day). My main triggers have been food (wine, cheese, MSG, sulfites and nitrites), although I sometimes also get them around ovulation even if I hadn't accidentally injest any trigger foods.
This academic year because I have been very stressed out I have been having a lot more migraines than usual. I've done everything I can to minimize the disruptions:
1) I make sure to stay fit and exercise as much as I can (not quite 2 hours a day though) 2) I avoid all trigger foods and quit alcohol and 3) I've been taking Omega 3 and might add magnesium as well. 4) I stick to a very strict sleep/wake/blood sugar routine.
All of these things have helped significantly, but I still get migraines around the time of ovulation. Even when I get a migraine that's not so painful (and so not so disruptive) I still get the aura (bright light spots in my vision) for an hour.
Is there anything I can do to either delay my ovulation, short of any hormonal therapy (which takes too long and has risks for migraineurs), or to further prevent having a migraine?
I'm not beyond starving for a week for this purpose at this point.
**I do plan on memorizing my job talk just in case I can't see for an hour. i.e. I will be preparing for the worst case scenario, but, you know, I want to try and avoid that also.
I'm super excited about the campus visit.
I've had migraines all my life (female, 33, never had kids). They get noticeably more frequent when I am stressed out or not fit, and less frequent when I am exercising a lot (like 2 hours a day). My main triggers have been food (wine, cheese, MSG, sulfites and nitrites), although I sometimes also get them around ovulation even if I hadn't accidentally injest any trigger foods.
This academic year because I have been very stressed out I have been having a lot more migraines than usual. I've done everything I can to minimize the disruptions:
1) I make sure to stay fit and exercise as much as I can (not quite 2 hours a day though) 2) I avoid all trigger foods and quit alcohol and 3) I've been taking Omega 3 and might add magnesium as well. 4) I stick to a very strict sleep/wake/blood sugar routine.
All of these things have helped significantly, but I still get migraines around the time of ovulation. Even when I get a migraine that's not so painful (and so not so disruptive) I still get the aura (bright light spots in my vision) for an hour.
Is there anything I can do to either delay my ovulation, short of any hormonal therapy (which takes too long and has risks for migraineurs), or to further prevent having a migraine?
I'm not beyond starving for a week for this purpose at this point.
**I do plan on memorizing my job talk just in case I can't see for an hour. i.e. I will be preparing for the worst case scenario, but, you know, I want to try and avoid that also.
The only over-the-counter med I've found to be effective is Exedrin Migraine- it really works for me!
posted by bearette at 3:41 AM on January 10, 2018 [1 favorite]
posted by bearette at 3:41 AM on January 10, 2018 [1 favorite]
Definitely add magensium, this has all but fixed my migraines (and is unlikely to hurt even if it doesn't help). You can be magnesium-deficient for a ton of non-obvious reasons (e.g. as a side-effect of PCOS or proton pump inhibitor use for acid reflux, both of which were true for me and neither of which I intuitively knew were linked to low magnesium).
posted by terretu at 3:42 AM on January 10, 2018
posted by terretu at 3:42 AM on January 10, 2018
I get hormonal migraines too, though usually at a different point in the cycle. Mine can be prevented as long as I remember to take vitamin D and calcium. Ideally every day, but definitely in the week before I would expect one.
posted by tomboko at 3:55 AM on January 10, 2018
posted by tomboko at 3:55 AM on January 10, 2018
I think your impressions about hormonal birth control are worth discussing in further detail with your healthcre provider, as oestrogen-free hormonal birth control is generally considered safe in migraineurs (of course I do not know your entire history etc)
posted by chiquitita at 4:11 AM on January 10, 2018 [2 favorites]
posted by chiquitita at 4:11 AM on January 10, 2018 [2 favorites]
Neurologist here, and fellow migraneur. There is no way to prevent ovulation short of hormonal therapy. However, lots of things you can do to reduce your chance of getting a migraine.
The biggest thing to know is that for people with menstrual migraine (including migraine when ovulating/at any predictable point in the cycle) there are prescription meds, like frovatriptan, that you take for the 2-3 days when you are at highest risk. At the risk of sounding like a drug ad... Talk with your doctor about whether these medicines are right for you.
If you can't get an appointment with your doc, or if they can't prescribe one of these long lasting meds:
-avoid your triggers, as you are doing. Are they taking you to dinner before your formal interview? Or lunch the day of? Order judiciously.
-hydration! I kept a small bottle of water in my purse during interviews, and a bottle on the podium during my job talk.
-eat regular meals. Please please don't starve yourself or overexercise in the hopes of not ovulating. It is unlikely to work (anovulation in famine and athletes is the result of months of fat loss, not a week of skipping meals), and will probably just make you cranky.
-yes to adding magnesium. You want mag oxide 400 mg daily. This is what I recommend as a preventative to migraineurs in pregnancy, when freaking every other med is off-limits.
- As a short term preventative, some people use naproxen 500 mg twice daily, for up to a week. It's longer lasting than ibuprofen, so less chance of a rebound headache. Check with your doctor if you want to do this, as high-potency NSAIDs should be avoided in some situations.
-As an abortive, ibuprofen, Exedrin migraine, caffeine, are all quick acting, but run the risk of rebound headache if taken too often. Not all abortives are created equal. As an example, for me, generic ibuprofen 400 mg at the beginning of my aura will knock out the headache completely, whereas the migraine just laughs derisively at Excedrin, and brand-name Advil (which is just ibuprofen) makes me woozy.
posted by basalganglia at 5:13 AM on January 10, 2018 [7 favorites]
The biggest thing to know is that for people with menstrual migraine (including migraine when ovulating/at any predictable point in the cycle) there are prescription meds, like frovatriptan, that you take for the 2-3 days when you are at highest risk. At the risk of sounding like a drug ad... Talk with your doctor about whether these medicines are right for you.
If you can't get an appointment with your doc, or if they can't prescribe one of these long lasting meds:
-avoid your triggers, as you are doing. Are they taking you to dinner before your formal interview? Or lunch the day of? Order judiciously.
-hydration! I kept a small bottle of water in my purse during interviews, and a bottle on the podium during my job talk.
-eat regular meals. Please please don't starve yourself or overexercise in the hopes of not ovulating. It is unlikely to work (anovulation in famine and athletes is the result of months of fat loss, not a week of skipping meals), and will probably just make you cranky.
-yes to adding magnesium. You want mag oxide 400 mg daily. This is what I recommend as a preventative to migraineurs in pregnancy, when freaking every other med is off-limits.
- As a short term preventative, some people use naproxen 500 mg twice daily, for up to a week. It's longer lasting than ibuprofen, so less chance of a rebound headache. Check with your doctor if you want to do this, as high-potency NSAIDs should be avoided in some situations.
-As an abortive, ibuprofen, Exedrin migraine, caffeine, are all quick acting, but run the risk of rebound headache if taken too often. Not all abortives are created equal. As an example, for me, generic ibuprofen 400 mg at the beginning of my aura will knock out the headache completely, whereas the migraine just laughs derisively at Excedrin, and brand-name Advil (which is just ibuprofen) makes me woozy.
posted by basalganglia at 5:13 AM on January 10, 2018 [7 favorites]
I just want to add to the comments here, yes of course take preventative measures as first course of action. It sounds like you've got a routine going already but maybe time for a revisit. But also go easy on yourself if you do get a migraine. I know all the blaming and self blaming habits when really after you've done everything you can - stuff just happens.
I just wanted to say consider whether you can attend the interview with a migraine. I've done so thrice, although admittedly one was very early stages and was not vomiting (I have rule that I can press on as long as that is not happening). I got the job in all three cases, so it did not affect my performance. Each interview was an hour or so an I was able to hold it together.
I just wanted to give you the confidence to know you can perform well in an interview even with a migraine. Make sure aftercare is arranged - taxi home/hotel/supportive family and friends. This may reduce feeling stressed beforehand.
posted by BAKERSFIELD! at 5:21 AM on January 10, 2018
I just wanted to say consider whether you can attend the interview with a migraine. I've done so thrice, although admittedly one was very early stages and was not vomiting (I have rule that I can press on as long as that is not happening). I got the job in all three cases, so it did not affect my performance. Each interview was an hour or so an I was able to hold it together.
I just wanted to give you the confidence to know you can perform well in an interview even with a migraine. Make sure aftercare is arranged - taxi home/hotel/supportive family and friends. This may reduce feeling stressed beforehand.
posted by BAKERSFIELD! at 5:21 AM on January 10, 2018
I hired one of my best editors after an interview where she (I later learned) threw up right after and couldn’t see me for part of it due to her aura, so there’s that. She didn’t communicate that she was having a migraine but I would have understood!
As a last-ditch effort, for me drinking a sports drink like Gatorade, which I hate, right at the first touch of aura or headache, along with ibuprofen, can buy me the time sometimes. I’m assuming it’s the hydration + electrolytes but it’s magic for me. I think I learned that here.
Also wearing sunglasses in winter, but that’s my particular set of triggers.
The only other tip I don’t see here that seems to help me is potassium - I try to make sure my diet provides enough.
posted by warriorqueen at 5:38 AM on January 10, 2018
As a last-ditch effort, for me drinking a sports drink like Gatorade, which I hate, right at the first touch of aura or headache, along with ibuprofen, can buy me the time sometimes. I’m assuming it’s the hydration + electrolytes but it’s magic for me. I think I learned that here.
Also wearing sunglasses in winter, but that’s my particular set of triggers.
The only other tip I don’t see here that seems to help me is potassium - I try to make sure my diet provides enough.
posted by warriorqueen at 5:38 AM on January 10, 2018
Side note for those unfamiliar with academic interviews: this will likely be an all day affair, potentially beginning with breakfast and ending after dinner. Holding it together for an hour or so like a normal interview length will not suffice.
posted by donnagirl at 6:54 AM on January 10, 2018 [4 favorites]
posted by donnagirl at 6:54 AM on January 10, 2018 [4 favorites]
Congrats on the interview! Pacing is so complicated for academic interviews (done them for academic library jobs).
- I take a supplement called Migrelief at my doctor's suggestion, which is B2, magnesium, and feverfew (she cares more about the first two.) It hasn't cut out my migraines entirely, but it's dropped the number way down and reduced symptoms most of the time when I do get them. Worth checking with your doctor about, but it takes a week or two to start working noticeably. (I get mine from Amazon: you can do the same thing with stuff from your local pharmacy, it's just more pills.)
- Figure out what you can do to help during the interview process. Can you bring relaxing stuff for the bath/shower at your hotel? Get a look at the menus of the places they're taking you for meals in advance (whoever was doing the travel arrangements was usually glad to check on my preferences and tell me what the plans were, and then I could look at the menu and decide what food would work for me without making a big deal of it or taking forever to read the menu at the time.)
- Ibuprofen at the very first twinge of 'maybe that's a migraine' works for me for everything expect weather-pressure triggers. (Bonus if I do a little caffeine with it, in my case, but depends on your response to caffeine.)
- Definitely hydrate a lot. And don't be afraid to ask for a quick bathroom break where you can take a few deep breaths, drink a fair bit of water, etc. between portions of the interview.
- It also helps me a lot to reduce discomfort in other areas a lot - I figure this is less stress on my body. Comfy shoes are a must: you'll be walking and standing a lot.
posted by modernhypatia at 7:38 AM on January 10, 2018
- I take a supplement called Migrelief at my doctor's suggestion, which is B2, magnesium, and feverfew (she cares more about the first two.) It hasn't cut out my migraines entirely, but it's dropped the number way down and reduced symptoms most of the time when I do get them. Worth checking with your doctor about, but it takes a week or two to start working noticeably. (I get mine from Amazon: you can do the same thing with stuff from your local pharmacy, it's just more pills.)
- Figure out what you can do to help during the interview process. Can you bring relaxing stuff for the bath/shower at your hotel? Get a look at the menus of the places they're taking you for meals in advance (whoever was doing the travel arrangements was usually glad to check on my preferences and tell me what the plans were, and then I could look at the menu and decide what food would work for me without making a big deal of it or taking forever to read the menu at the time.)
- Ibuprofen at the very first twinge of 'maybe that's a migraine' works for me for everything expect weather-pressure triggers. (Bonus if I do a little caffeine with it, in my case, but depends on your response to caffeine.)
- Definitely hydrate a lot. And don't be afraid to ask for a quick bathroom break where you can take a few deep breaths, drink a fair bit of water, etc. between portions of the interview.
- It also helps me a lot to reduce discomfort in other areas a lot - I figure this is less stress on my body. Comfy shoes are a must: you'll be walking and standing a lot.
posted by modernhypatia at 7:38 AM on January 10, 2018
Don't starve! My migraines have tapered off in the last few years, but every single time I've had one, it's been on a day when I haven't eaten. With mine, the danger time job interviewwise, assuming I didn't go blind driving to the interview, would be during the prodrome, right after the scotoma fades, when I can sometimes get aphasic--so I couldn't understand questions or answer coherently. That lasts maybe fifteen or twenty minutes. The rest of the time it's just pain and nausea, which depending on severity you might be able to power through. I would do all these excellent preventatives and then adopt the attitude: "Welp. If I get it, I get it; it'll be a rollercoaster ride, but it will end." Then if you start to see a scintillating patch while you're talking, just say to the interviewer, "Huh. I'm getting a migraine. Okay, sorry in advance if I become a little incoherent in a bit. No worries: it will pass." If the interviewer gets migraines, they'll think you're a rockstar. If not and the worst happens, at least they'll have been warned so thy won't think you're having a stroke and call an ambulance.
posted by Don Pepino at 8:21 AM on January 10, 2018
posted by Don Pepino at 8:21 AM on January 10, 2018
There are preventives like Ergomar that can stop migraine when the scotoma arrives. Also Botox injections along the hairline and back of the neck help some people.
Blood pressure meds, and calcium channel(?) meds also.
If you haven't seen a doctor, you really should.
posted by Enid Lareg at 9:40 AM on January 10, 2018
Blood pressure meds, and calcium channel(?) meds also.
If you haven't seen a doctor, you really should.
posted by Enid Lareg at 9:40 AM on January 10, 2018
My doctor has me taking riboflavin (B2, 400mg) in the morning, along with the magnesium. I agree that talking to a doctor would be ideal, though.
Good luck and congratulations to getting to this point!
posted by wintersweet at 12:23 PM on January 10, 2018
Good luck and congratulations to getting to this point!
posted by wintersweet at 12:23 PM on January 10, 2018
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Starving yourself probably won't work. Not eating can definitely be a trigger.
I have found the Headspace meditation app to be great at helping me reduce stress and control my chronic pain. I particularly like their respective modules for stress and pain.
If you do have one, tell your host or handler. As a faculty member who gets migraines myself, I would absolutely help my visitor and wouldn't hold it against them. But don't warn them preemptively, just know that you can disclose ("I very occasionally get migraines") if necessary.
Take care and really, see a doctor. This is now seriously impacting your quality of life.
posted by sockermom at 2:51 AM on January 10, 2018 [1 favorite]