Sunday, March 01, 2009

The Truth About Me

About three weeks ago I went to see my doctor for a minor issue. My ears had been bothering me, like they might be infected but maybe not, but it had lasted long enough I thought an expert should shine a flashlight into them. It turned out to be benign, allergies doing something funky, but during the visit it was noticed that my blood pressure, which I had brought under control during my year of walking, had jacked up again.

So the doctor prescribed me the meds I should have been taking but kind of sort of forgot to and pointedly didn't lecture me in a way that felt worse than if he had. He asked that I go get my pressure checked a few times over the next few weeks and make an appointment to come back. Then, almost as an afterthought, he said "You can't take your migraine medication any more, until we get this under control". I responded in a totally matter of fact way, Oh, ok no problem, which completely belied my internal state, which was freaking out. I asked him if it was ok for me to still take Excedrin, the migraine sufferer's over-the-counter best friend, and he said yeah sure.

I knew better than to argue with him, or even to ignore him. When I first started having problems with high blood pressure he explained to me, in his direct straightforward manner, that high blood pressure plus migraine medication equals playground for stroke. Ignoring him seemed like a risky and rather stupid proposition. So I left the office clinging to the hope that my migraines seemed to have been more or less under control lately, kind of, and it would probably be just fine.

I've suffered from migraines for as long as I can remember, at least as far back as high school. In college any promise I had as a burgeoning alcoholic was discouraged by the fact that drinking led to headaches that were hell's own punishment. I became an Excedrin addict instead, its magical combination of aspirin, acetaminophen and 800 milligrams of caffeine the only thing that could touch the pain once it had moved in.

Over the years I doggedly compiled my mental list of migraine dangers. Drinking, especially wine; birth control pills; my period; not eating; peanuts; sometimes but not always walnuts; strong floral scents, especially roses; maybe Indian food; some kinds of cheese and dairy some of the time; middle of the afternoon naps; and, as I cruelly learned after back surgery a few years ago, Vicodin, are all on my trigger list.

Growing up my mother had always had bad headaches, dealing with them by cloistering herself in a dark room with a cold compress. I dealt with them similarly, along with a healthy abuse of Excedrin and any number of alternative therapies. I had moderate success with accupuncture. I can still see the weird freckles that developed on my hands, in the fleshy area between thumb and forefinger, which is the magic spot for headache treatment. I tried positive visualization, lying in the dark and imagining a little broom sweeping the vast pain into a tidy pile and throwing it away. Lots of things worked once or twice, as if the pain was startled by the approach (Mother of God! It's an Imaginary Broom!) but eventually the effectiveness would wane (Oh it's just the imaginary broom again. Ignore it and it will go away).

A friend of mine, an Episcopal priest, told me she'd had great success healing her daughter's headaches with prayer and laying on of hands, an idea which is only risible to those who have never had a week long migraine. I greatfully allowed her to try her hand, and prayers, on my painful head but when she tried she said that although she could tell that I was in pain, she couldn't get a handle on it, couldn't visualize it well enough to focus her prayers on it.

I was suprised at how well her description of what she sensed matched what I felt inside my head. My pain is like a thunderstorm, roiling around with no focal point. My pain is like a lava lamp, bubbling through my brain. My pain is like an oil slick floating on the water; like a hydra; like mercury. I can focus on a point which seems the most painful, only to have it slip away and erupt somewhere else. If you add color and a soundrack, it would be a cutting edge 60s light installation. If it weren't for the pain, it would be facinating.

My migraines have evolved over the years, adding different nuances to the repertoire. A recent development has been nausea and car sickness, even and especially if I'm driving. If the migraine lasts long enough, the nausea gives way to ravenous hunger, as if the wildfire raging in my head were actually consuming calories (one could only hope). Sometimes I get a weird kind of euphoria, a surpluss of endorphins which have no effect on the pain in my head, but make me feel oddly serene and detached, as if the pain were taking place in a different room of the house.

It wasn't until I hit my 30s that it occurred to me to mention these headaches to a doctor. Eventually though, it got to a point where it was negatively impacting my job, mostly by eating through my limited sick time and irritating my boss. The doc prescribed me Immitrex, which was indeed a miracle drug as far as I was concerned. Unfortunately I quickly built up a tolerance for it and was soon running through a month's supply in a matter of weeks or less. Among other things, migraine meds are expensive, and while I'm sure it's for concern over health safety and not at all a cost control measure, insurance companies take that month supply designation seriously. If I ran through those nine precious pills in ten days, it was a long 20 days before I was allowed my refill.

The doc sent me to a neurologist, and we spent months trying different combinations of meds, mostly anti-seizure medications, that might stop my migraines before they started. Maybe nothing worked, or maybe I didn't have the patience to let them work, but we never found the magic combination of daily medication that stopped the migraines. We did, however, probably unintentionally on the part of the neurologist, come up with a solution which worked fine for me. In addition to the Immitrex, which works quickly to stop a migraine, but has an unfortunate tendency to cause "rebound" headaches which arrive within 24 hours, he also prescribed something called Amerge. Amerge works much more slowly, hours instead of minutes, but its effects are lasting.

The combination of the two drugs worked fine for me. If I felt the vague niggling of a headache, the tell-tale pinching behind my right eye, I'd take an Amerge, sometimes with an Excedrin chaser. If one came on quickly, or I awoke with one full blown, I'd take an Immitrex. The important thing, from my perspective, is that between the two prescriptions I had enough migraine drugs to get me through a month. And thus it has been for two or three years now. Although I would still get migraines, they weren't running my life any more. I no longer feared activities or vacations would be spoiled by a headache. I drank wine. I started sneaking dairy back into my diet. Once I even ate a Reese's Peanut Butter Cup, immediately following it with an Immitrex to stop the migraine that would certainly follow. It was a foolish challenge to fate, but I felt liberated.

Until three weeks ago. I've been doing ok since then, kinda, sorta. I only missed a partial day at work because of a migraine. Most of them seemed controllable with Excedrin. Maybe, I thought, this wouldn't be so bad. Then I woke up Saturday morning with a migraine.

When migraines approach you during the day, you can see them coming, the pinch behind the eye, a tenderness of the sinuses. Suddenly you can smell everything at 200 times its normal potency. Sometimes you get funny auras and a weird, disconnected trippy feeling which would almost be entertaining if you didn't know what was coming next. These are the signs to break out your drugs and often, if you swallow them in time, you get to skip the visitation from the migraine terrorists altogether.

But waking up to a migraine is one of the most miserable things in life. Before you've even opened your eyes, you know that your day has been hijacked. Coming awake yesterday I knew my plans for the day were shot. I staggered out of bed and swallowed some Excedrin and an Aleve for good measure, even though I knew with a sinking heart that it was already too late. I heated up my flaxseed and lavender eye pillow in the microwave and staggered back to bed. Sometimes heat works well to mute the pain, sometimes ice. Sometimes I use both, one temperature extreme on my forehead, the other on the back of my neck, hoping that some combination might startle the pain into remission.

I laid in bed defiantly, for as long as I could stand, but eventually the daylight seeping through the curtains became too hard to ignore. I also knew I had to get up and run at least one vital errand that couldn't be avoided. I was out of cat food and migraine or no, hungry cats will not be ignored. I rummaged through my drawers and found one the dozen sticks of Head On which I applied liberally to the forehead as directed. After limping out and back from Target, I staggered upstairs and stuck my head under an ice cold shower. In those moments that I could stand the icy needles of water the pain receded, only to return full force when I couldn't stand it anymore and had to pull my head out.

Once I overheard someone speaking disparaginly of Head On as a "placebo" which doesn't do anything for headaches and I had to bite my tongue to keep from calling out this total stranger. A placebo, to my mind, is something that has no actual effect and its benefits are completely imagined. It's true that Head On doesn't usually cure my headaches, but it delivers a weird chemical cold sensation, like coating your head in Icy/Hot. Sometimes this is enough to distract you from the pain, allowing you to focus on the task at hand. Like repeatedly slamming your hand in a car door, or putting a bullet in your brain, two things I've never done but contemplated plenty, sometimes all you want is a distraction. Head On and ice cold showers seem a preferable option to other forms of self injury.

A friend of mine at work who suffered from migraines for many years told me that menopause has cured them completely. I've heard this from other sources too, a reassurance of something to look forward to. I'm as emotional and conflicted about menopause as any woman in her late 30s who somehow forgot to have children would be, but when my lady parts doctor told me it appeared I was entering peri-menopause, my first thought was the migraines. Sainted heaven's above, could this be the beginning of the end of them?

A few years ago a book was published called All In My Head, about the author's 15 year struggle with a headache that would not go away. It's supposed to be a well written funny book, but I can't bring myself to read it. It feels too real and raw, like a rape victim reading about somebody else's horrible experience. One of the things about suffering from migraines, or any other chronic illness, is how totally helpless they make you feel. It infuriates me, that feeling. It enrages me. How dare these monsters steal my life away, bit by bit, Saturday by Saturday? Would I feel better about things if I owned them? Hello I'm Kati and I am a migraineur. Should I thank them for the booze they saved me from drinking, the dull parties they saved me from attending?

I've become used to not thinking of myself that way. I still got migraines, one or two a month, but the meds kept them reasonable, limiting their theft to hours instead of days. I don't know how long this moratorium on the drugs will last, but I'm taking my high blood pressure meds every day like a dutiful patient. I don't know what I can stand anymore, certainly not too many more days like yesterday. Do I cheat and go back to taking the Immitrex and Amerge, stroke risk be damned? Do I call my doctor and tell him, nuh uh, I can't do it. Give me something. Give me anything. The truth is, I don't know. Maybe I'm in denial still. Maybe I just don't want any of this to be the truth about me.


Holly said...

I'm so sorry that you have to go through this. :(

Lopez Kilpatrick said...

Oh, honey, I hurt reading it.

Georgia said...

OMG -- I am so lucky to not have migraines.

DawnP said...

Best descriptions of migraines I've ever heard, as I've never had one. Knock wood. You always make me laugh Kati, even describing your pain!