For What I'm Thankful
In a few minutes I have to go make some pies and cook a turkey and do all the other busy things the day requires, so I’m going to make this quick.
This year, I’m thankful for solving the problem of my migraines.
The path has been long and very, very painful. About ten years ago, I started experience pain around my eyes, accompanied by frequent nasal congestion. Sinus pain, in other words. Nothing worked, so I eventually underwent sinus surgery.
The pain didn’t go away.
In fact, it got worse.
I’ll describe it like this. I would wake with it, and the sensation was as if someone was digging above my eyeball with a fish hook, curving it up behind my brow, and then pulling. When it was bad, it was debilitating.
Eventually, a physician realized that my problem wasn’t sinus pain. My problem was migraine disease.
I tried anti-inflammatories. I tried nasal irrigation. I tried Excedrin. I tried meditation. I tried deep breathing. I tried sleeping more. I tried sleeping less. I tried breathe-right strips. I tried anti-anxiety medications. I tried anti-depressants. I tried anti-convulsants.
Nope. Nada. Nothing.
The only thing that would actually stop the migraines was Imitrex. Imitrex is one of a class of drugs called triptans, and they work by disrupting the…well, I should explain what a migraine is, hmmm?
All headaches are caused by the dilation of blood vessels in the head, neck and face. Blood vessels dilate for any number of reasons, but it seems that when they over-dilate, it’s usually in reaction to over constriction. Tight muscles can constrict blood vessels. They dilate in response…and voila…you have the cause and effect of a classic tension headache.
However, it’s not the blood vessels themselves that cause the pain, but rather the nerves that they’re slamming into when they expand. The culprit nerve for many migraineurs is the trigeminal nerve. When overstimulated by surrounding vasodilation, the trigeminal begins pounding the pain drum, triggering the release of pain-causing neurotransmitters. In addition to pain, this reaction can cause swelling and congestion, leading to more irritation of the trigeminal nerve, leading to more pain…
…until you’re in a full blown migraine. Some migraineurs (but not most) experience a visual warning, or aura, that is probably the result of increasing pressure on the eyeball. For me, there was no warning. I would simply wake up in pain. Sometimes it was so intense, I would either vomit or simply lie in bed.
And mind you, I have a rather high threshold for pain.
Imitrex and the triptans disrupt that vicious cycle, and the first time I took it, I was so happy I thought I’d cry. My migraines almost always last 10 hours or so. One hour after I took an Imitrex, it was gone.
Even better, Imitrex isn’t a narcotic or barbiturate or benzodiazepine or anything like that.
So for a while, things were okay. Wake up with a migraine? No problem. Imitrex. Feel one coming on? Imitrex.
Unfortunately, they started getting worse. And they started coming more frequently.
And during the summer of this year, they started coming every day.
Every day, I would wake up in pain. That’s when I started to really worry.
So, what am I thankful for?
Ignore the silly cover. Buchholtz, a neurologist, runs the headache center at Johns Hopkins. I reached for his book as a Hail Mary, the way I had reached for everything before.
His message was oh so simple.
My headaches had gotten worse because I was rebounding off the Imitrex. Okay, fine, but why was I getting them in the first place?
He reeled off a long list of things that can cause headaches, but the one thing he warned against the most, the one thing he said no migraineur should ever ever touch, was the one thing I had been consuming large quantities of for 15 years.
In addition to perking you up, caffeine is a vasoconstrictor. In fact, it’s such a good vasoconstrictor, they put a load of it in Excedrin. That’s why Excedrin works to stop headaches in some people when plain aspirin or Tylenol don’t. Unfortunately, if you’re neurochemically sensitive (and migraineurs are almost definitionally), that vasoconstriction will lead to vasodilation…and that’s going to lead to migraine.
I was waking up with migraines because eight hours of sleep meant eight hours without caffeine.
I was waking up in withdrawal, and once the migraine reaction had started, nothing but Imitrex could stop it…but that would only make matters worse.
So I went cold turkey. Quit the Imitrex and quit caffeine.
I will tell you that on day three, I was in so much pain I punched the wall.
But the headaches slowly started to recede.
First down to three a week. Then two. Then one.
It’s been a few months now. I have maybe one mild headache a week. Tylenol’s enough.
I’m incredibly thankful.