Headache Day 6. Migraine attacks usually last between 4 – 72 hours. I’ve had weird and interesting headaches since childhood and have accumulated a whole bunch of diagnostic terms to go along with it. I’ve also tried and trialled a wide range of possible treatment, but either treatment is contraindicated (and in some cases we didn’t figure that out until after administration), poorly tolerated or ineffective. The EDS dilemma again comes to the forefront when thinking about how to manage migraine headaches, it’s a complicated complication.
First Line Treatment: Painkillers
The first line of treatment is always painkillers. Starting with aspirin. Me? I’m hypersensitive. Paracetamol is next in line. Ineffective. Completely and utterly so. Nonsteroidal anti-inflammatory drugs (NSAID) are up next. Ibuprofen, Tolfenamic acid, Naproxen, and Diclofenac, but these are contra-indicated in those with asthma, so scratch that too.
Second Line Treatment: Triptans
I gave triptans a go before I was diagnosed with Basilar-type migraines. The injections sometimes worked to abort a headache if administered at just the right time, but neither the tablets nor injection got along with my supraventricular tachycardia, severe Raynaud’s and dysautonomia. Instead of a headache, I had severe dizzy spells, fainting, chest pain, palpitations, flushing, tingling, vomiting, muscle cramps and mercifully, drowsiness soon set in that knocked me out for 12+ hours afterwards. As soon as my neurologist diagnosed BTM, for which triptans are contra-indicated, this option was no longer on the table.
Third Line Treatment: Preventative Medication
I was prescribed Beta blockers by an ignorant GP despite suffering from asthma. It ended rather badly. Next up: Amitriptyline. Unfortunately, I have a pretty low seizure threshold and already having the odd seizure as part of a migraine aura, amitriptyline lowered my seizure threshold that much more and I had frequent seizures until it was discontinued. Anti-seizure medication was the next logical step. We tried topiramate, sodium valproate, pizotifen, few more with similar results as the triptans, dizziness, fainting, fatigue, nausea and drowsiness and on the more serious side, topiramate-induced metabolic acidosis. Sleeping for 20-hours a day and being confused, exhausted, drowsy and stuck in a nauseating blur of spinning whenever I moved was worse than the actual headache. I discontinued treatment.
My neurologist wasn’t ready to throw in the towel just yet and so we tried more antidepressants (prozac, venlafaxine hydrochloride, imipramine, zofran) and again the side-effects were intolerable. We moved on to prednisone, muscle relaxants (on the off-chance that it may help a little) then less standard treatments – working through the whole list of cluster headache medications as well as trying physiotherapy, hydrotherapy and finally various complementary therapies from acupuncture to osteopathy. Nothing preventative prevented anything much.
We finally settled on the very non-standard treatment of opiods and dimenhydrinate (dramamine/gravol) or hyoscine (scopolamine). Codeine when it’s bad, morphine when its awful, but not terrible, fentanyl for the nightmare headaches. I quite liked my fentanyl patches. Pity it caused hypoventilation leading to respiratory acidosis. I never did get used to the anti-emetics. Patches were nice though, no more worrying about taking drugs just to throw it up ten seconds later. Bottom line – when a migraine headache become atypical and intractable, nothing but quiet darkness and sleep make a difference. And even that has a limited efficacy. Day six and it’s just putting up with it for as long as it takes to get better. Stupid migraine headaches.