Part I: background
A migraine is not a headache.
I had frequent headaches as a child. I remember going to a neighborhood picnic when I was six years old; I had a bad headache, and had to go to bed after arriving at our friend’s house.
My family visited Disney World in Florida when I was ten years old; we flew Eastern Airlines, when there was a smoking and non-smoking section on the plane; like the smoke really knows to stop at row ten. Passengers weren’t just smoking cigarettes, but cigars, too. By the time that we landed in Florida, I had another bad headache.
I had headaches in high school; would visit the school nurse for pain reliever; I learned to “fake” feeling okay, putting on a smile – getting through the day – despite not feeling well.
My older brother, Doug, got married in 1988; after the celebration, we returned to his mother-in-law’s house; I had to go to bed with another bad headache.
I don’t remember having headaches in the Marine Corps. In graduate school, I started to get migraines; I visited the university health center, and I was told that I could take a daily anti-depressant for the rest of my life to minimize and prevent migraines; I declined.
In 2018, I traveled to San Francisco for business, and had a massive migraine, likely, the worst migraine that I ever experienced. I became concerned when it didn’t respond to OTC pain relievers, and walked to the local urgent care. Urgent care refused to treat me, after collecting its $75 deductible, suggesting that I could be having a (fatal) brain aneurism. Out of an abundance of caution, I took an Uber to the local emergency room. At check-in, the triage nurse asked for my level of pain on a scale of one to ten; I replied that the pain was an eleven, and that I wanted to puke and than die. The nurse replied that I couldn’t be that sick, because I was funny. The attending doctor, out of an abundance of caution, sent me through the cat scan, with and without contrast dye, to confirm no aneurism; ultimately, giving me some Benadryl, which did little to mitigate the pain. The attending nurse asked for my level of pain at discharge, and was shocked that I replied that it was an eight – marginally better – but still very uncomfortable; and I walked home. The insurance company was billed $15,000 by the hospital, and my payment was $3,000. Waste of time and money; won’t again make that mistake.
In 2019, I woke up at 4:00am with a migraine coming on; I went swimming at the YMCA at 5:00am, hoping that exercise would mitigate the pain. After cleaning up, I went to the office at 6:00am; with the pain becoming worse, I laid down on the couch in the lobby, before other employees arrived in the office. At 8:00am, I went to my office; the pain was growing worse. I passed the point of no return; I could no longer drive myself home. My co-workers volunteered to drive me home, but I didn’t want to vomit in the back of their car – the nausea was overwhelming. Despite wearing a suit and tie, I had no choice, but to lay down on the floor. I worked in that office for five years – I don’t recall anyone ever vacuuming the floor. The pain subsided later in the day, and I was able to drive myself home, and go to bed.
In 2021, I was living in Connecticut; and was supposed to have dinner with my family at my twin brother’s house, to celebrate our birthday. I had a massive migraine coming on; when I arrived at my brother’s house, I had to go to bed. He gave me ice to put on my head, but the pain only grew worse; I ended up driving home, and didn’t celebrate (anything) with my family. The migraine lasted more than two days; I eventually had to get out of bed, as I was scheduled to receive the second COVID vaccine.
Part II: triggers
I typically can feel when a migraine is coming on; my body tends to evacuate all contents; pee, poo, and puke, as if my body is anticipating that I won’t be able to move or function for 24 to 48 hours. During a migraine, the capillaries in the head become enlarged; an effective modality vasoconstricts the capillaries. I become sensitive to light, my pupils almost completely contract. I become sensitive to sound, too; every ding on the iPhone is excruciating. When the migraine breaks, known as the postdrome, or, migraine hangover, I’m typically exhausted, completely spent – often feel like I was hit by a truck – and often have a (garden variety) headache, so still not free from pain or discomfort.
I become very nauseous with a migraine; unable to eat or drink, or even think about eating or drinking; it’s easy to become dehydrated, which often exacerbates the condition. I can easily lose five pounds, and I can’t really afford to lose five pounds. It hurts to think; and becomes difficult to speak, sometimes referred to as migraine-induced speech aphasia. During the course of a migraine, my body temperature changes drastically, alternating between cold and chills, to overheated and sweating.
I track my migraines, to aid in identifying triggers, which may include lack of sleep, high stress, change in weather, most notably, a decrease in barometric pressure due to storms, strong scents, such as perfume or cleaning products, bright light, and certain foods.
I’ve learned that some foods have high tyramine, other foods have high histamine, and some foods liberate histamine, all of which are migraine triggers. Some of these foods include: wine, aged alcohol, aged cheese, fermented foods (bread, kefir, kimchi, kombucha, miso, natto, sauerkraut, tempeh, etc), overripe banana or avocado, vinegar, and dark chocolate.
Sometimes, these foods may or may not trigger a migraine; at other times, these foods behave cumulatively. For example, a small piece of dark chocolate by itself, may be okay. However, a piece of dark chocolate and an aged piece of cheese, could trigger a migraine. I used to take Benadryl, an anti-histamine, based on the recommendation of the ER physician; but over the years, this is no longer an effective modality.
In the fall of 2021, I had a five-month period with no migraines; between diet, specific vitamins, and (trace) mineral supplements, I had no issues. I was surprised in Mexico, when the migraines returned in mid-February. The migraines were severe, did not respond to OTC pain relievers, and lasted 48-hours each; I spent at least six days in Mexico sick in bed, I couldn’t even sit-up. In Mexico, I ate a lot of lentils, more than I would in the United States. Part of this was simply due to the foods that were or were not available. I soaked and sprouted the lentils over a two-day period; this is supposed to make the lentils healthier by reducing phytic acid. However, some legumes, like lentils, may be high in histamine, which may have triggered these migraines.
Part III: treatment
Often times in the past, when I would feel a headache coming on, I would take a pain reliever, to abort the pain. In my experience, once a migraine gets hold, it’s too late, and pain relievers are no longer effective.
However, overreliance on OTC pain medication may trigger and cause rebound, or, medication overuse headaches. The same medications that initially relieve headache pain may themselves trigger subsequent headaches if used too often. In addition, frequent use of non-steroidal anti-inflammatory drugs (NSAIDs) may also be harmful to the liver, kidney, and bones. In a given month, I could have ten to twenty migraines or rebound headaches.
I’ve experimented with alternative modalities, including cayenne pepper, ginger, white willow bark (precursor to salicylic acid, active ingredient in aspirin), magnesium supplements, homeopathic remedies, applying lavender or mint oil, applying ice, massage therapy, and chiropractors.
When I lived and worked in Houston, I consulted a neurologist; it was frustrating, because she appeared to treat the symptoms, and not the cause, prescribing an alarming number of pharmaceutical drugs. One drug, sumatriptan, the classic therapy to abort a migraine, includes a possible side effect of heart attack.
CRG made an investment in CEFALY Technology, a Belgium-based company, that specializes in electronic medical devices. After making the investment, one of the partners, David, aware of my migraine history, sent me a CEFALY device.
CEFALY is an FDA-approved, preventive and acute migraine treatment, used as an external cranial neuro-stimulation device, It is applied to the forehead using a self-adhesive electrode positioned over the trigeminal nerve which aggravates migraine headaches. The device generates electrical impulses that stimulate the trigeminal nerve. The device has two programs; a 20-minute program that may be used daily to prevent migraines, and a 60-minute program that may be used to abort a migraine. The device is beneficial for those patients who may not have success with pharmaceutical modalities.
I’ve had good results with CEFALY; I use the 20-minute preventative program each evening. If I feel a migraine coming on, I use the 60-minute program, which is effective at aborting a migraine. On occasion, a migraine will still develop, despite using the device.
In Mexico, I had only two Excedrin migraine tablets remaining. Since it was no longer effective, anyway, I stopped taking OTC pain relievers as of March 1st. My intention is to see if “quitting” OTCs improves my health, and, if my body returns to a steady-state in terms of migraines. I don’t take any long-term prescription drugs; I don’t remember the last time that I took a prescription drug, perhaps in 2018. I’ve always been embarrassed by my overreliance on OTC pain relievers. I would prefer a philosophy of, “let food be thy medicine and medicine be thy food” or the Ayurvedic saying, “when diet is wrong, medicine is of no use; when diet is correct, medicine is of no need.”
The fourteenth Dalai Lama, was once asked what surprised him most about humanity; he replied, “man, because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”
After returning from Mexico, I purchased a ProsourceFit acupressure mat; my family calls it the “bed of nails.” The mat may be used to relieve head, neck, and back tension, which may trigger tension headaches or migraines.
The acupressure mat turns the concept of acupuncture into an at-home regimen to improve wellness. The plastic points, which resemble the bottom of a golf shoe, create a rush of sensations and help to rejuvenate the body. The mat has 8,900 acupressure points; the neck pillow has 1,800 acupressure points. It took a month to become accustomed to using the floor mat on bare skin; I started off using less than five minutes a day, and building up to twenty minutes; using the mat is similar to yoga, and requires deep breathing.
Currently experimenting with hemp-derived cannabinoid oil (CBD), in the form of a gummies or soft gels, which may be used to treat inflammation and pain. CBD does not contain tetrahydrocannabinol (THC), known for producing marijuana’s high, or mind-altering effect. Purchased legally at a storefront in Austin, Texas.
Ideally, would like to see a 50% reduction in pain, which would likely allow me to remain “vertical” and hopefully, have a somewhat more productive day than lying in bed. Certainly wouldn’t be running a marathon, but would greatly prefer being up and about. Alternatively, a 25% reduction in pain would still be beneficial, as hopefully I could rest more comfortably. I haven’t tried them yet, but will update this blog post later this summer with my experience.
Part IV: quotations
Joan Didion was an American writer (1934 – 2021); she was married to author, John Dunne, who died from a heart attack in 2003 sitting at the dinner table with his wife. Their adopted daughter, Quintana Roo Dunne, died subsequently in 2005. Didion wrote, The Year of Magical Thinking, as a narrative to these two events.
That no one dies of migraine seems, to someone deep into an attack, an ambiguous blessing. – Joan Didion
Right there is the usefulness of migraine, there in that imposed yoga, the concentration on the pain. For when the pain recedes, ten or twelve hours later, everything goes with it, all the hidden resentments, all the vain anxieties. The migraine has acted as a circuit breaker, and the fuses have emerged intact. There is a pleasant convalescent euphoria. – Joan Didion
And I have learned now to live with it, learned when to expect it, how to outwit it, even how to regard it, when it does come, as more friend than lodger. We have reached a certain understanding, my migraine and I. – Joan Didion
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