I was floored when my physician said it might be a migraine. He prescribed Imitrex pills, one of seven triptans on the market, and referred me to a neurologist. Triptans, introduced in the U.S. in 1993, shrink the inflamed blood vessels and are currently the most powerful abortive treatment for migraines.

Fortunately, the searing pain subsided within thirty minutes.

When the neurologist saw that my brain scan, MRIs and blood work were normal he asked me what happens when my head hurts.

I tried to explain.

 My neck and my shoulders get stiff. There is tightness in my forehead. My nose gets stuffy and movements are slow. My eyes squint at the light and I cringe at harsh sounds. Exhausted, I rush home and collapse. My eye mask cannot stop the white light that dances inside my eyelids. The diarrhea starts and I dash to the bathroom. To steady myself I shuffle back in slow motion. My hands are sluggish and my limbs feel like lead. A fog descends upon my brain. Anger rises as sharp thoughts swim in my muddled mind. I try to banish the twisted thinking. Like a landslide they loom larger. I grab at some pills and crumble back down on the couch. The ache in my right temple ebbs and flows like the ocean tide. But the pounding pain flows back—faster and faster until the right side of my head becomes one deep searing burn. I press my hands against my head and groan. Nothing exists but torturous agony. I’m locked in a dark prison—a black inner world of nightmarish thoughts, pain, anger fear and depression. I stagger to the bathroom to throw up. My head feels as if it’s about to burst. I pray for relief and if I cannot I pray for death.

 My neurologist confirmed the diagnosis: I have migraines. Little did I know that, at the age of 44, my life would never be the same, a fifteen-year migraine ordeal had begun.

When I experienced five more migraines in the same month I started to do some research. The news was not good. I learned that one in 10 Americans suffer from migraines: eighteen percent are women and six percent are men. Due to hormone fluctuations a woman’s migraines may worsen prior to menopause and improve after menopause.

Migraines are not headaches they are episodes of a chronic neurological disease. Severe migraines rank with the most completely disabling conditions such as quadriplegia and active psychosis.

Scientists once thought migraines were caused by abnormally dilated blood vessels. But new imaging devices that allow scientists to watch patients’ brains during a migraine attack show sufferers have abnormally excitable neurons, or brain nerve cells.

When a migraine is triggered, those neurons suddenly fire electrical pulses that ripple from the back of the brain, across the top, then back down to the brainstem where important pain centers are located. This “wave” causes the blood flow to increase then quickly drop off again. The resulting pain comes from either the brainstem activation or from the blood vessels that are inflamed by the rapidly changing blood flow, or both.

Scientists used a powerful magnet to stimulate neurons and found evidence that some people’s brains are predisposed to “hyperexcitability.” People who were prone to migraines began to experience symptoms under the stimulation, while people who don’t get migraines were not affected.

Scientists also found that frequent attacks seem to physically change the brain’s pain centers, and could lead to constant migraines.

Some migraine triggers include: bright lights, certain foods, hormone fluctuations, low blood sugar, stress, exercise and changes in weather.

Migraines are far more than the pain. A migraine consists of four parts: the prodrome, the aura, the headache and the postdrome.

The prodrome starts hours or days before the migraine episode. The symptoms include food cravings, constipation or diarrhea, mood changes such as depression or irritability, muscle stiffness in the neck, fatigue and an increase in the frequency of urination.

Only 20% of migraineurs experience the aura that follows the prodrome period. It usually lasts less than an hour and the symptoms include: visual, auditory or olfactory hallucinations, vertigo, confusion, partial paralysis, difficulty finding words or speaking, hypersensitivity to light, hearing, sensation, touch, or tingling or numbness of the face or extremities.

While scientists continue to use their findings to hunt for better treatment: two types of medicines are currently available. Abortive medicines like the triptans that treat the pain and daily prophylactic medicines such as beta-blockers, antidepressants, calcium channel blockers or anticonvulsants. The prophylactics help modulate the excitability of the cells in the affected area to reduce the frequency and severity of the migraines.

The neurologist had me try a number of daily prophylactic medications. I continued to average the same number of migraines a month on all of them. However, Topamax 200 MG a day, a seizure medication, helped decrease the intensity of the migraines and improved my responsiveness to the triptans for awhile.

The Topamax has side effects. They interfere with short-term memory, concentration and ability to spell and write. I had many such “Topamax Moments”! Other adverse effects are confusion, depression, mood problems, anxiety and weight loss. I had most of them. I lost 12 pounds and liked that but didn’t like the depression.

After a couple of years I discontinued the Topamax and found no change in the number and intensity of my migraines.

I no longer take prophylactic medications.

For the first six years I averaged about five migraines a month. Then they climbed to an average of nine, thirteen, sixteen and then 20 a month.

The neurologist thought my taking Hormone Replacement Therapy HRT for two months increased the migraines. They shot to eighteen then dropped to sixteen when I discontinued the hormones. The neurologist said most patients have a similar history.

He also thought my increase in migraine frequency was due to a rising tolerance to the triptans. He said increased triptan pill use either reduces their effectiveness or backfires and causes rebound migraines. He said if my migraines continue to rise I’ll have to stop taking the triptans for a month. It’s called a “triptan holiday.”

I’m grateful that I’m migraine free for days and even a week at a time and that I’m only depressed when I’m in pain. Although I sometimes have daily migraines the triptans usually do give me relief from 12 to 24 hours.

Although there is no cure for migraines a genetic marker for Migraine Disease has been discovered. This is the first step toward better treatment and perhaps a cure.

I’m thankful that migraines are not life threatening and remain hopeful.

A 2009 Rebound : Medication Overuse Headache Update 

In early 2008 I was having 20 migraines and using 20 triptan pills a month. The triptan pill limit is no more than 12 a month.

My new neurologist was horrified. She told me to immediately stop taking the migraine medication for 30-days.

I tearfully told her about my 2005 15-day triptan pill holiday where I spent much of the time sleepless, throwing up and in agony for hours. I did confess that it had resulted in four less migraines and six less triptan pills a month for five months.

I agreed to do another triptan pill holiday because I knew she was right, and unlike my previous neurologist, she prescribed a narcotic to deal with the pain.

Although the first week was difficult I was stunned when I only had three migraines and took three narcotics the first month.

 It's been 18 months since I did my 37-day triptan holiday. I now average eight migraines and eight triptans a month as opposed to 20. The migraines respond more rapidly to the triptans and their intensity has decreased. 

 I’m grateful for my neurologist’s help. To read the complete story go to “Eckhart Tolle and Migraine Management.”

Eckhart Tolle and Migraine Management
http://www.authorsden.com/visit/viewshortstory.asp?id=34133