Migraine Chronicles
Stacey has migraines. She has had them for years. We've been going to Dr's and ER since 1990. I am writing this down as a way to remember and record our efforts in struggling to combat these chronically debilitating episodes. We've been to see three specialist during that time.
- A specialist at UC Irvine Medical Center when we lived in California (I can't recall his name)
- Dr. Sheena Aurora. I wrote about our visit with her in March of 2008.
- Dr. Rodney Johnson
Here is an update since my last blog, picking up with what happened subsequently in the past 2 years and what we found out today talking to Dr. Johnson.
Dr. Aurora immediately put Stac on a preventative medicine topomax. The plan was that the next time she had a migraine was to go into Aurora's office and get an administration of DHE and test how that did handling the migraine. With the hope that if that worked she'd be able to self-administer the DHE at home instead of having to go to the ER. The "problem" was that after this initial visit, Stac didn't have a reoccurring migraine for 6 months. Then in October of 2008 when she did have a migraine Dr. Aurora was in India and when I called her office the attending physician said the notes indicated that we were supposed to have been back to see her in 4-6 weeks, which apparently we never did and so they couldn't give her DHE until she was "seen again". Luckily we didn't end up going to the ER as that one subsided. Later that year, I can't remember the exact time Stac ended up getting another bad migraine, we went into see Dr. Aurora and they put her on an anti-nausea medicine reglan first (a side effect of migraines is that the pain is so bad it induced nausea) with the plan to try DHE out afterwards. Stac had a very bad reaction to the reglan. It made her very very jittery, almost to the point of paranoia. She called me from the room where they administered the IV of reglan she and wanted to leave immediately and get fresh air. So we never got a chance to even try the DHE. After that things went along quietly for another year until November of 2009.
A week before this past Thanksgiving (2009) Stac got a super bad migraine. It came on fast and strong. We ended up going to the ER late at night. The ER's response to migraines is in general pretty horrible. I think they are jaded by seeing something that is "invisible", you can't prove you have a headache and its probably an excuse used by addicts looking to get narcotics. Their approach is similar to the US military invading a new country : pull out the major artillery and bomb the countryside to hell. Medically this involves them giving the patient a huge dose of narcotic which knocks the patient out (for several days). This basically destroys all feeling of the headache and lets someone sleep and by the time they wake up and the pain medication wears off the headache is gone. But when the patient is in that much pain the ER is a last resort and by then you don't really care what they give you as long as it goes away. That night Stac went home and threw up many times before we ended up back in the ER because the first shot of dilaudid had not been strong enough. After that second visit, I lay in bed all night listening to Stac throw up over and over. She was almost comatose, sleeping on the bathroom floor for a while and feeling the numbing effects of the drug in her system for several days.
Immediately after this migraine we attempted to get Stac an appointment to see another specialist. Dr. Aurora was booked and the fact that she was in Seattle made it that much more difficult so we decided to search for a new doctor. Stac had an appointment to see a specialist in December, but in the hecticness of Megan's wedding we missed it. Headaches have continued for the past months. Stac finally got an appointment with Dr. Rodney Johnson who has offices in Bellevue and Issaquah.
Things didn't start off very well at Dr. Johnson's office. We arrived for the appointment at 3pm and we didn't get into see him until 3:55. He was in with an elderly couple before us and he apologized that with them it was more of a social visit vs. consultation. He listened to Stac's description of her experiences. In summary he said :
There are two different kinds of headaches, based on her description she has migraine-like headaches. The approaches to treat them were :
- Migraine Treatement : for when the patient feels a migraine coming on or has a migraine. There are two basic approaches here : using Ergot's like DHE or Migranal or Triptan's. Dr. Johnson prefers Triptan's and prescribed Relpax. He also noted that Imitrex was the first Triptan developed and is often prescribed but is most effective as an injection though the initial immediate side effects of Imitrex injections can be quite intense. We'll try Relpax first and go from there.
- Preventative medicines which try to prevent the onset of migraine conditions. He prescribed Depakote. Stac has been on Topomax before which is also preventative.
- Acute Pain Treatment : This is for when you have residual headache after the migraine or a headache that might lead to a migraine. For this he prescribed Phrenilin, which doesn't have caffeine in it.