Wednesday, April 18, 2007

Migraine Milestones

I was 12 when I had the first migraine and for the next 25 years they were all the "classic" migraines with visual disturbance starting with a small sparkly translucent crystal which grew into a semi-circular flashing zig-zag obscuring about half the visual field for about half an hour. This shrinks back to the side of the field of view and the headache and nausea begin. Occasionally numbness in the left arm and down the left side and an inability to speak accompany the headache. These symptoms generally lasted about half a day, and were relatively easy to cope with compared with today's attacks without aura ("common" migraine) which started when I was about 35.

These "classic" attacks occurred about once a month but not with any regularity that might have been linked to the menstrual cycle. At age 22 they were affecting my work sufficiently for my boss to insist that I visited The Migraine Clinic in Russell Square, London. Phenobarbitone was prescribed for a month and this helped but I was not allowed to stay on it. When I got married and went on the pill, the frequency increased to 1 or 2 a week, but some were "aura only" with very little headache. My husband read something about taking the pill being inadvisable if these symptoms occurred so I stopped taking it, the migraine frequency dropped, and I had my first child at age 25.

Being pregnant increased migraine intensity and frequency dramatically, but they returned to normal after the birth. The same sequence occurred with my second child, and the pregnancy migraine misery was a contributory factor in deciding to get sterilised immediately after the birth (at age 28).

Classic migraine returned to the approximately 1 a month level and continued unremarkably and manageably for the next 10-15 years. During this time I was unaware of migraine triggers and while never drinking red wine, I was fond of cheese, chocolate and citrus fruits.

When my mother died (I was 45) I developed stomach "erosions" and the specialist said these were is some way related to migraines. He put me on Sanomigran and suggested giving up cheese. chocolate and citrus fruits, a regime which worked quite well for about 5 years. Things get a bit hazy here, so I'll record the milestones and fill in the details as I remember them:

  • Sanomigran stopped working and I came off it, but can't remember what came next.
  • I had a spell with no regular medicine but used Migraleve and Maxalt whenever I had an attack.
  • These (especially Maxalt) worked when I could take them right at the start of a headache, but they seemed to delay the onset rather than preventing it. I'd have a day or two clear, and then it would start again, another Maxalt would "cure" it, but it would return yet again. Being allowed only 2 Maxalts per week, I then had to let it come, and after a couple of days of misery, I'd be in the clear for another week or two.
  • The best period was, as I said earlier, the year or two I spent oh the special diet which avoided all known triggers. This caused a not unacceptable weight loss, but was eventually abandoned simply because it was hard to enjoy life with such a restricted diet.
  • The migraines returned as the diet returned to normal, but it was impossible to tell which if any of the foods added back were responsible.
  • The doctor now recommended propranolol which I used for a year or two. I suppose this lessened the frequency but not to a manageable level
  • The doctor referred me to a specialist who prescribed amitriptylene - which was great to start with, but the dosage had to be increased every 6 months to maintain the effect and with each dose increase came weight gain.
  • Coming right up to date, having gone from 10mg to 50 mg of amitriptylene over 2-3 years and found the last increase seemed to have no effect, the doctor recommended coming off it and moving to lisinopril.

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