How A Doctor Finally Learned To Manage Her Migraines
My personal journey with migraines dates back to the early '90s. I was working 12- to 18-hour days in my medical practice as a family medicine doctor. A throbbing headache with nausea would often strike late morning as I was seeing patients. My instinct told me these were tension headaches from the pressure of running my own practice and seeing as many as 30 patients a day. My self-prescribed treatment was to take half of a butalbital/aspirin/caffeine tablet (often referred to as Fiorinal) and a short nap in my office over my lunch hour. I would wake up feeling slightly groggy but relieved that the headache was better.
I knew my work-life balance was contributing to my headaches.
During this time I struggled to achieve better balance in my life, but it was elusive. In 1992 I was given the option of selling my practice and becoming part of a large family medicine group with a salary and a reduced work schedule of only four days per week. I took the job and thought my "stress" headaches would go away. Unfortunately, they continued. I had traded the stress of being a business owner for the stress of no longer having control over my schedule. I was booked with patients as often as every 10 minutes and struggled to stay on time while addressing everyone's needs. Among the many health care issues I treated was migraine. In those early years of my practice, I did not enjoy seeing migraine headache patients, as treatment options were limited and often included a barbiturate like the bultalbital combination I was taking or a narcotic like hydrocodone. Treatments in a family practice setting often included a narcotic injection like Demerol and an anti-nausea injection. It was difficult to sort out which migraine patients were seeking narcotics versus legitimately suffering from migraines.
I discovered that my "stress" headaches were actually migraines.
In 1993, Sumatriptan injection for acute migraine treatment came onto the marketplace in the United States. This was a game-changer in the way migraines can be treated. Patients with migraine would come into my office, be given a 6-mg injection of Sumatriptan and would be 100 percent better in 10 minutes on average. Sumatriptan, unlike the injections we had been giving for acute migraine, was a non-narcotic, non-drowsy, and migraine-specific medication. I was thrilled and no longer dreaded seeing patients come in with a severe migraine attack. Sadly however, my own "stress" headaches continued. One day my head was throbbing, and I took an oral triptan. My headache and nausea were gone in about 45 to 60 minutes. I discovered that my headaches were actually migraines, too.
I listened to my body and learned to manage my migraines.
I began tracking my migraines and discovered that common triggers for me were hormonal changes, stress, travel, lack of sleep, poor eating habits, and changes in barometric pressure. Over time, I was able to get them under better control. Here are the six things that finally helped me manage my migraines:
1. Moving my body.
For me there is no better way to reduce stress than to swim, bike, run, or play golf. Most mornings I exercise before going to work. It is not always easy to get up between 5 and 6 a.m. to get my run or swim in, but I feel so much more relaxed as I head into work and know that I am less likely to develop a migraine that day when I can move my body in the morning.
2. Changing my diet.
Instead of stopping at a fast food place to get a breakfast biscuit, I typically have a protein shake or yogurt with fruit to start my day. Lunch always includes protein and a generous amount of water. I like caffeine but try to limit myself to two cups of coffee per day, and I completely cut out diet soda.
3. Sleeping at least seven hours a night.
For me, this means trying to get in bed between 9 and 10 p.m. and getting seven to eight hours of sleep. I am much less likely to get a migraine the next day if I've had a good night’s sleep—the increased energy and alertness are just an added bonus!
4. Getting real about my stress levels.
Over the years I have slowly learned to say "no" to fitting in extra patients if I'm booked in my practice. I see fewer patients than I used to as I choose to now spend 30 minutes with patients coming in for follow-up appointments as opposed to 15 minutes. I brought on a younger associate to help with my workload and now take Wednesday afternoons off to play golf while she covers the practice. I have far fewer migraines as my workload has become more manageable.
5. Identifying triggers.
These include surprising factors like barometric weather change. Once I started identifying triggers, I learned that drops in barometric pressure could be a trigger for my migraines. I learned about a product called MigraineX and began using it to minimize a migraine attack during weather changes that are causing significant changes in the barometric pressure. I have the MigraineX app on my phone, and it alerts me so I can be proactive by inserting the ear-pressure-regulating device in my ears and having my migraine medication with me—just in case.
6. Treating my migraines early, with migraine-specific medication.
For me this means triptan, which I take orally at the first sign of a migraine. It is non-drowsy and gives me relief of all migraine symptoms including nausea, sensitivity to light, and headache pain. I have learned to always have my triptan medication with me in my purse so I can take it as early as possible. Typically, I am migraine-free in one hour after early treatment and can resume normal activity planned for the day.
Over the years I've learned that while migraine is a condition that may not be curable, it can be manageable with a combination of lifestyle and dietary changes and medication use when it's necessary. My passion is to give my migraine patients their lives back—just as I now have mine.
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