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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Dr. Susan Hutchinson is a headache specialist and a migraine sufferer. She knows first-hand the disabling and unpredictable nature of migraine attacks. The driving passion in her life is to alleviate the suffering of migraine in patients’ lives and to help give them their life back. Her background includes practicing family medicine for 21 years with a special interest in women, hormones, and migraines. In 2006, she became certified in headache medicine and in 2007 founded Orange County Migraine & Headache Center in Irvine, California. She is also author of The Woman’s Guide to Managing Migraine: Understanding the Hormone Connection to Find Hope and Wellness.