The Migraine Brain

by Bernstein, Carolyn; McArdle, Elaine

  —Nancy, 37, store manager

  * * *

  In my practice, I have seen a number of patients who come in with migraines who confide in me that they are the victims of domestic violence. We also know that many victims of domestic violence suffer from PTSD and other mental health issues. It’s possible that more research will find a link between domestic violence and migraine.

  If you are a victim of domestic violence, please seek help. You deserve to be safe in your home and your life, as do your children. There are many supportive organizations that will help you. After you get out of an abusive relationship, you will be better able to improve your Migraine Brain’s health.

  If you’re in an unhappy relationship, please consider getting professional help. It may be that the relationship can be saved, if you both want to work toward health together. But don’t compromise your health—and your happiness.

  Addictions

  I have a patient who has had severe migraines since she was a little girl. At the age of six, she began stealing her parents’ liquor when they weren’t around, in an effort to imitate the adults around her. She found that alcohol helped dull the pain of her migraines, and by her teen years she was a heavy drinker. But she was equally driven to succeed, and she was accepted at an Ivy League college, where her migraines got worse, as did her drinking. She drank up to a case of beer a night, and often vodka, too. Somehow she made it through college and then graduate school, and landed a job at a top-notch financial firm in a major city. It wasn’t until age thirty-four, when she woke up in an emergency room, that she realized she was an alcoholic. She joined Alcoholics Anonymous and stopped drinking. Her AA sponsor told her the headaches she was experiencing were part of the detox process, and it was not until she was a year into sobriety that she realized her headaches were much worse than those of other alcoholics who were getting sober. Today, she’s still in recovery and is sober, and she is working on reducing her migraines through relaxation and exercise, since triptans, unfortunately, don’t work for her.

  Many migraineurs avoid alcohol because it makes them feel worse. But others can drink without antagonizing their Migraine Brain. That’s fine. But if you want to stop drinking and find you just can’t do it, you need help. Contact Alcoholics Anonymous (you can find a local group online or through directory assistance), or talk to your doctor. I commend you for seeking help.

  Painkillers are probably a much bigger problem. It isn’t uncommon for migraineurs to become addicted as they attempt to beat back their pain. And until triptans came on the market, a powerful migraine medicine (a combination of caffeine, a barbiturate, and an analgesic) was the drug of choice prescribed by many doctors. This combination is still in widespread use but I have real concerns about it. Many of my patients have a hard time giving it up, even when offered a migraine-specific medication that in almost all cases works much better.

  I have one patient who was taking thirty of these tablets a month. Another patient, who in her early fifties began getting migraines every day, was taken off a triptan by her neurologist, who instead prescribed this migraine drug and told her to take it every day, as much as she needed. “He thought it would break the headache cycle,” she told me. She was coming home from work every day and going to bed right away, getting fierce rebound headaches, and sleeping all weekend. She wanted to stop but the doctor’s secretary—he was consistently unavailable to take her calls—told her to keep taking the maximum amount. When she finally got through to the neurologist, he told her to stop the medicine cold turkey. She did—and got so sick she was admitted to the hospital for four days.

  She should not have been taking that drug at all, in my opinion, and certainly not six a day. And quitting any drug cold turkey—let alone one that includes a powerful barbiturate—is bad medical advice. It’s no wonder she ended up in the hospital. When she became my patient, I put her on a daily preventive medicine and gave her a triptan as an abortive med. From daily headaches, she’s down to one a week, at most, and she’s gone weeks at a time with no migraines at all.

  Her story highlights my concern about painkillers and this popular migraine drug. They usually aren’t the best treatment and have serious downsides. When I meet new patients who are having trouble getting off these drugs, we contract together for them to take fewer each month until they are weaned off. It may take two to four months, but I’m happy to work with them and help them stay as pain-free as possible with other treatments.

  If your doctor asks you to sign a pain contract—which specifies who will prescribe your medicines, how much you’ll receive each month, and what the limits are—please do not be offended. This request means your doctor is caring for your health and practicing medicine in an ethical and professional manner. She’s not accusing you of anything improper but trying to make sure both of you are doing the right thing when it comes to these potentially dangerous medicines.

  Please consider your use of painkillers. If you are using more than the prescribed dosage, you may have a problem. Talk with your headache specialist about weaning yourself off. It may be helpful to see an addiction specialist. Narcotics Anonymous can also be a very important recovery tool.

  Do not go cold turkey off any drug or you could end up with a serious migraine or other health issues.

  Psychotherapy

  Our staff at the Women’s Headache Center includes a psychiatrist, whom patients find a useful resource in migraine treatment.

  You may be depressed or having relationship problems because you have migraines, which are affecting your quality of life and your family’s, too. A therapist can help you devise practical strategies for reducing how much your illness affects you; for example, strategies for child care when you are sick. A therapist can also help you consider new ways of thinking about your illness, such as learning not to see yourself as victimized by migraine, or getting over any resentment you feel. It may also be therapeutic to talk out your feelings about your family’s reaction to your migraine and work through any sadness or guilt you have as a result of your migraines’ effect on them.

  * * *

  Migraine Support Groups

  Women with migraine often feel isolated, angry, and fearful. If you have migraines, talking with other migraineurs can be enormously valuable. We run a support group at the Women’s Headache Center, where women discuss their migraines, how their lives are affected, how they cope, and other issues. By sharing their experiences, group members tell us they feel less isolated, less guilty, and less victimized. They also learn from each other specific strategies for living with migraine. It can be an excellent way for finding people willing to trade baby-sitting during respective migraine attacks.

  You may be able to locate a headache support group in your area.

  Ask your headache specialist, or contact the closest hospital or medical center with a headache department.

  Search on Craigslist (www.craigslist.org) in your area.

  The National Headache Foundation has a state-by-state list of support groups at www.headaches.org/consumer/supportgroups.html

  * * *

  A therapist can also help determine whether you have depression or another mental illness as a primary problem, since these can and should be treated themselves, over and apart from their connection to migraine. Options include medication and talk therapy. Treating your headaches without also treating any psychiatric disorders will leave you far from the state of wellness you want.

  If you can’t locate a nearby support group, you may want to start one. Advertise in a hospital newsletter, ask your doctor to refer other patients, or announce it on your local Craigslist. Monthly meetings seem to work best, we’ve found. That’s not too often to impinge on people’s busy schedules but enough to find continued support.

  CHAPTER 14

  Migraines, Work, and Travel

  “In lawyer culture, part of your value comes from billable hours, and I had the top billable hours all the time. I always overshot it by 5, 10, 20
percent. I had a month where I billed 450 hours. I didn’t care how horrible I felt. If I had to throw up, I’d go into the bathroom and throw up and go back into my office. Because if you asked me who I was, I was a lawyer, and that was everything to me.”

  —Lisa, 39, who got daily migraines for years

  “When I was going through this tough time at work, every frigging weekend on Saturday I’d finally take a breath, and all of a sudden my eye would start going—and here comes the migraine. So I’d be stressed all week, then lie in bed all weekend with a migraine.”

  —Kent, 38, probation officer

  Work

  Work can be very stressful, and stress, as you know, is one of the most powerful and common migraine triggers. Even a job you love usually brings some measure of stress. Juggling work with your other responsibilities—children, aging parents, housework—only adds to the pressure. In short, for those of us with Migraine Brains, work equals migraine. Not always, but often enough that it is a serious problem for employers and employees alike.

  In 2002, Pfizer Inc., which manufactures eletriptan, a triptan drug, commissioned the first large-scale study of the impact of migraines in the workplace. The poll, conducted by HarrisInteractive, questioned 3,000 men and women who get migraines, and found:

  Nine out of ten had suffered a migraine attack at work.

  66 percent chose to tough it out at work instead of going home.

  91 percent said their work was somewhat to greatly affected by migraine.

  82 percent said their ability to solve problems and interact with others at work was negatively affected by migraine.

  Although they most often chose to stay at work through a migraine, they still lost an average of four days a year to migraine sickness.

  The 20 percent in the poll with severe migraines lost eight days of work in the three months preceding the study alone.

  Men are less comfortable discussing their migraines at work than women. Women were more likely to tell co-workers and bosses about their migraines and to admit that migraine was the reason they called in sick. Only 17 percent of women had not told co-workers that they suffered from migraines, compared to 29 percent of men.

  These results mirror earlier studies that found that the majority of migraineurs lose some time at work due to their illness and their productivity is significantly reduced if they remain at work during an attack. The recent study of Iraq war soldiers found that their migraines interfered with their military duties because many of them reported to sick call.

  It’s not surprising to hear that 90 percent of migraineurs report getting migraines at work, but it’s interesting that two-thirds of us have tried to tough it out instead of going home even when we feel really terrible. It seems we don’t want to let down our co-workers, leave projects undone, or maybe we fear retaliation or punishment if we miss too much work.

  * * *

  Millions of Americans have either gotten a migraine while at work or gone to work with a migraine. Two-thirds of them chose to “soldier on” rather than go home.

  * * *

  Since most of us don’t have the luxury of leaving work when we need to, are we doomed to be sick? No. You can do plenty to stay healthy in the workplace, reduce the number of migraines you get, and avoid getting really sick when a migraine appears.

  Does Your Job Trigger Your Migraine?

  Work itself may not be the trigger for your migraine. The attack may be ignited by other factors in your environment, and just happen to arrive when you’re at work. To minimize migraines at work, you have to take the same assertive approach you bring to other parts of your life: Prevent—identify all the potential triggers; Abort—get rid of the ones you can; and Rescue—be ready to respond when a migraine arises.

  Stress at Work

  Unless you are really unusual, your job most likely will include difficult tasks, conflicts with co-workers, tough deadlines, and other challenges that can stress you out. But there are many things you can do to minimize stress at work and to manage your response to it, and that’s one way to reduce migraines at your job. You also have to take a critical look at your specific employment to see whether there’s something there making you sick more often than you have to be. If so, what can you do to change the environment? If you can’t, here’s a radical thought: maybe this particular job isn’t worth it. If your job is making you ill—and if you have other options—perhaps you should consider a change.

  A sixty-year-old partner in a high-pressure law firm came to see me because he was getting severe migraines two to three times a week. “Give me whatever medicine you’ve got,” he insisted. “I want these to go away.” The man was thirty pounds overweight, and his skin was gray. He looked harried and unhappy. I asked him to tell me about his life. Work was his entire world, he said. He was at the office seventy to eighty hours a week, hunched over paperwork at a desk with almost no breaks. Each morning, he commuted an hour through rush-hour traffic to get to his desk before 8 a.m. He gobbled an unhealthy lunch while hovering over paperwork, then got home after 10 each night and grabbed a late dinner while knocking back a couple of tumblers of Scotch to sedate himself enough to fall asleep. Then he tossed and turned all night before getting up at 5:30 a.m. to start all over.

  * * *

  Migraines: Good for Golf—or Not?

  Professional golfer Se Ri Pak, who has won numerous championships including five major LPGA championships, most recently in 2006, gets migraines that can interfere with her play. But one of her pro golf opponents, Kathryn Marshall, actually credits migraines with helping her play better. In 1998, after shooting an impressive 68 and sharing the lead on the first day of the LPGA du Maurier Classic, Marshall said, “When you’re not well, you concentrate on each shot more. You just want to get off the course.”

  * * *

  Exercise? “I don’t have time,” he told me, waving his hand dismissively. Any relaxing time to himself? He just snorted. Any loving moments or fun times with his wife and family? “I can’t,” he said. “I don’t have time. Just give me some medicine to make these headaches go away.”

  “There is no magic pill,” I answered. And then I gave him the same news I’d give anyone in his situation. “You are going to have to change the way you live your life—if you want to feel better.”

  One option would be to quit the job and find more reasonable employment, I suggested. A seventy-hour work week is unhealthy for anybody. But he didn’t want to. He said he enjoyed much of his work and liked his clients. So we developed a different approach.

  Three months later, he came back to see me. He was a different person.

  “I feel great!” he said. “My migraines are down to just three or four a month!”

  As part of the treatment plan we developed, he’d installed a workout room in his basement at home, and he was walking on the treadmill for half an hour, four mornings a week, before work. Between this new devotion to exercise and a radical change in his diet—he was eating more grilled chicken, vegetables, and salads—he’d lost fifteen pounds. He’d committed to leaving work every night at 6 p.m., no matter what, and was able to have dinner with his wife, although he did bring work home. He also stopped going in to work on the weekends. If he really needed to get something done, he worked in his home office.

  The exercise was helping with sleep, too, he said, and he’d also stopped drinking so much alcohol and found he wasn’t waking up in the middle of the night. He was happier and more productive at work. To his complete surprise, his law firm had not complained that he wasn’t working eighty hours a week anymore, perhaps because the quality of his work was better.

  This patient took control of his life to reduce his migraines. He chose to cut back on how much he worked. After all, working fourteen hours a day is not healthy for anyone.

  Let’s say his law partners hadn’t been supportive of his reduced work week. Then I, as his doctor, would have asked him seriously to consider whether the job was worth feeling so sick
all the time. This man’s health had more risks than frequent migraines: Stress, lack of exercise, and poor diet can lead to increased risk of heart attack. I’m not advocating that you quit your job without careful consideration. But if you’re in an extreme situation where your health clearly is in jeopardy, you owe it to yourself and your family to consider whether your priorities are in place. If there’s other work you can do that won’t make you sick, please think about making a change. That’s not only reasonable but smart, if you want to live and live healthy. These days, plenty of people make significant career changes for a variety of reasons, including personal satisfaction. If office work gives you migraines—the fluorescent lights, the air conditioning, sitting at a desk all day—consider whether another field would suit you more. If your health is better when you work outdoors, it’s reasonable to rethink your job and find a different one.

  Maybe you don’t have many options career-wise. Maybe the best job you can find is one rife with migraine triggers. Or maybe the job that you love has lots of triggers. If you love being a firefighter, there will be plenty of nights when you don’t get enough sleep, when the clanging alarms, emergency lights, and adrenaline of an emergency situation set you up for a migraine attack. If you want to be a doctor, you’re going to have to put up with thirty-hour hospital shifts with no sleep when you’re in your residency. There’s no way around it. There are days, even now, when I have to lie down on the floor of my office in between appointments with patients to try and grab a little rest in hopes of staving off a terrible migraine.