What’s your worst Migraine trigger? Can you avoid it? How do you handle it?
My worst migraine trigger cannot be avoided being as I’m a woman. It is that dreaded hormonal migraine trigger every month with the fluctuations in hormones prior to our menstrual cycle. The migraines I get are brutal, acute and last for three days minimum but can persist for a week or more depending on other triggers. They also make me incredibly sick, especially the longer they persist. The migraine is also constant… no relief or change. Once it starts it stays acute until the end. In the very early stage a triptan may diminish the pain a little for part of the day, but not kill the migraine.
Handling it had been hard since these are by far the most crippling of migraines. I miss more work with these migraines than any other, but I can’t miss work all the time so work is an aggravating factor that can make these migraines last even longer. Actually it is very much like torture working eight hours with an acute migraine that is not responding to treatment under fluorescent lights while trying to focus on a computer screen. I just try to survive it. I try to get as much sleep as possible and avoid as much light as possible. Eating is difficult because I get quite ill, but I try to at least eat soup and simple things that are easy to digest. And I try to keep myself hydrated with water. When the migraine begins I try to aggressively treat with medication to ensure I get a good nights sleep as this can sometimes help ensure it lasts only three days and not longer, but fact is triptans are not very effective on this sort of migraine for me and when it fails it cannot be taken over and over. I just have to be extremely careful to avoid all other possible triggers and not to overuse medication. If the migraine does get out of control and persists beyond three days there is little I can do about it but wait it out. Occasionally I try going to the ER but that rarely does anything as they offer only one treatment and it is not an effective one, so I don’t bother with the extra pain and hassle unless the migraine is so out of control the pain has brought me to the point where I can no longer sleep. So I handle it like I handle it every other month I guess. I just get through it as best I can. Hope it is a moderately good month. Hope I can get through without missing work. I just suffer a great deal more simply because they are longer lasting, acute and don’t respond to treatment. More suffering means more stress which makes this time just harder to cope with overall. Often I tend to live minute by minute and sort of lose track of time, in that pain haze… just survival mode. It is a profound relief when it breaks and I am back to my ‘normal’ daily migraines, because while they are daily they are not all day, constant and they are not always acute and not always untreatable. That means some days are good pain days, but hormonal migraines are always very bad pain days. A different set of symptoms as well, as the nausea and irritable bowel complaints are significantly worse during the hormonal migraines making dehydration a constant risk.
Now, sleep deprivation is a close second because I have fibromyalgia and some serious problems with insomnia and getting deep restorative sleep. In fact when I’m in a bad migraine streak I have problems sleeping and then when I get to sleep it is as restless as usual but I can tell when I’m getting sleep deprived when I start getting reoccurring episodes of sleep paralysis… which is rather not pleasant. Then I get even less sleep. When I’m sleep deprived I’m more likely to wake up in the middle of the night with a full blown migraine or have a full blown morning migraine. They are a problem because they are difficult to treat, being as they are usually past the point for a triptan to be effective and for some reason in the morning the migraine associated vertigo and other perception issues is really messed up. More morning migraines means more missed work which means more work stress. I was put on sleeping pills precisely because of this. I was in a constant state of sleep deprivation with frequent midnight to morning migraines. Now they are far less frequent, but when I get a status migraine it severely inhibits my ability to sleep which then makes the migraine persist.