Tuesday was my sixth day in a row with a migraine. It wasn’t just the typical migraine pain or the nausea that I found particularly distressing, but the fuzzy feeling of my face and arms. While this is a particularly miserable byproduct of my aura and is also related to my occipital neuralgia, it really unnerves me. Despite trying a variety of home care and pharmaceutical interventions at my disposal, I finally had enough. I tried triptans until they were maxed out, myofascial release, massage, essential oils, heat, ice, meditation, and lidocaine patches. Every day, I tried to convince myself that the next day would be better and that I wasn’t in a very dangerous position. If I was thinking clearly, I probably should have stopped at day 3, but migraine and thinking don’t work well together.
When a migraine lasts more than 72 hours, as mine did, this is called “status migrainousus” or “intractable migraine”. It is very dangerous and can result in death (often from stroke) if not treated very aggressively.
“The principles of treatment for status migrainousus include the following:
- fluid and electrolyte replacement
- drug detoxification if medication overuse is present
- IV pharmacotherapy to abort the Migraine
- treatment of associated symptoms of nausea and vomiting
- concurrent implementation of Migraine prophylaxis (if indicated). . .
- After acute treatment is completed, many patients with status migrainousus require continuing care. . .”
Stephen D. Silberstein, M.D., Richard B. Lipton, M.D., Donald J. Dalessio, M.D., “Wolff’s Headache and Other Head Pain.” (New York, Oxford University Press, 2001) p. 207-211.
At 120 hours into my migraine, with barely a break, I called my neurologist. At this point, I was begging for instruction or relief and I was told that we would talk more at my appointment next month. That was it. I was crying. I should have gone to the emergency room at this point, but I didn’t. Instead, I called my primary care who told me to go to the emergency room. I refused because, well, I actually have no good reason here. Instead, I scheduled an appointment for an injection of Toradol and sought some home care tips from some of my favorite people in the world, the Ladies of Rare. I am sure that they were ready to get on a plane and drag me to the hospital, but instead of chastising me, they provided some great emotional support and helpful suggestions to get me through the night. I cannot even tell you how wonderful it is to have great friends, especially ones that have a background in nursing and medical research.
Tuesday morning, I was sitting in the dark at my doctor’s office. Although my doctor was still in favor of a hospital admission to get more aggressive treatment than she could offer, we went ahead with a Toradol injection. I would like to stop here and mention that it was extraordinarily painful. Despite some lamaze-style breathing, I nearly passed out. I cried and then apologized to everyone for crying. I wanted my mum, so it was good that she was there in the waiting room.
The injection itself offered me about 3 hours of relief, which was enough time to implement the home-care plan: Methylprednisolone pack, Promethazine, and 1000 mg of Acetaminophen 3 times a day. By the early evening, I started having the sensation of an intense fever. I was in pain again. I knew that migraine plan was failing. Ladies of Rare to the rescue again, with a plan to get me through the night. Sleep and hydration were major priorities. I followed everything and fell asleep assuming I would need to head to the hospital in the morning.
This morning, I am very tired, but I have significantly less pain. I am still having trouble with my occipital nerves. This is problematic because the occipital neuralgia acts as a trigger for my worst migraines. I will see my physical therapist this morning. Hopefully, with some neck work, that will further calm things down. Today’s most important task, however, is to find a new neurologist.