Cowboy, baby!

The first time a doctor referred to me as a migraineur (a person who experiences migraines), I pictured how to spell the word phonetically in my mind and came up with my-gran-ear.  I used word association to help me remember the proper pronunciation.  Migraineur ends similarly to the way the word pioneer ends.  That's the moment my mind jumped the track.  The word pioneer made me think of old west cowboys, and the word cowboy made me think of the Kid Rock song, Cowboy.  (Side note: I think Kid Rock is skeevy, but I do like some of his music.)  The song Cowboy is pretty trashy, but it has a great sound.  He sings about moving out to California, drinking, drugging, pimping, and whatnot.  Not a family friendly song (sorry Mom).  I don't know all the lyrics, I just sing along to the "cowboy, baby" chorus part.  Whenever I think of the word migraineur now, I have an instantaneous response to think about that song, (I wanna be a cowboy, baby!), and it is stuck in my head the rest of the day.  It kind of makes me feel like a bad ass for awhile.

Cowboy?

I wish being a migraineur made me feel like a bad ass, like the Cowboy song.  In reality it just really sucks ass.  Since I am blogging about migraines I feel that I must address what a migraine is and give you an idea of what a chronic migraineur deals with. To me this is about as much fun as reading the fine print on a sweepstakes entry.  As a general rule, I avoid talking about migraine specifics because it's depressing and I'm tired of discussing it, especially with doctors. Because of this aversion I am not going to go into tremendous amount of detail.

Migraine headaches are a neurological disease, not just a headache.  They are more common in women than men, and they can be triggered by a number of factors (stress, hormones, bright lights, flashing lights, diet, air pressure changes, strong scents, and muscle tension just to name a few).

A migraine occurs in phases, the first of which is called the prodrome phase that is associated with symptoms like hyperactivity, neck stiffness, food cravings, dizziness, ringing in the ears, excessive yawning, and irritability.  Some people will also experience an aura.  Aura symptoms include visual abnormalities like seeing wavy lines, experiencing vision loss, speech difficulties, and a tingling sensation in the extremities.

How I feel prodrome phase.

Following the prodrome is the migraine attack that can last a few hours to a few days.  It is a terrible, intense, throbbing pain generally experienced on one side of the head.  It can be accompanied by lightheadedness, nausea, vomiting, and sensitivity to light, scents, and sounds.  Migraines can be so severe that all you can do is lie down in a quiet, dark place and wait for a reprieve from the pain.

How I feel during a migraine attack.

Finally, there is the postdrome phase when the migraine attack has ended, but the migraineur is left feeling physically exhausted.  I also call this the hangover phase because after effects of a migraine attack feel eerily similar to the way I feel the morning after I consumed too many cocktails.

How I feel postdrome (aka hangover) phase.

One other term you'll often hear me use is chronic migraine, which is my diagnosis.  Chronic migraine sufferers experience migraines 15 days or more each month.   

I have read different theories about what goes on in a person's body when they experience a migraine.  The theory I've come across most often, as I understand it, is that migraineurs have excitable neurons bouncing around in their brains.  When a migraine trigger is encountered the neurons fire and eventually cause dilation/swelling of the blood vessels in the coverings of the brain.  The impulses transmitted by the nerves of the dilated blood vessels are sent to the brain and experienced as pain.  I'm not a doctor and I don't know what is going on inside my head when I have a migraine, but what I do know is that it is incredibly unpleasant.

So there you go, a brief introduction to migraines.  If you would like to learn more just do a web search and you'll be inundated with web sites dedicated to migraine.

Uncle Leo's Eyebrows

I looked at my husband the other day with my irritated/angry face.  I squinted my eyes, furrowed my brow, tilted my head, and gave him some stink eye.  Something didn't feel right.  I ran into the bathroom, looked in the mirror, and was startled by my reflection.  I couldn't scrunch my face or furrow my brow.  Botox had frozen my forehead!  I returned to the living room, stuck my face in front of my husband's face,  and attempted to make my angry face again.  I said, "I'm seriously pissed right now, just look at my angry face."  He laughed.  I shrieked, "It isn't funny!  I can't make expressions!"  He laughed harder.  To which I reiterated, "IT'S NOT FUNNY!"  The laughter continued.  "Argh!  I can't look surprised, angry or quizzical right now if I wanted to.  All I can do is squint my eyes and wrinkle my nose.  Oh my God, how am I going to function in my melodramatic fashion if I can't move my eyebrows?"  I stormed out of the room before I had to listen to him laugh at my expense anymore.  I retreated the bedroom where I sulked and tried to remember why I was irked at my hubby in the first place.

Have you seen that episode of Seinfeld where Jerry's Uncle Leo's eyebrows get burned off and Elaine draws new ones on with a Sharpie?

Uncle Leo sporting Sharpie eyebrows.

I'm thinking maybe I should try that.  I could shave off my eyebrows and use an eyebrow pencil to draw on appropriate expressions.  I'd use a Sharpie, but that is too permanent since I change my expressions many times each day.  I wonder if dry-erase markers would work?

Botox may have made me expressionless, but I can report that in the two week period since I had the Botox treatment I have only had one bad migraine headache.  I'll take the frozen forehead in return for fewer migraines any day of the week.  Things are looking up.

Food Poisoning

I worked at a pizza place for four years while I attended college.  The state health department required food service employees to be certified to safely prepare food by taking their food handler safety course every few years.  The first time I attended the course the instructor played an audio recording of a woman recounting her experience with foodborne botulism illness.

After the health department investigated her case they discovered the culprit to be a foil-wrapped baked potato.  The woman and her husband had gone to at a restaurant where she ordered a baked potato with her meal.  It was later determined that the potato had been prepared the night before, but had not been served.  It had sat out waiting to be served for far too long after being cooked.  The restaurant staff didn't have the opportunity to serve the potato, so they placed it in the refrigerator at the end of the night.  The next evening they reheated it to serve.  I think the instructor told us that the botulism began to grow when the potato was left out at room temperature too long the night before.  Unfortunately, the temperature of the refrigerator wasn't cold enough to kill the botulism overnight.  Then, when the potato was reheated the next evening, it wasn't brought up to a high enough temperature to kill the botulism.

Do not confuse this potato with the culprit potato.

The woman described her hellish ordeal.  The botulism caused major swelling throughout her body and paralysis, including respiratory paralysis.  I don't remember the entire story, but I do recall this woman had to undergo a number of medical procedures without anesthetic because it could have completely shut down her failing body.  She talked about being cut open for these procedures and unable to scream out in pain even though she was trying.  She couldn't speak because her tongue was so swollen it was sticking out of her mouth.  She couldn't see because her eyes were swollen shut.  She could barely breath because of the respiratory paralysis.  Her tale was utterly horrifying.  For quite awhile her doctor didn't think she'd pull through, but she did.  Ever since I heard her story I have associated baked potatoes with botulism.

Fast forward to May 2011 when my pain doctor said we had exhausted all the migraine treatments he knew of, with the exception of onabotulinumtoxinA (Botox) injections.  (WTF?  Even the name, onabotulinumtoxinA, has the word toxin in it for crying out loud.  Who was the brainiac that thought shooting a toxin into your head was a brilliant idea?)  The doctor explained that the FDA has approved the use of Botox in chronic migraine sufferers to dull future migraine headache symptoms.  He proceeded with the preauthorization for treatment with my insurance company.  My insurance denied the request, as well as my appeal.  At the time I thought that maybe it was for the best.  Maybe fate was stepping in and didn't want me to have baked potato food poisoning injected into my head.  Before we could discuss any further treatment, my doctor left his clinic and I gave up the idea of having the procedure.  I tried to suck it up and figured I was out of treatment options since he said Botox was the last treatment he had in mind for me anyway.

In early 2012 I was once again at the end of my rope dealing with these effing migraine headaches.  My massage therapist mentioned that my facial muscles didn't seem to relax during a massage.  She suggested I research getting Botox injections in my forehead to relax those muscles.  I talked myself out of doing it many times because of the expense.  Then, a few months later, a friend of mine told me that she had cosmetic Botox injections in her forehead and a nice side effect was that her tension type headaches had disappeared.  After talking it over with my husband, I decided to give it a try.  We also decided it was time for me to look into going to a new pain clinic.  I made the appointment to get the cosmetic Botox injections in my forehead to help with my furrowed brow, then called my regular doctor to start the referral process to a new pain clinic.

In January 2013 I had cosmetic injections and noticed results within a few days.  I was not scrunching my forehead or furrowing my brow constantly.  Also, I was finally unable to unclench my jaw, which had been in a painful, permanently clenched state for years.  I still had migraines, but the tension release in my facial muscles was sweet relief.

About a month after the cosmetic Botox I visited my new pain doctor for the first time and he felt that migraine Botox treatment would be the next logical treatment option for me.  He went ahead and put a preauthorization request into my insurance company and lo and behold it was approved straight away.  I made an appointment to get the 25 injections in what he called a migraine pattern (spread around my temples, forehead, scalp, and neck).  Within two weeks of the treatment I should see results, and with any luck I won't have any migraines.

I went in for the treatment recently.  I attempted to distract myself from the boredom of sitting in a tiny exam room by reading the tattered, two-month old copy of People magazine and read about speculation that Princess Kate was pregnant.  (I have never been in a doctor's office with a current issue of a magazine...what's up with that?)  I got tired of reading old news so I sat in silence while my overactive imagination was hard at work.  I imagined scientists donned in white lab coats working diligently in a high tech laboratory.  They were piercing improperly prepared/handled, foil-wrapped baked potatoes with syringes and withdrawing botulism from them.  Next, they transferred the substance from the syringes into test tubes, then they put the test tubes into a centrifuge.  (I don't know why the centrifuge portion was necessary...it just seemed science-y.)  After that, the test tubes were labeled as Botox and shipped out for injection into migraine patients such as myself.

The doctor finally came in with a tray holding syringes he went over the possible side effects of the treatment.  Your eyelid could droop, you could have difficulty breathing, you could have flu-like symptoms, yada, yada, yada.  He then asked me if I still wanted to go through with the injections after hearing about the potential side effects.  I threw caution to the wind and told him I'd be remiss if I didn't give it a try, so let's get started.  The procedure was somewhat painful, but at least it didn't take too long.  Having needles shoved into your temple is never cool, unless they are for acupuncture or a really awesome face tattoo.

Awesome face tattoo?

I'll keep you posted on my progress.  I'm keeping my fingers crossed.
 

Nature's Superfood

I love the movie Zombieland.  Woody Harrelson plays a character named Tallahassee who has a fierce craving for Hostess Twinkies during a zombie apocalypse and there are no Twinkies to be found.  There is a scene in the movie where he comes across a broken down Hostess delivery truck and he's totally jazzed at the prospect that it could be filled with Twinkies.  When he opens the door he is greeted with an outpouring of Hostess Sno Balls.  He's pretty pissed, (totally understandable).  He yells, "Sno Balls?  Sno Balls?  Where's the f@*!ing Twinkies?"  His acquaintance, Columbus (played by Jesse Eisenberg), says, "I love Sno Balls."  To which Tallahassee replies, "I hate coconut.  Not the taste; consistency."  I can totally relate, but for me it is not coconut, it's bananas.  The consistency is disgusting and I cannot eat them without gagging.

My Mom has long touted the nutritional benefits of bananas.  They have potassium, vitamins C & B6, lots of fiber, they're a healthy way to satisfy your sweet tooth, and they are fat & cholesterol free.  There are probably other benefits she's told me about, but I just don't care.  The consistency trumps nutrition in this case.

As most migraineurs know all too well there are a number of foods that can trigger migraines, including aged cheese, chocolate, red wine, hot dogs, and bananas to name a few.  I could sit here and be bummed out that chocolate made the list, but instead I'm going to revel in the fact that bananas are on that list too!  Not only did they make the list, but when I tell my Mom she just might stop lecturing me about bananas being one of nature's superfoods.  Hallelujah!

100% Pure

I went to a new pain management doctor several weeks ago. I compare this experience to dating after a divorce.  In no way am I implying anything romantic happened, I simply feel the two experiences parallel one another.

Whilst searching for a new doctor I felt out of practice and resistant to change.  I wasn't excited about finding out if I clicked with a new doctor.  I missed my comfortable routine at my previous clinic.  My old doctor knew my migraine history and I knew what to expect from him.  Alas, my old doctor kicked me to the curb.  (Perhaps I'm being too harsh on him.  He moved out of the area for a different job opportunity.  To keep in line with my post-divorce dating analogy I'm going to go with it.)

My cousin recommended a new pain clinic, so I initiated the process of getting a referral there.  (My aunt and another cousin had set me up on a date with a tall, handsome fellow several years ago, after my divorce, and I ended up marrying the guy.  So far the family had a good track record of giving recommendations.)

After going through the referral rigamarole, I was accepted at the new clinic and the day of my first appointment finally arrived.  As I waited for the nurse to call my name I sat in the lobby with mixed emotions.  I was wondering if the people at this clinic were as nice as the people at my last clinic.   Another part of me was excited and hopeful at the prospect that this might be the start of a successful relationship.  Ideally, the doctor would have some new treatment ideas that my previous doctor and I had not yet considered.

The nurse called me back to start the appointment and off I went.  She immediately made me give her a urine sample.  What the hell?  I guess they wanted to make sure I wasn't a drug-seeking narcotics user.  Jeez, where's the trust these days?  (Maybe it is no different than Googling a date's name to see what dirt you can find out about them?)

When the doctor came in he, understandably, had a lot of questions.  Squeezing 20 years of migraine medical history into an initial consultation is a daunting task.  (Similarly, it's like going on a first date, except date questions are much more fun.  "What's your sign?"  "Do you like to ski?"  "What movies do you like?"  And, when you're on a date you can order up a cocktail and appetizers, and that somehow makes the whole question & answer deal less grueling.)

While the doctor fired off questions I was busy multi-tasking by answering questions and trying to get a read on him so I could decide if we clicked.  After the seemingly never-ending question & answer session the doctor enthusiastically declared, "You're a pure migraineur!"  (I got lost in my own thoughts for a few seconds after he said that.  Pure migraineur, eh?  Pure is usually a positive adjective, but I wasn't feeling that pure followed by the word migraineur was a good thing.  Sure, some things are best in a pure form.  Pure vanilla extract is usually better than imitation vanilla.  100% pure cotton is, in my opinion, better than a cotton/poly blend.  So what was the deal with pure in my situation?  I guess it means I am an authentic, perfect, flawless migraineur.  Yay me.  I'm competitive by nature and strive to give 100% in any endeavor I undertake.  I guess it is appropriate (or ironic)  that I'm considered a pure migraineur.)  The smile on the doctor's face quickly dissipated and he said that being a pure migraineur is probably not considered to be a good thing, but it was uncommon because he didn't see many people with chronic daily migraines without other health issues.

All in all it was a successful doctor appointment.  I felt like he listened to me and we came up with a treatment plan that I am looking forward to starting.  Perhaps I was being a drama queen about this appointment from the very beginning.