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Migraine Medication Detox, Week Two: Transition Period

migraine medication detox“This too shall pass.” Those words provide immense comfort when my migraine attacks are severe and disabling. They have carried me through many difficult years. As encouraging as this phrase can be, there’s a flipside to it: the difficult, trying times in life pass, but so do the pleasurable ones we never want to end. “This too shall pass” means that everything passes.

When I had migraine attacks last Sunday and Monday after having a remarkable few days, I was too busy panicking to remind myself that they would pass. My mind churned on my most fear-filled thoughts: What if my new treatment isn’t working? What if it’s making me feel worse? What if I will never again feel as good as I did these last few days?

Although I was 100% sure I was overreacting, that did nothing to assuage my fears. My worry settled a bit on Tuesday after I stopped the oxytocin (which was definitely a migraine trigger for me), but I continued to fret.

I didn’t remember that this too shall pass until Wednesday. That’s when I finally realized that detoxing from medication overuse headache and trying new meds mean I’m in a transition period. That should have been obvious, but I was so caught up in excitement—and then the fear—for the future that I wasn’t paying attention to the present. I’d forgotten that progress is not linear.

“Transition period” became a mantra of sorts in the last week. When I start to panic, I remind myself that I could still be detoxing from my meds (especially since I gave in to Amerge last Monday) and that the effects of my new treatment tends to build over months. Even more turbulence comes from experimenting with new treatments (Compazine, oxytocin, and some new-to-me preventives), changes in my meal frequency, and introducing new foods. I still have a ton of variables to work out. “Transition period” is now shorthand to remind myself that it will take time to sort out all these confounding factors.

It’s kind of an odd mantra, but I like its hopefulness. It tells me that I’m on my way to somewhere new, somewhere that could be great. (It could also be awful, but I’m not dwelling on that.) This too shall pass. I have no idea where I’ll be when it does. That’s a little scary, but it’s mostly exciting.

Learn more about my migraine medication detox:

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Mindfulness Practice: Overcoming Discouragement

This is the fourth post in a series exploring the topics covered in the book You Are Not Your Pain [Amazon affiliate link]. See You Are Not Your Pain: An Introduction to learn more.

My orange silk eye pillow is still tearstained from the first time I tried to meditate. After three minutes of attempting the homework for the mindfulness-based stress reduction (MBSR) course I was in, I went to Hart in tears. I said, “She doesn’t have any idea how hard this is! How can she possibly expect someone to meditate when they feel as bad as I do? This can’t work for someone who is as sick as I am.” Eight years later, that memory is still so strong that I asked Vidyamala Burch about it during our interview.

Kerrie Smyres: The first time I tried meditation was homework for an MBSR course. I was crying within minutes, angry that the teacher had no idea how hard it was to be in my body. How do you encourage participants who have a similar reaction?

Vidyamala Burch: I know how you feel because when I first started doing body scans I felt much worse afterwards, like I had been run over by a train, because my body was holding so much tension that when I came into my body, I was completely flooded by the tension. But I just intuited that I needed to keep doing it and those feelings eased off over time.

If you have got a body that you don’t like because it hurts you, because you feel let down by it or whatever—it is one of the hardest things in the world to come into that body and it should never be dismissed as something that is easy.

At Breathworks, we really know how hard it is, so we put a lot of emphasis on comfort, making sure people have the blankets and cushions that they need, we are sort of loving people, tucking them in literally and metaphorically, and if people cry or get angry, we say ‘Yes, of course,’ that is a totally appropriate response. We put a lot of emphasis on love and kindness which is very important. Otherwise body awareness can seem a bit more mechanical—you are trying to just come into your body and go through the different body parts without this attitude of love. Well, that will be a really hard thing to do.

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Migraine Medication Detox, Week One: Easier Than Expected

migraine medication detoxMy first week of migraine medication detox began with a final dose of Amerge (naratriptan) and two Midrin after breakfast on Sunday, August 21. Despite a rough start, the week’s been surprisingly easy.* I feel better than I have in almost two years! Here’s how the week of detox went.

The treatments to get me through the week were:

  • Compazine 30 minutes before each meal. Although it’s a nausea med, some people get migraine relief from Compazine. (It only made me tired and helped the nausea; it did not give me any migraine relief.)
  • Oxytocin as an acute medication once a day. (Which I discovered is a migraine trigger for me.)
  • A new treatment I’ve been using since June 22. It is a preventive treatment that can also be used acutely. That’s all I can tell you right now, but will share more as soon as I can.

Day 1: Monday was the worst day by far. I was too nauseated and dizzy to eat breakfast until 1 p.m. and that required dosing with Zofran and Compazine. The pain, which felt cold and high on my head, hovered around a 4 and peaked at a 5, which lasted a couple hours. Ice exacerbated the pain. Thanks to Compazine, I slept from 2 p.m. to 7 p.m. I definitely had a migraine attack in the night and didn’t sleep well (probably because of the Compazine-induced nap).

Day 2: I started Tuesday with a decent amount of energy and little pain. I even showered and did housework before eating. The migraine attack that followed breakfast was slight, but definitely present. Between it and the Compazine, I was laid up until I took a nap. Within 30 minutes of waking from my nap, I was perky and functional. I spent three hours working on chores and even did some writing. All with overcast skies! I once again had a migraine attack in my sleep, but it didn’t keep me up. Night sweats and vivid dreams were the only evidence that an attack happened at all.

Day 3: I switched from taking oxytocin at night to taking it after breakfast on Wednesday. It was a remarkably good day. I slowed down for a couple hours after eating, but am unsure if migraine or Compazine was the culprit. I even ran errands in the afternoon. After dinner was the first time I felt like my new treatment actually aborted a migraine attack! It was also the first night in almost a year where I didn’t fall asleep minutes after getting into bed.

Day 4: I woke up feeling fine Thursday and skipped the pre-breakfast Compazine hoping that I would be less sluggish without it. I used my new treatment after eating and it once again appeared to abort the migraine attack. I felt a little slow for maybe an hour afterward, but was able to write all day. My mind got a little fuzzy in the late afternoon, so I decided to rest. Before I did, I cleaned up a mess in the laundry room and put a coat of sealant on the bathroom tile… and discovered I no longer needed to rest. I finally stopped “doing” for the day at 7 p.m.

The other big news of the day: I ate three meals instead of two! I can use my new treatment three times a day, so I wanted to see if it would abort all three eating-triggered attacks. It did!

I then stayed awake the entire night. It wasn’t one of those maybe-I-slept-maybe-I-didn’t kind of nights. I read and did housework all night long. What kept me up? NOT having a migraine attack. I’m one of those fortunate folks who gets sleepy during an attack. After 17 months of nightly attacks, I think my body had gotten used to using migraine as a sleep aid.

Day 5: Despite not sleeping one wink, Friday was another remarkable day. It was house-focused, including signing the paperwork to have the grass removed from our yard and replaced with waterwise plants. (I’m so excited!) And I finally fixed the mess created when shelves in the laundry room fell a few months ago. Nothing to write home about… except that having a day of normal chores is absolutely worth writing home about.

I’m trying to temper my excitement about how much better I feel (Hart is, too). I feel so different, so much better, that I want to believe the ketogenic diet, my new treatment, and getting out of MOH have made a huge, lasting difference. And maybe they have, but I don’t want to go (too far) down that path until I have more data. I don’t want to be (too) crushed if this improvement turns out to be a fluke. Then again, I know my body really, really well. This feels different. (I might hate myself later for writing those words.)

Day 6: I felt great all day Saturday! I woke up at 8 a.m. and organized the house until 11 p.m. I didn’t even check Facebook. I slept well, too.

Days 7 & 8: Both days started well, but migraine attacks crept up through each morning. Both attacks made me so tired I couldn’t avoid napping. Both times, the migraine attack lifted within 30 minutes of waking up. Napping usually gives me some degree of migraine relief, but it only began aborting attacks completely this summer. I’m still surprised when it happens. (I was so afraid of losing another day that I took one Amerge (naratriptan) as soon as I felt symptoms on Monday. My background headache was more painful that day.)

Day 9: I spent this morning preoccupied with Sunday and Monday’s migraine attacks and obsessing over whether an attack was coming on. As I sifted through potential triggers, I kept worrying that my new treatment is backfiring. Although that is unlikely (I’ve been using it for two months with no problem), it’s my biggest fear, so it’s what my mind settled on. Other possibilities are that oxytocin is a trigger, I’ve developed reactions to some foods I thought were OK, or that merely touching cleaning product bottles now triggers attacks. I went with the oxytocin hypothesis and skipped my dose this morning. I’m going strong at 3 p.m., so I’m guessing oxytocin was the culprit.

Future weeks: Medication overuse headache symptoms can last six months after the final dose. Given how easy my migraine medication detox has been and that I’ve only been using excessive amounts of medications for 16 months, I doubt I’ll have symptoms that long. Still, I’m hopeful that the next few weeks or months could bring even more improvement. Maybe I’ll one day be able to eat without having a migraine attack at all.

*My experience does not represent the typical migraine medication detox. It has been easy because of the preventives I was on before I started (and possibly because I was only in MOH for a year). The drugs I used as a bridge were ineffective—Compazine only made me sleepy and oxytocin made my migraine attacks worse. In the six months before starting the detox, my pain rarely got above a 4 and my most disabling symptoms were fatigue and cognitive dysfunction.

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Quick Survey on The Daily Headache

survey-on-the-daily-headacheCan you help me with something? I’m trying to figure how to best sum up what I write about. Everything I come up with sounds flat and academic. I have a couple questions:

  1. How would you characterize what you read about on The Daily Headache?
  2. What topics do you most enjoy reading about on The Daily Headache?

You can leave your comments below, on social media, or by emailing
kerrie[at]thedailyheadache[dot]com. Answer either or both. Thank you!

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You Are Not Your Pain: Primary and Secondary Suffering

This is the third in a series exploring the topics covered in the book You Are Not Your Pain [Amazon affiliate link]. See You Are Not Your Pain: An Introduction to learn more.

Pain has two components, the physical sensation and our emotional reaction to the physical sensation. We cannot control primary suffering—which is the pain itself—but we can control secondary suffering through our reaction to the pain. I used to believe this distinction was immaterial, but I’ve come to believe it is possibly the most effective coping strategy for to help me deal with all manner of adversity. I use it in every aspect of my life.

Kerrie Smyres: How do the principles of “You Are Not Your Pain” apply to someone who has pain as one component of a chronic illness with other symptoms that can be just as, or even more, debilitating?

Vidyamala Burch: The principles of the book “You Are Not Your Pain” equally apply to anything that is unpleasant, whether that is pain, some other debilitating symptom, or more mental and emotional suffering. The absolute core principle is that when we have anything unpleasant we resist it. The pain isn’t really the problem; the resistance to the pain is the problem, the response in the heart and the mind of ‘I don’t want this.’

This response means that you are kind of pushing it away and when you push it away you make it worse. In the book we make a distinction between ‘Primary and Secondary Suffering’ to describe his. Primary suffering is the unpleasant sensations in your body, heart or mind that have already arisen. We call this a ‘given’ in this moment. But if you automatically push it away you then get lots of other suffering—and we say that this suffering is optional and that is the secondary suffering.

To summarise: the primary suffering is anything that is unpleasant in your experience; it doesn’t matter whether that is pain, illness or a painful mental state. All the approaches in my book will teach you how to accept the primary suffering and reduce/overcome the secondary. This means your overall suffering will reduce—sometimes dramatically.

KS: Primary suffering can seem so overwhelming that secondary suffering feels inevitable and unavoidable. What advice would you give someone struggling to separate secondary suffering from primary suffering?

VB: It is difficult, as pain can feel incredibly solid. We can feel as if we are solid and the pain that is the enemy is also solid and there is very little room for separation within this solidity. But the deeper awareness that comes from mindfulness is that life is like a river, it’s not solid at all. It is a flow of thoughts, emotions and feelings arising all the time. So, what we are doing is learning is to rest our awareness within the flow of the river of life—we are learning to work with this fluid experience as it comes into being and passes away moment by moment.

One of the models that I use to help people struggling to separate secondary suffering from primary is blocking and drowning. When we look at discomfort the first thing we do is resist it, so first of all is the ‘I don’t want this’ response then that bifurcates into two different reactions: one is where we harden against the experience, perhaps tuning out or becoming quite blank and at the same time the body becomes quite hard because of tension, the mind is rigid, and we get emotionally numb; this is what we call the blocking response.

The drowning response is the opposite. We feel overwhelmed, where there is nothing else other than this pain. You are just completely overwhelmed, you feel ‘Oh my god, this is just far too much.’ Part of the skill is to understand which of the two things you are doing, because most of us either do one or the other. If you find that you are blocking, numb, a bit stuck, rigid, bored—often boredom comes with blocking—then the art, or the skill, is to come a little closer to what is actually happening – what are the sensations in my body? What am I thinking? How is my heart feeling? Then come a little closer.

But if you are in overwhelm, then you need to broaden and become aware of other things as well. If you are overwhelmed by pain, or discomfort and there is nothing else in the universe other than this stress in my heart, or this pain in my head, or whatever it may be then the task is to notice other things around you. You can look in your body for pleasant sensations, in the moment there is always something pleasant, so what is pleasant? It might be warm hands, well I notice right now that the sensation of the hair on my forehead is actually quite pleasant, it might be something as simple as that. It’s like you pull back a wide angle lens on a camera. How many other things can you feel? You can feel your bum on the seat, your feet on the floor and hair on the forehead, cardigan on the skin, warm hands, breath in the belly, soft face, eye lids touching—that is often very pleasant!

So you learn to ‘calibrate’ blocking and drowning tendencies with awareness. You are playing around with going closer, pulling back, then going closer and pulling back. Eventually we arrive at a place of beautiful equanimity where the pain is there but we are not overwhelmed nor are we blocking—for most of us it’s a dance and dancing between those two movements of pulling away and broadening is very interesting, it can become so fascinating.