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Chronic Migraine Time Management… and More Self-Doubt

While time management for accomplishing daily tasks on schedule despite chronic migraine still eludes me, I’ve found a system that works for me for big activities, like a party, travel, or even attending an important work function with Hart. I have to budget my time very carefully. I plan out everything I need to do, break it down into small tasks I can reasonably expect accomplish each day, and allow for a few extra days in case I have to take a day off. I always give myself way more time than I think I need and work in time to rest as well. I focus all my energy on these specific tasks and set aside everything non-essential.

I’ve just arrived in Seattle where I’m house sitting for the rest of the summer to get away from Phoenix’s monsoon season. Getting here has been convoluted. My mom, who lives outside of Portland, OR, is lending me her car this summer. Monday I flew there and spent the evening with my family. Tuesday I drove to Redmond, WA, to stay the night with a high school friend. Wednesday I picked up groceries (I’m still on an über strict diet that requires making all my food super fresh and freezing it) and moved to the place I’m house sitting for three weeks. This was all after spending last Thursday to Saturday in Flagstaff, AZ. I did some packing for Seattle before Flagstaff, then dedicated Sunday to finishing that up.

A healthy, energetic person wouldn’t find this schedule taxing; I found it stressful and exhausting. I’m more than a little embarrassed about that. Most of my years with chronic migraine, I have pushed myself constantly, pretending that I had a healthy body that could withstand a normal schedule. In admitting that I don’t and I can’t, I’m able to manage life and cope with the migraine attacks a lot better. I am mostly happy with it in my day-to-day life, but writing about it publicly is uncomfortable.

Admitting how much effort I expend to accomplish so little is humiliating. I hear the voices of all the people who have told countless migraineurs (and those with many other chronic illnesses, I’m sure) that we’d get better if we only tried harder or worked at it more. Despite knowing that method is not only fruitless, but counterproductive for me (and probably for most people with chronic illness), I still feel ashamed to share the unimpressive minutia of my daily life. I know intellectually these naysayers are wrong — and I’m even beginning to believe this in my heart — but I nonetheless feel defective in the eyes of society.

Being sick is really hard work. Those who have never had an extended illness have no idea how difficult it is. And, sadly, many of them are unwilling or unable to step outside their experience to consider what we go through. Still, those are the voices that haunt me as I work my butt of to manage chronic migraine. I want to be well and I want to be a productive member of society. It’s infuriating to know that others refuse to see this and instead pass judgement, assuming their way is the only right way, and that I must be doing something wrong if I’m not getting better.

I’m not one to care much what other people think… unless I fear there is truth to what they believe. Rationally I know they are wrong, but I can’t seem to shake my own doubt. I’m not defective or lazy and I want others to stop thinking that I am. Because if they don’t believe it, maybe I won’t either.

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Pushing Through Migraine Attacks… More Harm Than Good?

What would happen if, as soon as I noticed a migraine coming on, I took meds and rested instead of pushing until I absolutely can’t do another thing and I’m beyond exhausted before sitting or lying down? “I’d never get anything done,” is my immediate response, and I’m guessing most chronic migraineurs would think the same thing. But what if the behavior I see as helping me cope with chronic migraine — pushing myself — is actually making my health worse?

What if resting at the first warning of a migraine would reduce the severity of that migraine attack? What if pushing myself to the brink actually makes the migraine attack worse? And beyond individual migraine attacks, what if my habit of constantly pushing myself to severe fatigue compromises my body and health in such a way that makes me have more frequent migraine attacks?

These are some of the thoughts floating in my head thanks to therapy and the article about validating pain that I wrote about last week. I have no answers, but asking these hard questions feels like a step in the right direction.

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Searching for Fatigue Source Reveals Overlooked Midrin Overuse

As you’ve likely noticed, fatigue, both physical and mental, ranks high on my list of migraine complaints. Since finding some effective preventive medications in the last year, fatigue has probably become my most debilitating — and annoying — symptom.

Though my doctors and I think the fatigue is a migraine symptom (it is far worse during a migraine attack) I’ve searched for other causes. My thyroid’s been scanned an biopsied, I’ve taken supplements after tests indicated low vitamin D and B12 levels, my internist has probed a variety of possible causes… and yet the fatigue lingers.

Then, a bright light bulb suddenly switched on. I’ve taken an average of two Midrin each day (some days none, other days four or five) for the last three years. The drug is a combination of acetaminophen (Tylenol’s active ingredient), a vasoconstrictor, and a mild sedative. Though I don’t feel sleepy when I take it, I wonder if the sedative could have an additive effect that’s left me worn out after three years of a continuous dose. (Not to mention I could have medication overuse headache, a.k.a. rebound, from daily acetaminophen.)

I am so careful with the medications that I take. I research them well and track whenever I take an abortive, but somehow the frequency with which I was taking Midrin didn’t register. I’ve been off it two weeks and both my fatigue and migraine frequency have lessened (though the roof debacle has muddied my results). I’ve taken plain acetaminophen three times each of the past two weeks, but am going to try to go without it completely this week.

The number of different migraine triggers, the possible effects of medications on migraine frequency and severity, and the variety of symptoms that can be present during a migraine make for a complicated juggling act. I never intended to join this circus.

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Ritalin Side Effects

With my lighthearted approach toward Ritalin, I fear I’ve diminished the fact that it is a a real drug with potentially serious side effects. Sorting through information on the medication was surprisingly complicated. On one hand, it seems like a relatively mild, safe medication; on the other, there are dire warnings about its risks. I assume this is because it is often prescribed to children (many believe it and similar medications are overprescribed) and has a potential for abuse.

The most common side effects, compiled from the FDA-approved medication insert (PDF), WebMD, Drugs.com and RxList, are:

  • nervousness
  • agitation
  • anxiety
  • insomnia
  • loss of appetite
  • nausea
  • vomiting
  • abdominal pain
  • dizziness
  • heart palpitations
  • headache
  • increased heart rate
  • increased blood pressure
  • dry mouth

Serious side effects, according to MedlinePlus (from the National Institutes of Health), are:

  • fast, pounding, or irregular heartbeat
  • chest pain
  • shortness of breath
  • excessive tiredness
  • slow or difficult speech
  • fainting
  • weakness or numbness of an arm or leg
  • seizures
  • changes in vision or blurred vision
  • agitation
  • believing things that are not true
  • feeling unusually suspicious of others
  • hallucinating (seeing things or hearing voices that do not exist)
  • motor tics or verbal tics
  • depression
  • abnormally excited mood
  • mood changes
  • fever
  • hives
  • rash
  • blistering or peeling skin
  • itching
  • difficulty breathing or swallowing

For a complete list of potential side effects and their severity, see this thorough list of side effects of 10 mg of Ritalin from Great Britain’s National Health Service or WebMD’s Ritalin side effects.

Personally, I was a little shaky the first couple days I took it, but less than I would be if I had a cup of coffee. Since then, I’ve been careful to eat 30 minutes after taking it, as the label recommends. My feet also seem excessively sweaty and I’ve lost a couple pounds. Having gained 13 pounds on cyproheptadine, I haven’t minded the weight loss and hope that the weight-related side effects of the two medications ultimately cancel each other out. In case you’re concerned, be assured that my casual approach to the drug is not out of a sense of euphoria, but because I’m so happy to feel like my normal self again. The absence of serious side effects makes this even easier, of course.

The possibility that the drug with disrupt sleep is a big one for migraineurs, many of who already have trouble sleeping. I take it first thing in the morning and haven’t had a problem. Because I don’t use it to manage ADD or ADHD symptoms, I don’t need multiple doses in a day. I’m not sure why, but my energy and mental clarity last all day with only one dose.

Beyond the immediate side effects of the drug, there are concerns of its potential for abuse and the effects of long-term use. You’ll have no trouble finding alarming article on either topic. I’m not worrying about either one right now. By taking only 5 mg a day and using it for a legitimate medical condition, I don’t think I’m at much risk for abuse. If I’m still on it in a year, I’ll look into the long-term effects. For now, I’m just enjoying having the mental wherewithal to write long, research-intensive posts like this one.

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A Morning Person After All? A Return to Normal With Ritalin

When I was teaching public speaking in graduate school, I had a student I called Lawyer Boy who argued about everything. I told the class, which began at 7:40 a.m., that I was not a morning person. He responded, “You’re a morning person, you just don’t want to be.” This was about a year into the migraine attacks disrupting my life significantly (it was actually the last class I was able to teach).

I’ve wondered since if I really am the morning person I remember being as a kid, but the migraine attacks and fatigue were causing me to sleep more than usual. Now, on my seventh day of Ritalin, I have to admit that Lawyer Boy was probably right. I fall asleep at 10:30 or 11 p.m. and wake at 7:40 without an alarm clock. Before Ritalin, I’d sleep until 10:30 a.m. on a good day. On a night I had a migraine (which was most of them), I’d sleep until at least 11, often noon or even 1 p.m. Then I’d lie in bed for an hour or two, mucking about on my phone and gathering the energy to get up.

It doesn’t feel like Ritalin is amping me up, but is restoring my rightful self. This morning, when my head was throbbing at a level 4, I was still up at 7:40. I popped out of bed and started writing immediately. Even better, the head pain decreased to a 3 within 30 minutes. Reduced fatigue, a clear mind, less head pain, minimal side effects*. . . . I hope this lasts.

*For me at least. I’m working on a post about side effects and potential problems of Ritalin.