I’ve had migraines since well, my teens — more intensely since my late twenties. I’ve seen neurologists. I’ve had MRIs. I’ve tried chiropractics. Alternative therapies (acupuncture, massage). Dietary changes. Botox. Behavioral therapy. EVERYTHING. I’m fifty-one now and as I write this, I’m on a preventive treatment that includes medication and diet, exercise, meditation, and therapy, and I still get them. In fact, I’m in a stretch right now that’s lasted about a week and it’s just as awful as you can imagine.
But I function. I’m luckier than most, though on bad days I feel like crawling into a cave of soft blankets and binge-watching Scandal reruns for hours and hey, sometimes I do. I may not be a gladiator, but I can watch them on TV.
Meds like triptans (Imitrex, Relpax, etc), aka serotonin receptor agonists, are the most effective in terms of treatment because they are non-addicting and work quickly. Triptans narrow (constrict) blood vessels in the brain and relieve swelling (Source: WedMd). They are also expensive if not covered by your formulary, and don’t come without their own side effects (sensitivity to hot and cold, nausea, sleepiness). Like any medication, you can only take so much without experiencing rebound (aka, a form of dependence), so you have to mix in anti-inflammatories along with stronger meds, if needed. Occasionally, I’ve had to go to an urgent care for a Toradol (anti-inflammatory) shot or even the ER for a shot of Demoral when the pain has been THAT bad.
What’s interesting to me is that nobody, not one physician or health care specialist, ever once suggested that my migraines could in any way be tied to the sexual abuse I experienced as a child. It’s only through my own research and connection with the amazing community of survivors (in #SexAbuseChat that I started in 2014 with therapist/survivor Bobbi Parish, every Tuesday on Twitter at 6pm PST — join us — all survivors and families are welcome) that I realized how commonly migraines occur in survivors.
PTSD In Abuse Survivors
Take a look at the research. Here’s just a quick sample:
“Several studies demonstrate that childhood injury or abuse makes it more likely to develop migraine later in life. The more severe the abuse, the stronger the link grows. These headaches are also more likely to be frequent and disabling. Severe abuse is also linked to other conditions, including chronic pain, fibromyalgia and irritable bowel disease.
Chronic maltreatment early in life alters the brain’s response to stress. This may make it more likely to have migraine. A study of inflammatory blood tests suggests a mechanism for the link. In this study, adults showed higher levels of biomarkers in the bloodstream when exposed to abuse in childhood. Genes are also important in this process. Genes are responsible for how a person and their body respond to early stressful experiences. It is also possible that early stressful experiences may become hard-coded into DNA. This creates a memory of events that leads to impaired health at a later date.” (Source: American Headache Society.)
I’m honestly thankful to know this. It explains so much! To say that finding this out has been life-changing for me seems almost trite at this point.
There are people who say that knowing this is a crutch of some sort — that because someone told me that my migraines are due to the PTSD from the abuse, I now have an ‘excuse.’ Whatever. I’ve had these things for twenty-five years. I’ve seen the top experts and they don’t even know or understand the causes of migraines or how the brain works. So, good luck with your rationalizations. (Here’s more information on how abuse affects the immune system, which can also lead to migraines and other diseases. Source: American Nurse Today.)
People are well-meaning in the advice. I’ve heard everything from using lavender (done it), to Vitamin D (use it), to garlic (love it), to gluten-free (tried it, didn’t help). You may recall, I was in Big Pharma for seventeen years. My company made migraine meds (nasal spray — hated it, awful taste). I’ve bought and sold these meds. I have spent a lot of time with neurologists and scientists (as a patient, a sales rep, and as a trainer in the home office). I don’t claim to be an expert — far, far from it. The brain is this crazy thing that almost defies explanation. I do know that what works for one person may not work for another, yet sharing information is crucial.
This explanation about PTSD makes sense to me, but it doesn’t take the migraines away. And that’s okay.
Meds and the Ridiculousness of U.S. Healthcare
One of my doctors told me something that has stuck with me all these years — there are no long-term physical negative side effects of having migraines. You have one, it goes away (eventually), and you get on with your life. Sure, psychologically, a migrainer, as we are called, lives in well, if not exactly fear — it’s more like dread — of getting one, at least we know we are actively living our lives and doing what we can to prevent them.
Some people don’t, though. They become addicted to prescription pain meds — typically opioids like Vicodin, for example. There’s a reason for that.
I have a prescription for it myself, for when the pain is really bad. My doctor can only write thirty (I’m in California, and since Vicodin is a controlled substance, a prescription must be picked up in person with ID, written in triplicate, and presented at the pharmacy by the patient, no more than once per month). These are federal guidelines, actually, which are only becoming even more strict. I only take them when the pain is unbearable and none of the other meds help. I don’t drive when I take them, and it makes it hard to write or function, which is why I avoid them until I just give in.
Triptans work differently. You take them at the first sign of a migraine. Some people aren’t aware of triptans, or simply can’t afford them. Get this: one prescription of six tablets of Relpax, the triptan that works best for me, isn’t covered by my PPO (Anthem/Blue Cross). The price: $250. FOR SIX TABLETS. I can only take two in twenty-four hours. If my headache lasts a week, that’s only three days worth, and I can’t get more for another month. So, my options are to take Advil (which can cause rebound — take more Advil, which causes more headaches, which means I have to take more meds, which causes more pain, and on and on it goes), or take Vicodin, and the same cycle begins.
Vicodin (or other controlled pain meds) are available in generics, are covered by insurance, and cost about $5. Despite it being more difficult now to get filled, it’s still an easier and more affordable option for people on a budget and in pain. It does not cost more to make a generic triptan than it does a generic Vicodin, but Pharma companies have years of research to pay off. Of course, there’s always the ‘street’ option, not something I’d ever consider, yet people do because of what I mentioned above.
I’m thankful there are non-opioid options for migraines that do work well for me when in fact, more and more people are turning to heroin to relieve chronic pain because of these new guidelines…but that’s a whole other post.
To avoid rebound headaches, I do non-drug and natural therapies like vitamins, meditation, yoga, and behavioral therapy. I also take preventive medications like Topamax and Cymbalta (an anti-depressant which is also indicated to help prevent pain). I also get Botox shot into my temples and jaw (yes, TMJ is part of my issue, too — isn’t this fun?) every three months. And though migraine prevention is a covered and FDA-approved treatment for Botox, my insurance company, in their infinite financial wisdom, refuses to pay for it. Don’t get me started.
Listen, this is my story. Knowing that migraines and PTSD are closely linked has been eye-opening for me, because it’s a partial answer to a complicated question that has dogged me for years. People want to relieve my suffering and the symptoms of my migraines and give me a ton of advice, and I appreciate the love and support from so many caring individuals. I do, truly. What I’m doing usually works, and sometimes it doesn’t, which is why I’m here, sharing what I’ve learned.
I’d love to hear your stories about what does or doesn’t work for you, or those you know and love. Please share below!
**Update January 2017: I’ve started taking a blood pressure med preventively from the calcium channel blocker class. CCBs work in the arteries this way: the entry of calcium into muscle cells constricts the arteries and thereby dilates (widens) the arteries (Source: RxList). This is the same way the triptans work to help with migraines. And it’s helping — I’ve gone from 3-5 migraines weekly to one every few weeks.
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