Migraines aren’t easy to treat or diagnose. After suffering from various types of head pain since age 10, I was able to find a persistent doctor who diagnosed me with migraines. The diagnosis was complex because my migraines sometimes begin as sinus headaches (often diagnosed as chronic sinusitis) and evolve into full-blown migraines, complete with dizziness, nausea and vomiting.
Diagnosis and Specialist Visits
The key to an accurate diagnosis was persistence. As I grow older, I find persistence to be the number one remedy to alleviating most health problems. When a doctor couldn’t help me, I went to another one who tried. Eventually I did find a doctor who observed me over time and helped me find medications that worked to alleviate the pain.
My doctor also recommended I speak with an ENT (ear, nose and throat doctor, also known as an otolaryngologist). While the pain I was experiencing were specifically different varieties of migraines, many of them resulted from sinus issues and perssure.
A coworker had sinus surgery and recommended me to a very helpful ENT at Jefferson Hospital in Philadelphia. After several visits and attempts at treating the sinus problems with steroids and antibiotics, my specialist recommended me for sinus surgery.
I was on three different insurance carriers over the course of my major migraine suffering and diagnosis. All three of them put strict limits on the amount of triptans I was able to purchase. Triptans are drugs that act as seratonin resceptor antagonists to relieve migraines after they already occur.
I noticed and reported an increase in migraine headaches during several times: ingestion of food allergen, seasonal indoor and outdoor allergy reactions, during emotional stress, during physical stress following car accidents and chronic back pain and before my period. My doctors assured me these were all common migraine triggers and the insurance companies required documentation of these triggers to continue dispensing triptans.
At last, my insurance gave me a reprieve. I learned it would only cost $100 to have the endoscopic sinus surgery. I scheduled the surgery and had it.
Endoscopic Sinus Surgery
Endoscopic sinus surgery isn’t for everyone. If your sinus problems can be controlled with medication and you aren’t planning on having children soon (you’ll have to drop most of those medications if you are), deal with the medication instead of the pain from the surgery.
It took a full three months for me to recover from the surgery. During this time I was on pain medication that caused side effects. I was freelancing full time, but if I had been at my previous desk job, I would not have been able to perform efficiently for almost three months (my former coworker returned to work after about a week, but she still looked like she was in pain). For more information on my experience with endoscopic sinus surgery, see this article.
Migraine Triggers and Work Environments
Because I have so many migraine triggers, I took care to avoid anything that could start a migraine. This includes fluorescent lighting, perfumes and cigarette smoke. When I worked full-time in an office and commuted by train, it wasn’t always possible to avoid these triggers. Inconsiderate smokers always walk with their smoke and ashes trailing on city sidewalks, and some folks just don’t know when to lay off the cologne or perfume on the train–which, incidentally, is lit with fluorescent lighting.
My work conditions were decent at my old office, but some mornings I would wake up with a migraine and take my triptan drug before leaving. Since the drugs made me tired, I had to be careful not to fall asleep while driving, at my desk or on the train. My daily commute exposed me to multiple migraine triggers. On top of that, I was involved in multiple accidents in 2009. I had to take time off because of them, so I couldn’t call out sick frequently without taking disability at 60 percent of my pay rate.
Eventually it made more sense for me to work from home as a full-time freelance writer. With injuries and migraines, my only other choice involved taking the disability, and my freelance income (even while recovering from two car accidents in December of 2009 while suffering from migraines) exceeded 60 percent of my salary. Fortunately, this was also a career goal. It allowed me to focus on treating migraines.
Unsatisfied with the effectiveness of the triptans, I started talking to friends suffering from migraines and I switched to a new doctor. One of my friends suffers from diagnosed depression and told me that migraines and depression are related. This made sense to me, considering how triptans work with seratonin, a factor in depression and anxiety.
Considering the stress I had been under from planning a wedding, supporting my husband when he was out of work and being involved in multiple car accidents, I knew I was under mental strain. Sometimes it’s hard for other people to recognize this because I always meet deadlines, I manage my time well and I am an extremely hard worker.
I decided it was time to find a new doctor. She did not like that I was taking so many medications to treat allergies, sinus problems and migraines. She switched me to a nasal spray and a drug called amitriptyline This drug is also a mild anti-depressant. It’s a preventive medication that I take daily before bedtime because it makes me tired. The amitriptyline works extremely well. I no longer need to take the triptans to cure migraines. If I know I’m about to get a migraine, I can take some ibuprofen and chase it with caffeine.
My husband and I have talked about having a family in the future. Unfortunately, the amitriptyline drugs are not drugs I can take while pregnant. I also suffer from back pain due to accident injuries. The good news is that simple over-the-counter drugs and yoga relieve this pain most times–I just take some ibuprofen and use Icy Hot. However, there are limits to the drugs I can use (even over-the-counter) if I want to become pregnant.
My doctor also said that since we know some of my migraines are hormone level-induced, my migraines may increase or subside when I am off of my preventive medicine and conceive. She predicts that the most difficult time will be after I am off the medication and before I become pregnant, because the estrogen levels found in a woman’s body when pregnant or on the birth control won’t be there–and without those hormones, I get migraines.
The biggest difficulty overall has been others’ lack of sympathy. If a disease or impairment doesn’t visibly destroy someone’s ability to walk or move around, others often have difficulty understanding the pain. When I was is in college, I would occasionally have to skip classes due to migraines. I’d work twice as hard later and do extra credit to make up for my absences.
My college roommate and current friend Jackie never understood why I would just want to sleep every time I had a migraine. One day, Jackie experienced a migraine. While I feel bad that she was in pain, she understood what I was going through that moment on and always did her best to keep the room dark and answer calls for me when I was sick.
In the corporate world, most HR departments don’t care or understand about migraines. If you have a family issue in addition to chronic pain, your only choices are disability and FMLA (Family Medical Leave Act) time. From what I understand, once you take those options, companies often seek to legally discharge you.
I don’t know what I would do if I did not have a husband willing to stay at a job that provides excellent health care. This enables me to see my doctor for continuing care with my migraine and to get the pre-conception consultations doctors now recommend if a woman plans on becoming pregnant (even if she does not have any medical conditions). My friends, family and fellow writers often take the time to support me by clicking on links to articles such as this one, published on Associated Content and Yahoo! partner sites.
Even though I am managing my own schedule, I still have to do things ahead of time in case I get a common cold or succumb to a migraine. I do my best to complete work well ahead of the deadlines, but also take on a generous amount of work with open deadlines. One of the companies that employs me hires many writers and offers no negative consequence if the writer does not complete an assignment by the due date. I use this site to meet my financial goals, but when I have difficult weeks involving migraines, I let some of that work slide and make up for it the following week.
While I detest having migraines, I’ve learned that I can do more work than most other people while suffering from a handicap. I’m proud of the fact that I can always do work ahead of time or make up missed work. Thanks to the amitriptyline, I haven’t had a migraine in more than a month, but in coming months I am going to have to stop taking this medication if I want to safely become pregnant. It’s going to be hard, but I’ll make it work because I love my job and require the income it provides.