Migraine

Since I have been on preventative meds I have had less very painful Migraines. My neuro claims a Migraine does not HAVE to be an 8 or 10 on the pain level scale. There are times however where I will have low grade Migraine pain for days. Sometimes during these days I feel so exhausted I can hardly work. I believe at certain times these headaches are from hormones. During these times I try to alternate the abortive meds like Imitrex, and Fiorocet for pain. I have also gone from 15 Migraines a month to ones surrounding my cycle. I took Seasonale for a year which also helped. Now my doc gave me Lybrel to try instead to possibly help even more with the Migraines.
My question is can you really know if you are having a low grade Migraine or simply a rebound headache. Sorry if this sounds confusing.
I have learned a lot between my Neuro,Teri and you guys. !
Khrystaa

Hi Khrystaa,

As I read this, I thought, what a great Ask The Clinician Question this would be! You should submit it for Dr. Krusz to take a look at-just a thought of course

Fiorocet is a rescue medication not an abortive like your Imitrex, here's more information on the differences:

Preventive, Abortive, and Rescue Medications - What's the Difference?

Here are some more articles that you may find helpful:

What Type of Head Pain Is It?

Medication Overuse Headache

I'm happy to hear your head pain isn't as severe as it used to be before you started your preventives. That's wonderful news

One more tid bit of information I've learned from this site; if you put your head down between your knees and it makes your pain worse, odds are, it's a migraine. I hope this helps!

Are you taking Imitrex or Fioricet more than 2 or 3 days a week? If not, it might not be rebound. When I was in a rebound cycle, my head hurt all day, every day, and didn't respond well to the offending med.

I thought for years that I had both tension-type headaches and migraine. The specialist I started seeing in November, however, said that all my head pain is migraine, even the 3 and 4 and 5. And even the pain that feels like tension. I'm not sure I believe her, but she's the expert, and I'm feeling better under her care.

So, according to my specialist, even a 1 or 2 is migraine pain, at least for me. I treat from 1 to 3 with Skelaxin, and when it gets from 4 to 6, no more than 3 times a week I'm to treat it with Imitrex and a whopping dose of naproxen.

I hope this makes sense.

Gretchen in Mississippi

Hi khrystaa,

I'm so happy to hear that your neurologist believes Migraine pain does not have to be in the 8 to 10 range all the time. It is very true.

Low grade Migraine pain for days, or Migraine pain lasting longer than 72 hours without a four-hour pain-free break while could be a condition called Status Migrainous and needs medical attention right away. This puts us at an increased risk of stroke.


I hope this helps, how are you feeling?

quote:

Originally posted by khrystaa:
Since I have been on preventative meds I have had less very painful Migraines. My neuro claims a Migraine does not HAVE to be an 8 or 10 on the pain level scale. There are times however where I will have low grade Migraine pain for days. Sometimes during these days I feel so exhausted I can hardly work. I believe at certain times these headaches are from hormones. During these times I try to alternate the abortive meds like Imitrex, and Fiorocet for pain. I have also gone from 15 Migraines a month to ones surrounding my cycle. I took Seasonale for a year which also helped. Now my doc gave me Lybrel to try instead to possibly help even more with the Migraines.
My question is can you really know if you are having a low grade Migraine or simply a rebound headache. Sorry if this sounds confusing.
I have learned a lot between my Neuro,Teri and you guys. !
Khrystaa

I don't believe I've ever known of a migraine specialist or a neurologist to use pain level to differentiate migraine from another type of diagnosis. A person can have a migraine attack with no pain at all. I hope no one has ever made you feel bad telling you that your migraine attacks couldn't be such a thing because the pain wasn't 'bad enough'!

I go through periods of status migrainous. My migraine speck has diagnosed me with it twice since November 2006. He hasn't hospitalized me either time. I suspect I may have been in some form of it recently when my speck bumped up my Topamax dosage. I had been in an extended period of constant migraine and made the first phone call to his office ever in the 16 months I've been seeing him.

Neither time was my continuous pain ever worse than, oh, maybe 5? It would spike to 10 but rescue meds would bring it back to below 2 until they wore off. Zonegran and Topamax have broken the cycles at home each time.

Hang in there. Pain level IS DEFINITELY NOT a diagnostic criteria for migraine!

Nancy,
I have had a few bad days here and there but only one really painful day in quite a while. I chalked that one up to a combination of my cycle, shellfish and a martini. I knew better. Some times my Migraine condition overwhelms me and I ignore what I should be doing. Some days I feel exhausted and I`m not sure why. I will say I am a little concerned about the Status Migrainous condition you talk about. I have not had a high level of pain on say a 72 hour time frame in over a year. But I have had low grade pain for about 24 hours at a time. It does not happen every day though. It does vary so much, therefore I get confused,sigh. I currently take Inderal as a preventative. I was also taking Elavil along with it but It makes me gain too much weight and I can`t wake up easily in the morning, so I cut back on it. I take Imitrex as an abortive. I forgot that Fiorocet was a rescue med...oops. I do not take either one of those more than twice a week. I am so grateful to hear from yourself and others who know what we live with. Sometimes, when others I deal with daily,refer to Migraine as a headache it just makes me doubt a reality. Migraine is enough to start making me crazy.

Oh, we totally understand. One of my favorite expressions is "can't you just take a couple of aspirin"? If that would do the trick don't they think I would have done it already!!!

Hang in there, and let us know what else we can do for you. Watch that head, ok?

[QUOTE]Originally posted by Nancy Bonk:
Hi khrystaa,

I'm so happy to hear that your neurologist believes Migraine pain does not have to be in the 8 to 10 range all the time. It is very true.

Nice to know that pain level is not a diagnostic tool for migraine. I always have some level of pain. I get fewer than 5 pain free days/month, but the pain is only occasionally disabling. My neuro calls me a "migraine waiting to happen" and believes that I always have a migraine, I just can't detect it. It is also interesting that, on those days when the migraine is "flying under the radar", all I have to do is touch the left side of my head or face and then I can feel the pain (goes up to a 4-6).

However, it is also interesting to see that ER docs sometimes use pain as a diagnositc tool.

ER doctors are a different breed. They really need that scale for patients with kidney disorders, or autoimmune issues, or heart attacks. It gets down and dirty in the ER and when somebody comes in and says "my chest is on fire" I think more often then not the 10 on the pain scale may come in handy.

When we come in with our "Migraine pain" the ER doctors may be comparing it to the poor chest man, or lady with the bullet in her arm or even the child with cancer pain. No, it is not fair, or right. But something to think about.....pain is pain.....putting in perspective for us, for our families, for our doctors, for the ER staff feels like a continuous battle.

Oh my, I guess I got a little carried away.... I'll now step off my

Don't step off that soap box Nancy! It's something we need to hear and remember when walking into the ER. Each ER visit is going to be a different battle, sometimes we have to fight harder to get the medical attention we deserve and need and other times it's not a battle at all. Those are the ones I pray for everytime my husband makes me go to the ER...no battles please, just an understanding staff!!

Khrystaa,

When you migraine, are they unilateral? Do you also get tension type headaches?

I know for me, when I was in rebound mode, it felt like the worst tension headache I've ever had, but with nausea and dizziness like I get with a migraine. The difference was the pain was "banded" like in a tension headache.

Have you ever done the "head between the knees" trick to see if it's a migraine? You put your head between your knees, if the pain gets worse, trobbing, then it's usually migraine. If it stays the same, it could be "just a headache" (what's that, right??!!) or a rebound, tension headache.

How are you doing today? Feeling any better?

Eileen,
My Migraines are always bilateral. I also get tension type headaches that you speak of. Sometimes I don`t know if one ends up leading to the other. I can think of times where yes,if I put my head between my knee`s the pain gets worse. I think that is a given for a true Migraine. With me a lot of the time it is the feeling of pressure. A lot of days I will not have a lot of pain but I do get a pressure feeling. My sinus feels like they are stuffed with Cotton. Its hard to tell if it is my allergy's or swollen blood vessels from a Migraine. I do know that getting a message is not a good thing for me. If I have to face down for too long I end up with a Migraine and a feeling of pressure. My neuro did not say much about it. I had a MRI on my neck and there is a slight herniation in a disk but he said that was not causing the kind of pain I get. I can take Imitrex to relive some of that pressure feeling but sometimes I skip it because I end up even more exhausted when I have a hard day ahead. Unfortunately I have a pretty physical job (Housekeeper). I simply do not go to work if I am in too much pain. I feel like a zombie the next day too. I had some blood work done by my regular Dr. He said everything was fine
except my Cholesterol was a little high. Now they wanna take away my comfort food. I am ok today pain wise. Just feeling wiped out.
Khrystaa

Good morning Khrystaa,

I'm glad you're starting to feel better! I'm going to give you some follow up links I think you'll find helpful:

Medication Overuse Headache

Tension-Type Headache-The Basics

I hope these help! Enjoy your weekend, I hope it's pain free

I found this question and the answers to be of great interest! As I get my chart together (in an easier to read fashion) for my doc visit, I've noticed that recently most of my prementrual HA are only 3-4 BUT last 4-5 days and involve nausea.

Since these are "low pain" HA and they involve neck pain it's just tricky to decide what type they are and I just treated them with advil, fioricet and phenergan which does help. So the one time I did try Imitrex to "break" the cycle b/c it had gone on so long it didn't work. I pretty much knew it was too late but desperate times bring desperate measures. Fortunately they end pretty soon after my period starts.

So I guess I'm now wondering if I tried the Imitrex from the get go (or at least day 2, since it may be tricky to decide if it's just a random "daily" HA or the start of a premenstrual one) do you guys think it should work based on your experience? I've been staying up WAY too late doing my research here and have read up on using Frova and Amerge so I plan to ask about them (though once again, tricky to know what day to use them AND I'll have a crazy copay if they are even covered). The other thing he suggested was adding a BP med which could help with my other random HA throughout the month. But I'm going to focus on the weeklong ones first.

I do find so much info here. It's really helping me develop a plan in my head to be more effective at my appointment. Thanks!

Diane