28 May, 2008

Migraines: A common misunderstanding

Mi - graine: (n)
A headache characterized by throbbing head pain, often greater on one side; may be preceded by a warning (aura) and accompanied by nausea, vomiting, and sensitivity to light and sound; in rare cases, weakness, language problems, or other neurologic disorders are associated with migraine.


Over my years of coding I've endured what I thought were migraine headaches, not uncommon to those of us who spend waking moment after waking moment staring at multiple screens as part of both work and hobby.  I say "thought" because up until this past weekend, I was sure that the harsher headaches I had endured qualified as the infamous 'migraine' variety.   I was wrong.
On this past Saturday, I had the pleasure of seeing one of my best friends (and also my best man at my wedding) tie the knot with his sweetheart (both are coders by trade as a sidenote).  The day was perfect, the weather was wonderful (as it was an outdoor ceremony) and all was well in general.  I on the other hand aside from coping with sciatica down both sides of my body (a relapse of a previous L4/L5 left disc rotation), awoke with what I thought, was one of my annoying 'migraine' headaches.  I took Excedrin Migraine along with Vicodin for my other-pain and proceeded onto the wedding with my wife.  The headache didn't subside, regardless of a second round of 'migraine' strength medication.

The first lesson to be learned here is that Excedrin Migraine (I'm pretty sure any over the counter "migraine" medication as well) , while great for 'bad' headaches, is lightweight against 'textbook' migraines (more on this later).  

     After the wedding was over and we made the drive home (hellish for me as my headache seems to have grown from annoyance to throbbing), I started to feel dizzy with a bit of nausea, yet did not succumb to an involuntary protein spill thankfully.  I ended up retiring fairly early figuring that my 'migraine' was just particularly bad and was exacerbated by the fact that our table at the reception was next to the live band.
     Sunday morning arrived and that horrible headache was still present.  I took two vicodin and several aspirin in the hopes that it would finally kill the beast within but it was all for naught as much to my dismay, the headache only soldiered on.   I spent much of the day in a narcotic (vicodin) induced stopor in an attempt to mask the pain which was at this point pressing heavily on my head, and would remain this way the rest of the day into the evening when I retired early in an attempt to once again let tomorrow come without the now 36 hour headache.  Little did I know that this was about to get worse, much worse. 
     Memorial Day arrived, complete with plans to go to my in-laws for a barbeque and family goodness.  04:00 on the clock and I arose from my sleep to the udder shock that the pain was not only existant, but worse.  I quickly (well, as quickly as I could) went downstairs to take three Advil (I was now out of Excedrin Migraine), and then return to bed, hoping this was finally the end.  The time was 08:00 according to the clock and I was expected to rise.  Problems.  The headache was still there, and it was rather angry with me.  Outside of glancing to see that it indeed was 08:00, I had to keep my eyes shut, the dizzy feelings, nausea and pain from the light (through the blinds, mind you) was unbearable.  It felt as if my head had been mounted between the the grips on a vise.  I at this point, took the decidedly un-male action and asked my lovely wife (and child) to get me to the Doylestown Hospital Emergency Room.  Something was obviously wrong and I was quite worried, not to mention blinded by the pain.  
     After what seemed like an hour (when in reality it was half of that), I entered the ER and was promptly thrown in a wheelchair, tagged and admitted to ER room #5.  At this point the pain caused me to writhe in pain in my open-backed hospital gown in my new metal bed.  Another 10 minutes came and went, along with an increase in the pain until one of the nice ER nurses (and a doctor I believe) tapped my arm to place an IV line, which was utilised shortly thereafter to inject a medication (a narcotic of which I'd never heard) that immediately overpowered the pain with a feeling of numbness.  This enabled me to speak somewhat lucidly to several nurses as well as a doctor about all of the aforementioned backstory leading up to this point.  
     First comes the catscan at this point to check for abnormalities.  None found.  Then the blood tests, no oddities either.  ER Doctor then comes to the conclusion that a LP (Lumbar Puncture) was the next logical step.  I consented, though it was not to be, after a considerable number of jabs and sharp pains, said doctor gave up and contacted a Neurologist who would come in later to do said LP.  
     The pain started to return and I was given another dose of said magic narcotic.  All remained well for another 90 minutes or so (at this point, I've been in ER room #5 for approximately 6 hours).   During this time the Neurologist arrived and I spoke with him and allow him to have a crack at a lumbar puncture.  Needless to say he was an expert at this procedure and was able to withdrawal 4 vials of the clear cerebrospinal fluid from my spinal column.  He then surreptitiously disappeared for what seemed like hours.  
    It was at this point, my pain surprisingly started to return, first on the right side of my head, but then started to migrate over to my left side as well.  The pain became so severe that I could tell that the lights were on in the next room over (separated by a curtain), even though I had a folded over pillow case upon my eyes, with my hand over that.  The lights in my room had been out since my arrival as they were painful, even with my eyes shut.  I felt as if I were going to tear the metal sides of my bed clear off.  I suffered like this for another 60 or so minutes as we were awaiting the results of the spinal fluid from the lumbar puncture, and it was already stated that I was given an extraordinarily large amount of narcotics already and they worried about providing anymore until they knew more about the cause of my pain.
     After all was said and done, I was told that this whole episode of the worst head pain in my life, was a 'real' migraine.  I was told that they would provide me some additional medication intravenously before being discharged which would 'kill the headache' this time.  I was also being given more subscriptions, one for vicodin (as if I didn't have enough for my back pain, which I already try to avoid using), but a medication which i had never heard of before, specifically meant to stop migraines at their onset.  That final migraine killing injection came, along with a complimentary spewing of my stomach contents shortly thereafter and I was on my way to being released.  I was informed by the doctors that there were a few things I could do to keep migraines at bay aside from the medication provided.  

"Caffeine, Caffeine, Lots of Fluids, and of course, more Caffeine."

     I'm thankful to all of the wonderful nurses, doctors and specialists who provided help to me after suffering what ultimately will be remembered and hereafter referenced by me as the 60-hour migraine.  I will never use the term "migraine" mistakenly to mean a "severe" or "bad" headache as they not only aren't in the same ballpark, they're not in the same league, region or country.  
     I decided to share this with everyone in the coding community because I'm sadly sure that this will happen (if it hasn't already happened to some of you) again, and to others.  I hope that having read this, those who find themselves suffering one of these 16 tonne behemoths will not wait an exorbitante amount of time before doing exactly that which I did, contact professional medical help as quickly as possible.  No one should have to suffer that kind of pain any longer than it takes to realise what said pain was; that being a 'real' migraine.  

     Wishing everyone good health.

Eric