That’s right, we’re moving to Boston in August! Hart was offered a job he couldn’t refuse. As much as I love Seattle, I’m excited for an adventure. I’m also terrified, but isn’t that a part of every adventure?

I hope better health and more time to write will coincide with the move. Although a change of location is unlikely to spur the change, birth control pills might. My migraines and headaches reduced in frequency and severity after I had taken birth control pills for three months. Unfortunately, they also caused horrendous nausea.

I’ve spent the last few months drugged up and conked out. Deciding I was better equipped to handle head pain than nausea, I stopped the pills last week. Sure enough, the nausea is gone, but head pain and general wooziness are back. I’m seeing a gynecologist tomorrow to determine what to try next. I imagine it will be a brand with different synthetic hormones. I hope I won’t have to wait another three months for them to take effect.

So, that’s what’s been going on in my life. I hope you have been doing as well as possible!

Telcagepant, a migraine abortive with much success in clinical trials

The article doesn’t explain why, but here’s my take: People with frequent migraine episodes often take abortives more frequently than recommended. Even using telcagepant as an abortive, these patients could also develop high levels of liver enzymes.

The bad news for migraineurs is the findings could be significant enough to shelve the drug permanently. Merck, which was banking on the drug, can’t be too happy either.

What are your thoughts on why the drug is on hold?

Did you know The Daily Headache is tdhblog on Twitter? So are a bunch of other folks with headache and migraine. Set up a Twitter account and you can follow any of us. All the cool kids are doing it!

This is great news for the many people who have found relief from migraines or headaches with Topamax. Except for the side effects, which many find intolerable, Topamax is often called as a “miracle drug.” I don’t believe in miracle drugs, but one that can help so many people is pretty impressive.

Ortho-McNeil Neurologic’s patents on Topamax began expiring last year.

Related posts:

• Trouble Thinking on Topamax? Study Finds “Language Disturbances”
• Antiepileptic Drugs Linked to Increased Risk of Suicidal Behaviors and Thoughts
• Preventive Drugs Improve Quality of Life for People With Migraine

[via Somebody Heal Me]

The stress, caffeine I drank at the hospital, and messed up sleep schedule has extended Wednesday’s planned migraine into multiple migraine days. The nausea has been unbearable and I’ve been drugged to the hilt. That made yesterday not too bad!

Hart is out of sorts too. He went straight from the airport to the ER after returning from a three-day business trip to Atlanta. Except for constant drilling outside — we have to replace the main water line to our house — things are quiet around here. Baseball season starts Sunday and MLB has free games online this weekend. I imagine we’ll spend a lot of the weekend watching baseball. Sounds perfect to me!

Rereading this post, I’m pleased to see my automatic response is to turn lemons into lemonade. This isn’t the case all the time, but is my default. I don’t know how I would survive migraine life without a positive attitude. I’m so grateful.

After years of constantly overdoing it and constantly being sick, I learned I become terribly ill when I push myself too much. Now I know to hold back; sometimes I think too well. I’m stuck at home with migraines so often. There’s only so much time I can give up because one might come along.

Last year, a friend taught me that I don’t have to shirk anything that might make me sick — even if it is something that I’m absolutely positive will result in at least a day in bed. She showed me I can choose certain times to push myself without doing it every single day. The trick is knowing one day of indulgence can lead to one (or more) days of feeling awful.

When planning yesterday’s trip, I factored in today as a sick day. Other than letting the plumbers in, I made no appointments or plans. I stocked up on easy food and checked out a good audiobook. By intentionally making a trade off, I feel no guilt.

I know I should never feel guilty for being sick, but I rarely do what I should. Today I can see what a reprieve it is to just let myself be as I need to be.

Related posts:

• Balance is Overrated: Choosing Fun Despite Knowing Vengeful Migraine Imminent
• Balance & Illness (and Always Overdoing Pushing Myself Over the Edge)
• A Banner Day
• Walking the Tightrope
• The Spoon Theory of Illness
• Balance? Yeah, Right

The allergist thinks I’m one of about 20% of people who have nonallergic rhinitis. These folks aren’t bothered by typical allergenic inhalants, but by a host of other possibilities, including odors, irritants in the air, weather changes, medications… Mayo Clinic’s definition of rhinitis:

If you do have rhinitis, the lining of your nose swells due to expanding blood vessels. The mucus glands in your nose get stimulated, causing a congested, drippy nose. The symptoms of nonallergic rhinitis are similar to those of hay fever (allergic rhinitis), but there’s no allergic reaction involved.

The treatment is a simple spray of intranasal corticosteroids, like Flonase. Great news, right? Except that a study written up in this month’s issue of the journal Cephalalgia indicates nasal steriod sprays can trigger migraines! I’m going to try it, but nasal irrigation (with a neti pot) might be a better solution. You may have heard of nasal irrigation about a year ago, when Oprah praised its benefits.

Using a neti pot is simple. Basically, you pour a saline solution up one nostril and it comes out the other. I won’t lie — it feels bad and weird at first. It takes patience to put up with the initial unpleasantness. Once you get the hang of it, nasal irrigation actually becomes pleasurable! Here’s how it works:

I’ve never used a neti pot consistently, but am always pleasantly surprised by how my sinuses feel afterward. It’s an easy, inexpensive treatment to try. Neti pots, some of which come with salt packets, are $10-20 on Amazon. Making your own saline solution is simple and much less expensive. The basic recipe is 1/4 teaspoon non-iodized salt to 1 cup warm water. (Distilled or purified water is preferred. To use tap water, bring it to a boil, then let it cool before using it.) You can choose to add extra ingredients. A 1/4 teaspoon baking soda makes the solution more soothing. You can keep your nose from drying out by adding 1/4 teaspoon glycerin.

I’m dedicated to giving nasal irrigation another shot. I’ll do it every day for a week, starting today. If you’re interested, you can track my progress on Twitter. How about you? Does it sound like a good treatment or does it just gross you out?

Check out neti pots on Amazon and help support The Daily Headache!

I’ll still write in-depth posts sometimes, but would rather share them with short comments than not at all.

WebMD’s triptan overview is excellent. Check out specific drug websites for detailed information on each one:

• Axert
• Relpax
• Frova
• Amerge (PDF)
• Maxalt
• Imitrex (available in generic as sumatriptan)
• Zomig

I’m dropping off my Relpax prescription right now!

I’m in my fourth week of birth control pills. I’ve been spotting for the last 10 days, which I assume has contributed to the migraines. I plan to give the experiment a couple more months, but am not sure if I can make it that long.

I’m increasingly certain that allergies trigger at least some of my migraines. You may remember last spring was also horrible for me. Magnesium certainly was a factor. I wonder if allergies were also involved. Taking a Zyrtec yesterday appears to have reduced my agony tremendously. I had to reschedule yesterday’s appointment for allergy tests (for the third time) for later this month. (Please note that although allergies don’t cause migraines, they can be a trigger.)

My outlook is surprisingly good. Especially considering a bad appointment with my headache specialist Monday. The gist of the appointment: I have headaches and migraines that haven’t responded to treatment. With time, headache research will uncover more clues. Until then, why not try some more things in case they help? And I should think about medication to “make life bearable,” like morphine. (That’s a can o’ worms I can’t open right now.)

Back to the good outlook: If I have to live with migraines and headaches, at least I can do it the best way possible. I have a comfortable home; supportive, patient friends and family; and an understanding husband. My insurance covers a variety of treatments. I can stream NPR and audiobooks from the library. I eat good food that I don’t have to make. My life is as good as it can be right now.

I’m sad to not post more on the blog. I want to write about news and research. I want to share resources. I want to write about myself less. I want the blog to be like it was two years ago. Change is inevitable, so I’m trying to not worry about it much. Maybe I’ll get there again, maybe not.

Yesterday I slept while Hart went to lunch with friends. From 3 p.m. on, I sat in my corner on the couch. We had plans with friends for dinner. They came over, we ate pizza. I stayed on the couch.

Today I felt great when I woke up, then I showered and crashed. I slept while Hart went to lunch with friends. After they all left, I moved to the couch. I’ve had several swings of feeling better today. I get up each time, happy to have energy. I keep my activities light, but am always back on the couch within 10 minutes.

I don’t think I’m being lazy, which might be worse than doubting myself. This weekend I’ve seen that nothing I do will guarantee I’ll feel better. I work so hard to feel better. Whenever I feel like I’ve made progress, I’m knocked down again.

I’ll wake up tomorrow morning no longer angry. I’ll still know how easily I can be defeated.

I’d like to end this post with my usual upbeat twist. I can’t do it right now.

Monday morning: As usual, I cried it out with Hart last night and am much happier this morning. I also feel much better physically. Phew!

Then the hormones from the birth control pills I started Sunday morning kicked in and triggered a massive migraine. It eased off today and I’m enjoying the break. My migraines will probably be more frequent as my body adjusts to the hormones. I’m trying to be extra vigilant so I can use abortives as soon into the migraine as possible.

It has been a tough week, but I’m in good spirits. Since this last migraine let up, I’m using my migraine-free moments wisely. I’ve spent four hours organizing the basement, made cookies and cleaned the kitchen. Now I’m working and looking through the picture window at falling snow. I have a pretty good life.

I’m flat on my back in bed, holding my laptop in the air with one hand and typing with the other. Will likely spend the day watching Ugly Betty in a similar position. I plan to give updates through my Twitter account, TDHblog.

First I need to call the doctor to schedule a blood patch.

The generic hasn’t been as effective as the brand name drug for some patients. In Generic Imitrex (Sumatriptan) — Is it as Effective as Brand Name Imitrex, blogger Doc Shazam writes:

…I have taken 2 of “Dr. Reddy’s” generic sumatriptan tablets with almost no relief of headache symptoms, but a plethora of side effects, including aching muscles, nausea, “light headed” feeling and general dis-ease.

Read about other patients’ experiences in their comments on earlier posts on The Daily Headache:

• 11/18/08: Generic Injectable Imitrex (Sumatriptan) Now Available
• 2/4/08: Generic Form of Migraine Abortive Imitrex Available By December 2008

This is particularly frustrating for me because I turned down a well-paid gig for this very reason. It is something I checked for on Wellsphere, but somehow missed. I admit, it was in the fine print, but e-mails with company representatives were murky.

I have requested to have my account with Wellsphere removed and am no longer participating in the health blogger awards. If you are a blogger, please read ChronicBabe’s post on intellectual property rights. You may want to consider cancelling your account as well. In a show of solidarity, registered members without blogs may want to do the same. To do so, email your request to community@wellsphere.com, wellsphere-system@wellsphere.com and dr.rutledge@wellsphere.com. If that doesn’t work, try this method from Kerri at Six Until Me.

[via ChronicBabe]

Update: I realized Wellsphere is the company that created an account for me last year and republished my content without my permission! I had them cancel it in November, then was dumb enough to sign up again this year for the blog awards. Apparently flattery will get you everywhere with me.

I was early enough in the migraine for caffeine to help, so I got a latte next door to the yoga studio and headed to my car. When the music started in the car, I had to turn it off — that almost never happens. I sat in silence, wondering if I could make it to Whole Foods. No, probably not. I went anyway.

I was in a daze, but the pain had lessened. Although it took five minutes to find my misplaced cart (I’m not exaggerating), I made it through the store OK. Cook’s Illustrated and Real Simple magazines were my only impulse purchases. (My impulse control is severely impaired when I’m shopping with a migraine. Does that happen to you?)

Now I’m on the couch. The active part of my day is over, but it isn’t all bad. Reading isn’t make my migraine worse, so I’m grateful for the magazines. I’ll get to listen to my current audiobook, On the Road. I have leftover cherry cobbler. I have a backlog of Ugly Betty episodes. It could be better, but I’m not unhappy.

People with migraine are likely to have mood disorders, like major depression, anxiety and panic attacks

From the current study’s press release (emphasis mine):

Mood Disorders, Migraines Might Be Connected

Migraine headaches can precede the onset of mental disorders, according to a growing body of knowledge that includes a new study in the January-February 2009 issue of General Hospital Psychiatry.

“Together, migraine and mental disorders cause more impairment than alone,” said lead study author Gregory Ratcliffe. “Patients who have one condition should be assessed for the other so they can be treated holistically. Although it is important to know that both are present, treating one will have an effect on the other.”

Ratcliffe is with the department of psychiatry at the University of Manitoba in Canada. He and his colleagues analyzed data on 4,181 participants in the German National Health Interview and Examination Survey. Migraines were diagnosed by a physician and trained interviewers evaluated participants for mental disorders.

Researchers found that 11 percent of participants had migraines. Participants had a variety of disorders: major depression, general anxiety disorder, dysthymia, bipolar disorder, panic attacks, panic disorder, substance abuse disorders, agoraphobia and simple phobia.

The authors considered two theories that might explain the relationship between migraine and mental disorders. The first theory is that a common factor influences both conditions, such as low activity of enzymes that deactivate certain chemical messages sent to the brain. They also considered a causal relationship: This study and others found that anxiety often precedes migraine, which often precedes depression.

Frederick Taylor, M.D., director of the Park Nicollet Headache Clinic in St. Louis Park, Minn., said that migraine co-morbidities — depression, anxiety and other disorders — affect 83 percent of migraineurs and explain 65 percent of their inability to function in life, more than the pain itself.

My bouts of depression show this is true for me. It is also true for other headache bloggers, like Diana from Somebody Heal Me. How about you?

Thanks!

for The Daily Headache thedailyheadache.com

My body felt better. My mind felt better. My head even felt a little better. At home, my practice is always half-hearted and rushed. It is more about getting through what I need to do. What I’ve always loved about yoga is focusing on the good my body can do instead of how my health drags me down. I feel strong and whole. I haven’t found that in my home practice, but I felt it in class.

Maybe because I felt safe with the teacher walking me through everything I had to do. I pushed myself, but gently. My neck and shoulders, already loosened up after a massage on Monday, felt better than they have in a year. Seriously.

Having only a few good hours most days, usually in the morning, has kept me from class. If I devote that time to class, then I don’t get anything else done. Tuesday I went to class, then had a great rest of the day. More energy and strength followed. I got my good hours and then some.

Maybe it was a fluke, but Monday and Tuesday were great days. I felt good physically and mentally. I’d like to attribute it to massage and yoga. Or maybe it was the return to exercise, as not exercising contributes to headaches. (Although I doubt one day made much difference!)

In any case, I’ve planned a new routine. Such plans aren’t usually successful for me, but I think I can do this. Massage at 9:30 a.m. Monday and yoga in that time slot on Tuesday and Thursday.

Just like that I swung from despair to hopefulness. I’m trying to temper my excitement, but it is hard. Not only did I do something I love last week, I think it actually helped my head. *fingers crossed*

To reassure myself, I looked at the review of my 2007 treatments and treatments I planned for 2008. The lists are so long I tire remembering all appointments I’ve been to. This should be proof that I’m trying to get better. Too bad my inner perfectionist tells me I should be able to do more, no matter what the project.

During my (mild) meltdown last night, Hart asked how he could help. I asked him to tell me that I do work hard at getting better. He looked so pained when he told me I work as hard as I possibly can. Having him say that was so reassuring. If he thinks I’m trying hard enough, I must be.

I wish I didn’t need outside confirmation for things like this. Ha! That sentence makes me laugh. Of course I’m too stubborn and independent to ask for help. Of course I want to do it all on my own. I simply can’t — none of us can. Maybe I’ll remember that for a few days at least.

And maybe I’ll remember I’m working my butt off to get better.

Every hands-on craft I try causes wrist pain that I haven’t been able to conquer. Baking is fantastic, but consuming all that I make isn’t a smart dietary strategy. So I’ve decided cooking will be my new hobby.

Although deciding to do something I’ve never particularly liked for fun is a little weird, it makes a lot of sense. I’d love to have a hobby again. I like food, I need to eat, and eating better food would probably make me feel better.

By approaching cooking as a hobby instead of a chore, I hope it will be fun, not the high-pressure job of reforming my diet. Ideally cooking will become something I want to do, not have to do.

These are the guidelines I’ve established so I don’t exhaust myself. Is it contradictory to set goals for a hobby?

Use Simple Recipes
I’m currently taking Mark Bittman’s (aka The Minimalist) no-nonsense approach: Make better food in less time with fewer ingredients. I’m starting small with his very short cookbook, How to Cook Everything: Quick Cooking. It isn’t an overwhelming tome, but a short introduction to tasty basic recipes. A perfect housewarming gift for someone in their first apartment, the book includes variations for the more experienced or adventurous cook. I’m supplementing with The Minimalist Cooks at Home for variety. (It’s out-of-print, but is available used.)

I’ve owned it for four years and have liked the few things I’ve made from his books. Now my plan is to approach it methodically. Like Julie and Julia, where blogger Julie Powell set out to make every recipe in Julia Child’s Mastering The Art of French Cooking. The Minimalist’s goals are much less lofty, but the idea is the same.

Buy Ingredients for One Meal at a Time
This is to avoid wasting food and feeling like I’ve failed. I broke this “rule” one day into my plan. Because this is a new hobby, not a resolution, I’ve no need to beat myself up. Good things hobbies don’t have rules. Besides, I still think I can do it.

Learn New Techniques
This is the part that turns work into entertainment. I’ve always been reluctant to cook meat on the stove. In fact, I’m reluctant to cook meat at all. Not only do I get to produce an edible product (however bad it may be), I expand my skills and learn new recipes. This will make my hobby more fun in the future.

Tomorrow I’m taking the knife skills class I’ve wanted to take for years. It’s a morning class, so I’m confident I’ll make it this time. I’m already daydreaming about future classes.

Do It
I made my recipe plan yesterday morning, then Hart called to say he had a work dinner. I felt crappy, so it was fine, but my motivation is far weaker than 24 hours ago. I hope applying the techniques of the knife skills class will boost my overall motivation.

Clearly there’s little difference between my new hobby and a New Year’s resolution. Since resolutions usually fail, I’m relying on the power reframing. It’s an essential skill of every optimist.

I hope simple cooking will become a frequent topic on The Daily Headache. Nutrition and ease are some good topics for a headache blog.

Photo by Joe Zlomek.

Although the doctor wants to see me monthly, the next available appointment is in March. Before then I’m supposed to get a lumbar puncture (spinal tap) and more blood work. My last lumbar puncture resulted in a three-week headache and wasn’t responsive to a blood patch. I’m not looking forward to it.

Menstrual Migraine
I got a birth control pill prescription to see if it will manage the two-day migraines I get when my period starts. In typical fashion, I haven’t filled the prescription. The migraine that kept me in bed my first two days of vacation in Mexico should motivate me to to take it to the pharmacy.

Allergies
After always feeling worse after vacation, I finally admitted my headaches and migraines are worse in Seattle than elsewhere. I was in Kansas for a funeral the last weekend of October. I was shocked to wake up two mornings in a row with a barely perceptible headache. Nor was I as congested as I always am at home. I took Zyrtec for a few days and both my congestion and migraines were less. Not a reliable experiment. It unfortunately made me nauseated, so I couldn’t keep taking it. I’m trying Claritin now.

When I was tested for allergies when I was 14, I responded most strongly to mold. That wasn’t an issue in Phoenix — quite the opposite in Seattle. Studies indicate than while allergies don’t cause headache, they can trigger migraines. Thursday I’m seeing an allergist and will probably get tested for allergies. Maybe she can sort something out.

Migraines Triggered By Reading & Working on the Computer
These are still in full-force, hence my infrequent posts. A loved one who is an ophthalmologist gave me a thorough vision and eyestrain exam when I was in Phoenix for Thanksgiving. The diagnosis was convergence insufficiency. That means:

Convergence insufficiency occurs when your eyes don’t turn inward properly when you focus on a nearby object. When you read or look at a nearby object, your eyes should turn inward while you focus, so you can see a single image. But if you have convergence insufficiency, you need to use extra effort to move your eyes inward for focusing. This extra effort results in various symptoms, including eyestrain.

I’m now using an eye patch when I read or am on the computer. So far, I’ve been able to squeak out about an hour on computer with it. I still get a headache if I push it, but it is mild and doesn’t explode into a migraine. If the eye patch continues to be OK, I’ll get prescription reading glasses with a prism, which I can wear over my contacts.

From Par Phamaceutical’s press release:

Par Pharmaceutical Begins Shipment of Sumatriptan Injection
November 6, 2008 – Par Pharmaceutical Companies, Inc. today announced that it will begin shipping generic versions of Imitrex® Injection (sumatriptan succinate injection) 4mg and 6mg starter kits and 4mg and 6mg prefilled syringe cartridges to the trade immediately.  In addition, Par anticipates launching the 6mg vials early next year.

[T]he problem with statistics is that they’re misleading. 8 times more likely… 8 times what? You need to find out what the baseline actually is, and you need to find it out for your own ethnicity, gender, circumstances before you know if this is a problem. If for example the baseline is 10% then 8 times is pretty ghastly, however, if the baseline is 0.01% then you’re still at 8 times 99.92% likely to NOT get one.

I’m kind of embarrassed I didn’t think this through before I wrote the post. I’m always urging readers to think critically. No matter how much I recommend caution, I too fall into the trap of fear. “Stroke? Eight times more likely? No way!” is how I reacted yesterday.

According to the American Heart Association’s stroke risk factors, I’m at very little risk. That’s reassuring. I’ll talk with the doctor on Monday and see what she recommends.

Check out the this BBC article on understanding — and critically evaluating — statistics, which Kersti suggested.