I am not a headache sufferer . . . nowhere to the extent of my patients at least. My mother and sister, both suffered from migraine with aura. I have had episodic migraines that, while severe, are rare. Each time I have one, I think of what a horrible nightmare to suffer like this, as my patients do, and they do at a high frequency. Each time I have one, I learn something new. It is also the watershed of my compassion to do whatever I can do to help these sufferers get better.
I often deemphasize stress as a “cause” for headaches. The reason is, I believe, is that I’m reacting to society’s misconception that headaches are always caused by stress. While stress is not the cause, it can be one of many triggers.
Yesterday’s Attack and What I Learned This Time
I was working in Mount Vernon yesterday. I received two bits of bad news back to back (if you own a small medical practice, these days, bad financial news has become a daily occurrence). I felt stress building but had an over-booked schedule of patients and, as usual, didn’t have a second to think about it. By noon, when I should have been pausing for lunch but couldn’t, I was starting to feel a headache build behind my eyes. I had to ignore it. By 1 PM it was getting out of control with a pain level at least at a 6/10. I knew I had a full day of work still ahead of me and I had to get through it one way or another.
By 2 PM it was a 7-8/10 and becoming unbearable. I paused to use a Zomig nasal spray (only the second time I had ever used one). In about 10 minutes, still seeing patients, I noticed a horrible bitter taste in my throat, I am glad I had no severe nausea with this headache or I would have been puking by then. That taste eventually faded and by 2:30 my headache had paused at the 7-8 mark. Still busy with patients, by 3 PM I noticed that my headache had dropped to a 5-6 but I had a significant pain in my chest/throat. The best way to describe it as like an apple on a rope being pulled up from my stomach through my esophagus. The intensity was about a 4-5/10 and lasted about 25 minutes. I knew what it was, a side effect that sometimes comes with the triptans, but I had never experienced it before.
By 4 PM my headache was at a 3-4 /10 and the throat pain was gone. By the time I finished my day at 6 PM, my headache was still hovering around a 2-3. It continued at a 2-3 pain level (driving facing bright oncoming lights raised it a point or two) until I go home at 7 PM. Then I took another Zomig, but a tablet this time. Once again the throat tightness came back for 10 minutes (milder) and went away. I went to bed early, at 10 PM with a 1-2/10 headache and awaken this morning headache free.
Of course most of my patients are not this lucky and I know that. But the thing I observed with this attack was this was the first time I had the side effect from a triptan (I only have to use a triptan about once a year). While the chest pain was uncomfortable, compared to the headache it was nothing. It was not scary just . . . uncomfortable.
I have met a huge number of patients who have tried injected sumatriptan (the worst for chest tightness) or another triptan and had this same side effect. Then either they, their family member or sometimes even their provider freaks out and says, “You better never take one of these kinds of drugs again!” And they don’t. This idea or belief then takes away an extremely useful resource for them, making their headaches much harder to treat in the future.
Migraine is like a saber-toothed, fire-breathing dragon. You can’t fight it and win with a water pistol. I, personally, would not hesitate for a second to use Zomig nasal spray again despite the bitter taste and 30 minutes of chest pressure. As compared to a terrible headache (and I was heading towards a 9-10/10) it is NOTHING.
So, while other personal migraines have taught me about sensitivity to light, the terrible pain of vomiting when you have a severe headache, noise sensitivity and the inability of others to understand your headache pain when you are having one . . . this one taught me how much worse a headache is than the side effects of a triptan. I am grateful for them and for how the brain’s headache alarm does have an off switch.