Rogue Migraine

Like a rogue tsunami, a rogue migraine arrives in waves, alternately searing, squeezing, throbbing, burning, knife-stabbing inside the skull. It's a ten on the ten-point ER pain scale. And one trauma doctor told me this weekend that one in every twelve emergency patients in his hospital is there with a migraine.

Most serious migrainers probably know about drugs like Imitrex, Zomig, Amerge and Frova, all serotonin adjusters which have become available within the last fifteen years or so. For many sufferers, these drugs and others like them can eliminate or at least reduce the symptoms of migraine, if they can get to them at the first sign of pain. I know, because in the past ten years or so these drugs changed my life.

Over nearly four decades of migraining I've tried everything. Wild synergies of substances like Fiorinal, Vicodin and Percocet, often with caffeine for backup and alcohol to sleep, were not uncommon. I don't care to think of all the addictions I've barely dodged or unconsciously adopted and ultimately shed. How I managed to function through all that is unclear, a residual fog. I don't know.

But this week nothing worked. From Monday afternoon, when I began alternating Imitrex and Frova, to early Saturday morning when I was injected in a hospital with two full doses of Dilaudid, I was hammered by a constant crescendo of pain. By Saturday night I was curled into a fetal position on the floor of an ER waiting room in Encinitas, California, writhing, screaming and startling a roomful of onlookers as I tried to kick a coffee machine into submission. Or at least so they tell me. I don't really know.

What I do know is that I got lucky. I landed in a hospital where doctors have formulated a new drug cocktail for dealing with migraines, one that uses none of the opiate painkillers which have been the backbone of such therapy for decades. Instead of trying to simply ease the pain, as you try to do with Vicodin, or even to fix the serotonin imbalance, which can be done with drugs like Imitrex, this new protocol goes after the cause of the pain, which is inflammation of the brain lining. The intravenous sequence introduces a coating for the stomach, then a non-opiate painkiller, cortica-steroids and an anti-siezure drug. Within a couple of hours and after two of these intravenous sieges, I emerged from six days lost to pain.

Several of my doctor friends have weighed in on this experience, and all confirmed that inflammation is the new frontier of preventive medicine and pain relief. But ask any healthcare professional these days and he or she will tell you most insurance companies are too slow to embrace prevention. To make the system work for you, it's important to self-educate, to remain aware of advances in medicine that might affect you. It's not often you'll get as lucky as I did last night, walking into a hospital which happened to be on the cutting edge in fighting migraine.