Sensitivity

So far, so good with the inderal - no migraines, and it’s been nearly a month since I started taking it. The side effects haven’t been too bad, either. But I still find myself very sensitive to environmental stimuli. Smells, bright lights, and loud or repetitive noises grate on my nerves, even though they don’t trigger migraines for me, at least at the moment.

I was, therefore, amused and sympathetic when I saw Kerrie Smyres’ latest post on The Daily Headache.

Something similar happened to me yesterday. I was waiting for a friend outside her office in a suburban office park, and the little shuttle bus that ferries people around the complex pulled in - and sat there idling its smelly diesel engine for 15 minutes. Between the sound and the smell, I was actually fantasizing about calling the police. (Aren’t there are laws about how long a vehicle can idle?) Instead I suffered until my friend came out, and I’m afraid the first thing I said was not, “How are you?” or “Nice to see you!” but “Does that damn thing always sit there idling for 15 minutes at a time?!” My poor friend. Like everyone in my life, she’s had to adjust to the recent resurgence in my migraines, and I’m sure she just did not see that outburst coming.

The starting construction work at 7:00 am thing that Kerrie describes has always bothered me, though, even before my migraine remission ended. It makes some sense in the winter, when daylight ends at 4:00 pm and the crews can barely get in a full day’s work. But the other 9 months of the year, why on earth can’t they work 8:00 to 5:00, like everyone else? I’ve heard people argue that it’s to avoid the heat of the day. But the hottest hours of the day are 2:00 to 4:00 pm, which they don’t avoid by starting at 7:00 am. (Oh, heaven forbid anybody gets the idea that construction crews should start at 5:00 am! Forget I brought it up!)

Food Triggers followup

I just ran into this post about chocolate on Migraine Chick’s blog.  I read it with great interest because it is, of course, about food triggers.

Don’t miss the comments.  There are two which talk about the idea of false attribution, which is really just an instance of the infamous post hoc fallacy:  if A comes after B, A was caused by B.  In other words, every time I eat steak-and-kidney pie, I get a migraine.  Therefore, steak-and-kidney pie must be a migraine trigger.

This is false reasoning because there could be many other reasons for the steak-and-kidney pie/migraine correlation.  In this case, you need to understand the concept of the prodrome, that period of time before the migraine aura, pain, or other extremely dramatic symptoms set in, when you’re not quite yourself but you’re not experiencing any debilitating symptoms.  Lots of people have food cravings then.  Perhaps, then, a desire for steak-and-kidney pie is a symptom of the prodrome?

(This reminds me of a group of scientists, clearly in the minority but with worthwhile arguments, who argue that high blood cholesterol is not the cause of cardiovascular disease, but a symptom of it.  Their argument, in part, is that cholesterol is used by the body in tissue repair, and a lot of it gets released into the blood vessels if they are damaged and need repair.  If they are right,  one implication of this is that cholesterol-lowering drugs will not only fail to prevent cardiovascular disease, but they might actually be counterproductive.  Sort of off topic for this blog, but interesting.)

Food Triggers

Dear Migraineur readers,

I am curious - what do you think of the concept of food triggers?  I will prejudice the discussion by telling you what I think.  I think that people who have the occasional migraine (you know, once a month or less) certainly could have a food trigger.  For those of us who have several a week or more, I think it’s probably nonsense.  Or maybe it’s not total nonsense, maybe it’s just that folks who have frequent migraines have dozens of food triggers, so many that it’s effectively everything.  And, saying all foods trigger a migraine isn’t that much different from saying no foods trigger a migraine, if you see what I mean.  (A migraineur’s gotta eat something, after all.)

This is a bit of a sore spot for me, because there seems to be a pervasive notion out there that if we just keep our little food journals and review them carefully, we will magically realize, “Oh, I should definitely not have eaten that coconut cream pie!”  And then if we continue to eat the coconut cream pie, our migraines are our own fault!

Look, this is complex, like any issue of health and illness.  Now that our affluent society has conquered, or nearly conquered, most of the worst infectious illnesses, many the truly devastating diseases are lifestyle-related.  But many lifestyle-related diseases have a genetic underpinning; we are more susceptible to diabetes, or cancer, or heart disease because we have the parents we have.  Those genes are expressed in an environment, though, and if you don’t give the genes the environmental raw material they need– no expression.  So it does seem to me that there’s a certain way in which many kinds of illness kind of are our fault.  Sort of, in a limited way.  If you get what I’m saying.  I know that’s not a popular thing to say to people who are sick, and I know many of my readers come here to be consoled, not to be blamed.  And I sure as heck don’t want to be blaming people, any more that I want someone telling me that surely my migraines are caused by something I voluntarily did to myself.

This is why the food trigger issue still bugs me, if only because my experience eliminating the most common triggers was so disheartening.  I gave up red wine for 6 weeks - still got 3 migraines a month.  Gave up artificial sweeteners for several weeks - migraines galore.  Avoided MSG and all other sources of glutamate, including the hair conditioner the Red-Haired Boy likes - migrainey-migrainey-migrainey-boo!

So then I started thinking about less common food triggers - you know, some extra-special personal food trigger that is Mine and No One Else’s.  The problem with this is that I eat an extremely varied diet, and there is no one thing that I eat often enough for it to be a problem.  Seriously, I don’t even eat bread every day the way most people do.  After my success several years ago on a low-carb diet, I got out of the bread habit, and while I do consume bread now, it’s only a couple of times a week.

I’d love to find a food trigger, even it turned out to be my absolute most favoritest food in the whole wide world.  Because then it would be under my control.  But I’d hate to find a food trigger, even if it turned out to be something that I could easily give up.  Because then my migraines would be my own damn fault.

Endure-All, Day 15

Today I go to get my blood pressure checked.  I’ve been following it in the drugstore (not accurate, I know), and it seems to be going down slightly.  Yesterday it was 96/53, probably the lowest I’ve ever seen it, but not out of keeping with 99/59, a fairly typical reading.

People with low blood pressure don’t do well in hot or humid weather, and I think the Inderal might be exacerbating this, but only slightly.  I have been getting tired a lot lately, but I’ve also been under stress.  So I am not sure whether it is a drug side effect or not.

Speaking of under stress, I was, in a way, pleased to learn that the adrenalin receptors in my brain have not been totally shut off by the Endure-All.  Yesterday was a day of great demands - lots of work demands, lots of stuff to do on the upcoming purchase of a house, and everything with a deadline - and I actually felt a little stressed.  This pleases me because for me the ideal drug will treat my condition but leave me feeling like me.  And the real me would definitely be stressed out by a day like yesterday.

No News, Good News

I haven’t written much lately because there hasn’t been much news on the migraine front.  This is my 15th consecutive day without a migraine.  Considering the amount of stress I’ve been under, with our frantic househunt and the attendant loss of sleep and delayed or skipped meals, I’d say this is a #%@*!! miracle.

I have been migraine-free for more than 14 days before, but never under such conditions.  Either the Endure-All is helping, or I am the beneficiary of the Placebo Effect.  I hope it’s the drug, because in my experience, the Placebo Effect is temporary.

Thus far, the side effects seem to be manageable, too.  I felt kind of icky this weekend when the temperature rose, and in fact at one point my diastolic pressure was a slightly alarming 55, but hot weather always lowers my blood pressure and leaves me a little tired, weak, or faint.  I am still keeping an eye on myself, but so far, so good.

Man With Green Blood Redux

According to a blog called Kevin, M.D, the dosage was 200 mg daily, which is supposedly the maximum “safe” dose.

I not only don’t take Imitrex every day, I also have never taken 200 mg at a time, ever.

News of the Weird - Man With Green Blood

http://www.azcentral.com/offbeat/articles/0607greenblood-ON.html

To understand why this is on my migraine blog, you have to read down to the last sentence.  Apparently the poor fellow has been overdosing on Imitrex!

How cool is this?  I want green blood!  Except I’d like mine to be a nice pretty emerald green, please.

In all seriousness, though, I wish I could find an article about this which says how much is too much.

Endure-All, Day 2

Blood pressure 103/59, pulse 73.  I think the pulse number is inaccurate, since when I took my pulse moments later at my carotid (I can never find it at my wrist), it was 63.  See yesterday’s entry regarding the inaccuracy of drugstore blood pressure machines.

Did you ever look something up on the net and find about forty pages that all say virtually the same thing in virtually the same words, and you wonder who copied from whom?  That was my experience yesterday looking up beta blockers.  In the end, I discovered that beta blockers block the adrenalin receptors in the nervous system, that Inderal is particularly good at blocking the ones in the brain, that the theory about why this works for migraine is that it keeps the blood vessels from spazzing out so much, and that it could take 4 to 6 weeks for it to really work.

The last one is what I was after, because that is probably how long it will take for me to have enough Endure-All in my system to faint while crossing the road and get run over by a car.

Endure-All, Day 1

The beta blocker I’m taking is Inderal.  “Inderal” is pronounced like “Endure-All,” which must be on purpose.  It’s a drug to keep the heads of people with high blood pressure from exploding, a phenomenon I (probably wrongly) associate with people losing their tempers over trivial annoyances.  So Endure-All is, basically, the Suck It Up drug.

I took the first 60 mg capsule of Endure-All last night about an hour before lights out.  I was scared that my BP would drop dangerously low in my sleep and I would die.  But thus far I haven’t fainted.  I haven’t been dizzy or had that “everything is going black” sensation I sometimes get when my pressure is too low.  I felt sleepy, but only at bedtime.  I put my finger on my carotid during a meeting and thought my pulse was chugging along at about its usual rate, maybe a little sluggish, but not alarmingly so.  I took my blood pressure at a pharmacy on my way to work.  The doctor warned me that those drug-store machines aren’t always so well-calibrated, but I couldn’t restrain my curiosity.  The numbers were a little low:  BP 99/59, pulse around 63.  Heck, my BP is often that low naturally.  Truthfully, my pulse should’ve been a wee bit higher, as I had just walked three blocks, but as I hadn’t exactly been rushing, I am not that alarmed.  Also, those heart rate monitors on the gym exercise equipment always under-estimate my heart rate - I think something about my low BP makes my pulse too faint for the machines to detect.  I’ll be going along just barely able to carry on a conversation (which would put my heart rate at around 120-140), and the little heart rate monitor will either register at 55 or flash the helpful message “Heart Rate Too Low - Pedal Faster.”

Endure-All hasn’t killed me yet.

So far, so good.

Doctor Appointment Results

I got everything I wanted - a referral to the neurology clinic, to an ophthalmologist, and to the reproductive endocrine clinic.  In preparation for the last, she is sending vials of my blood to the lab to test my levels of thyroxin, estradiol, prolactin, LH, and FSH.  (For those of you not in the know, the first is a thyroid hormone and the latter are involved in a woman’s menstrual cycle.  Here’s a very good article about them.)

The doctor also told me there’s no point in taking either the magnesium or the B-complex any more, so hopeful my excretory functions will return to normal soon.

Finally, and this is one area I disagreed with her, she prescribed a beta blocker as a prophylactic.  I wanted a prophylactic, but my normal blood pressure range is around 100/60, and often the lower number dips into the 50s, and my resting pulse is about 60, which ain’t bad for someone who is not a marathon runner.  Beta blockers, if you are not familiar with them, are prescribed to lower your blood pressure and heart rate.  It just so happens that they are a migraine prophylactic.

Great, now instead of having an aura while driving, I’m going to faint.  Thank goodness I don’t drive all that often.

She’s being cautious, giving me a very low dose, telling me to take them at bedtime, bringing me in in just two weeks to monitor my pressure, and encouraging me to call her immediately if anything bad happens.  To this I am adding a little card in my wallet:

Medical Alert

I have low blood pressure but am taking 60 mg of Inderal daily for migraine.  If I am unconcscious, I have probably just fainted.  In emergency, call <name and number of doctor> and <name and number of the Red-Haired Boy>.

I am not really happy about this turn of events, but I will try for a few days because I am desperate to stop having migraines three times a week.  And I’m going to a real neurologist who specializes in migraine soon.  I’m sort of hoping he’ll have a fit and say, “You’re taking what?”