Thursday, November 7, 2019

Managing Migraine...With Legal Drugs

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Contrary to popular belief, migraine is not a synonym for "really bad headache."  Migraine is a chronic neurological condition that causes a range of full-body symptoms of which head pain is just one.  It's actually more like epilepsy than a typical headache in terms of physiology and is often treated using the same medications, such as topiramate & gabapentin.  But these meds are only a Band-Aid: there's no cure for migraine--only management of symptoms.  In addition to severe one-sided head pain, sufferers often experience nausea, vomiting, sensitivity to light, smell & sound; changes in sleep & appetite, mood disruption & difficulty with memory or speech.  But symptoms can be even weirder & include things like frequent urination or cravings for specific foods.

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from the American Migraine Foundation

Nobody knows the exact cause of migraine other than that there's a strong genetic link, and women are disproportionately affected.  18% of all women in the U.S. are affected compared to 9% of men, but up to 43% of all women during their reproductive years will experience migraines.  That's a lot.

So what's the solution?  Many medications are prescribed to treat symptoms like head pain or nausea--these fall into two main categories:  preventatives & abortives.  The former are taken on a regular basis to prevent or reduce migraine frequency while the latter are used only when a migraine attack is in full swing.  Some of the most common are the triptans like sumatriptan (Imitrex) & rizatriptan (Maxalt).  For the really severe or resistant ones, you may be lucky enough to get Fioricet, which contains a barbiturate (butalbital) and caffeine.  I am prescribed this & it is a potent benzo-like med that indeed knocks out the pain but comes with an entire day of depression & irritability after it wears off.  Caffeine tablets help with the less severe headaches, though caffeine can cause rebound pain for some people.  Ditto for opioids, acetaminophen & other painkillers.

While some folks may have luck with various diets & other tailor-made strategies, each migraineur is unique & there's no one-size-fits-all solution.  That said, I've found that CBD in the form of isolate or hemp flower prevents at least 65% of my chronic migraines when taken regularly.  This is significant because nothing else I've tried comes close to that.  Vaping, smoking or sublingual administration are the most efficient methods for consuming CBD (see my previous article here).  Don't waste your time with weak gummies or cheap CBD bought through Groupon.  Quality is already too variable because it's a totally unregulated industry.  Choose pure CBD isolate or hemp flower from a reputable online source that offers 3rd party lab testing.

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CBD isolate

If you respond well to meds like codeine or hydrocodone but can't acquire a prescription, kratom is a great alternative (and generally safer too in that it doesn't cause respiratory depression).  Red-vein strains like Borneo or Bali are the best painkillers in the kratom family, but again, everyone's different so you'll need to experiment to see which works best for you.  When possible, opt for plain ground leaf instead of extracts as the former is more cost effective & safer since nothing is added or altered.  And avoid buying kratom (or CBD for that matter) in gas stations, smoke shops or other brick-and-mortar establishments that market things like bongs or faux pep pills, as the price tends to be jacked up & adulteration is more likely.  A kilogram of quality kratom can be purchased online for $70-$130 and will last much longer than a few pricey capsules or extract "shots" in fancy packages.

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Kratom whole leaves

If you've found relief with Fioricet or benzos, you might try kava or Valerian root.  These legal, plant-based supplements act on the same GABA pathways in the brain to produce a mild relaxing effect but without the addictive effects or dangerous withdrawal symptoms of benzos & barbiturates.  I find them especially helpful for the muscle tension in my neck & shoulders I get before a migraine hits.  Gentle massage & use of a heating pad are also good for this purpose.  These supplements can cause drowsiness so be sure to avoid driving until you know how they affect you.

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Valerian root (whole)

Another unlikely ally I've found are Benzedrex inhalers (used as directed, not taken orally).  Benzedrex contains menthol, lavender & the stimulant propylhexedrine which constricts blood vessels in the nose.  This can feel really good during a migraine when all the blood vessels in your head are dilated & throbbing.  Just be sure not to overdo it lest you risk rebound congestion which isn't fun.  If you prefer the more subtle route, magnesium is a safe & proven way to ease the muscle spasms & tension that often accompany migraine attacks.  I prefer Epsom salts dissolved in water, which have a mild laxative effect--much milder than magnesium citrate.  But any form will work.

Identifying your migraine triggers is vital to prevention & management.  Some common ones include:  hormonal changes before your menstrual period, weather/barometric pressure changes, crying, stress & dehydration.  Keeping a journal of your symptoms & what you did that day can help identify patterns you might otherwise miss.  Make sure to tell your doctor about any supplements or over-the-counter meds you take so they can create a safe treatment plan for you.

Found something that knocks out your migraines & isn't listed here?  Share below in the comments!

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  1. I've tried most meds mentioned over the last 35 years, for me amitryptaline and maxalt are the preventative/abortant combo that works best. Tylenol & ibuprofen are underrated, perhaps because they aren't exotic, but largish doses of these are great at reducing inflammation and so are more effective than any opiate short of of dilaudid, with far fewer side effects and suspicious doctors. Very very effective is an NSAID called torodol, which is unfortunately only available in injections now, I've got something called Lodine instead which doesn't appear to be much more than ibuprofen. Kratom causes migraines for me; true opiates, even when I can get them, hit me rather hard but do very little for migraine pain. But everyone is different.

    One point I want to make is that migraines can have serious physical causes - I ignored my worsening headaches for years until I ended up in the ER for the nth time that month and they sent me for an MRI. Less than 24 hours later I was in brain surgery having a large tumor removed, and the headaches have been substantially reduced. Migraines are a chronic condition and basically a nuisance but they don't prevent other more serious and fairly common conditions with similar symptoms.

    1. Oh wow, that's terrible about the tumor! Thanks for the warning. I think all migraine sufferers fear things like tumors at some point. A good neurologist should rule that out at the outset. I still need to just to be safe, but based on the timing of the onset & fact that they stopped when I quit birth control, I'm pretty confident mine were triggered by hormonal meds.

      For some reason I never got an ounce of relief from NSAIDs at any dose. Same with Tylenol. No matter: I can't take NSAIDs now due to chronic gastritis/GERD (which sucks because they DO work for my endometriosis pain, heh). You're right that everyone is different & treatment is trial-and-error.

      Hope you remain migraine & tumor-free!


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