"We're dealing with two different illnesses"

Last week I got the pleasure—at last!—of meeting some of my longtime blogger friends. Most of the faces were familiar since I’ve seen most bloggers’ photos before, but it was lovely to at last interact in real life and in real time.

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We had a handful of helpful, eye-opening conversations over the course of a couple days in Philadelphia. I’m constantly amazed at how much I’m learning about my disease, a disease I’ve lived with more than half my life. How can it be that I just learned that others experience nausea early in their migraine progression? I’d always assumed that everyone else, like me, only got sick to her stomach at the very end of the attack. I also learned that my beloved melt-away triptan drug, one I always saved for when I was feeling particularly nauseous, is not absorbed under the tongue—like any pill you’d swallow, it’s broken down 100% by the digestive system, meaning it won’t be any particular help if you’re about to throw up.

I could go on and on about what I learned, but I’ll wait for another blog for all that. What I’m thinking about today is a comment my friend Diana Lee made. (And excuse me here, Diana—I’m paraphrasing.) She said that what people (patients, doctors, caregivers, and even those who’ve never had migraine) need to realize is that we are dealing with two different illnesses here: episodic migraine and chronic migraine. Unfortunately, most of the patients in the room were, or were at one time, chronic migraineurs.

Treatment plans for chronic migraine are so different than those created for episodic migraine. Almost all the information out there focuses on the patient who gets a migraine attack once every couple of weeks, max. Guidelines about medication use, dosage, preventive care, etc., tend to be focused on people who do not live each and every day hyper-aware that they may be hit with a migraine attack. I know that my prescription triptan drug tells me to take a pill at the first sign of a migraine attack. If I did that, you guys, I’d be popping pills five, six days a week. Rare are the days that I don’t get the beginning twinges of a migraine or the hints of aura. Luckily I am in good enough shape now that there’s not always a full-blown migraine attack coming my way even if I feel the beginnings of one. When I do get a breakthrough migraine, however, I have to decide when to take my meds—is this one going to go away on its own or not? If I take drugs today and tomorrow, I’m done for the week—what will I do if I get a migraine a third day in a row? There are so many concerns and questions for those of us who deal with chronic migraine, and our disease patterns and concomitant treatments are markedly different than what episodic migraineurs have to contend with.

Do you think you have episodic migraine, chronic migraine, or neither? If you are a chronic migraineur, have you noticed how the medical community usually focuses on episodic migraine treatment instead of dealing with chronic migraine? Share your thoughts here.

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