When Migraine Isn't the Most Pressing Problem

It's unfortunately no secret that I live with several comorbidities of migraine. I've written in the past that I live with Crohn's disease, rheumatoid arthritis and adrenal insufficiency, and struggle regularly with symptom/problems like insomnia and loss of appetite and functional GI distress. There are sometimes days or even weeks where migraines are my number one problem, priority, and concern...But honestly, it's been a minute since that's been the case.

What has my migraine care looked like?

I've been in a fairly decent prevention/abortive pattern with my migraine care for the last year - but about a thousand other problems have happened with my body which have required immediate attention (testing, appointments, hospitalizations and even surgery).

It took me more than a decade to find a migraine doctor that I trusted, that felt educated, patient, and willing to be conversational with me about my symptoms and treatment plan. I've been working with him for the last two years, and we've finally settled into what feels like a sustainable routine (at least for the time being).

What is my preventive treatment routine?

I take one medication preventatively: Qulipta (a CGRP antagonist), which I can choose to wean off of relatively quickly if I choose to try to go through IVF again. Additionally, I get Botox for migraines and for teeth grinding/jaw clenching every 84 days (the optimal window, I'm told), injections done at the headache clinic by my neurologist. Honestly, they are painful and not my favorite (I'll have to write about this sometime soon), but they seem to be playing a role in reduction in frequency of severe migraines. I also see my chiropractor regularly for a variety of issues, but I honestly believe that my adjustments from him have helped to reduce the number and severity of migraines I've need to abort this last year.

What is my abortive treatment routine?

Abortively, I have a few options. For when a migraine is just starting, or it doesn't feel crippling, I usually try Fioricet first - mostly because its oral and I always carry it on me. If it doesn't work, or the severity of the migraine is already too great, I utilize ketoralac injections, which sometimes take two, but that plus a nap has been a solid migraine reducer for a while now.

Has my treatment plan worked?

Most importantly to me: Since I've been on this regimen, I've remained out of the emergency room and the migraine infusion center and not needed IV medication to disrupt my migraines. I'd call that a major win.

How else has my body attacked me?

While I wish that managing migraines honestly was my major focus right now, it hasn't been. I've had migraines, and I've cared for them as necessary, but there have been so many other ways that my body has attacked me, including struggling with recurrent pregnancy loss, needing emergency spinal surgery, having 6 weeks of RSV plus long term lung damage and continual inhaler use, learning how to live with adrenal insufficiency and be steroid dependent (including what it means to stress dose steroids and when that's appropriate treatment to determine on my own), working through a trauma processing program, and managing the mental health symptoms that come with c-PTSD, depression, and anxiety. Each of these could have their own novel, but I drop them like a list simply because I know that nearly every community member here can relate to having a laundry list of health issues, and migraine attacks fluctuating on where they fall in the severity and time commitment of response from day to day, week to week, month to month and year to year.

Do you struggle with other conditions too?

If you're someone who struggles with migraines every single day - I see you. I've been you. If you're someone who struggles with migraines amidst other health issues that require more of you - I see you. I've been you. I share all this to remind everyone here that none of us are alone.