The Catch-All Treatment: Prednisone
December was rough for me in a lot of ways. Besides having increased migraines and an extremely busy schedule with Zo's Nutcracker Ballet performances, I did something to my left wrist. While driving I felt a strange twinge, and then the area between my thumb and forefinger tingled bizarrely and started hurting really badly. And I have a pretty high pain tolerance, as I'm sure most of you do, as we live with migraine disease.
Carpal tunnel syndrome?
I bought some topical pain relieving gel, did some research, and came to the conclusion I maybe had developed carpal tunnel syndrome. I bought a brace. The inside of my thumb had gone completely numb. I waited a week, and then with Nutcracker performance weekend approaching, I decided to go to urgent care. Meanwhile, my migraines were bad as well, with my worst one since last year (and nearly on the same date in mid-December) hitting the weekend prior, requiring two separate ER visits. I will be writing about that experience in another post.
Prednisone for wrist pain
The urgent care doctor maneuvered my hand and wrist and said that one movement he did would have caused severe pain if it were carpal tunnel, and it hadn't. He said it was likely to be another type of twisted nerve issue or maybe the beginnings of arthritis, and prescribed 5 days of Prednisone. He said that the steroid would help inflammation and decrease pain, possibly solving the problem altogether, but he referred me to an orthopedist as well. Prednisone! It had been awhile, but my headache specialist used to prescribe Prednisone “burst and taper” therapy for intractable migraines. I also receive IV steroids (either Solu-Medrol or Decadron) every time I go to the ER.
Improving migraine and wrist pain
I filled the prescription, which was for one 20 mg tablet three times per day. I was pleased, hoping that I would have better use of my hand during the Nutcracker quick changes, and maybe my daily migraine situation would improve as well. And actually, my migraines improved more quickly than my hand did. With the help of Imitrex, I made it through all the Nutcracker performances with few problems. I wore the brace in between shows and still dealt with more discomfort than I would have preferred, but I will take hand pain over head pain any day. By the time I had finished the Prednisone prescription, my hand was much improved.
Sinus infection and migraine
However, by Monday I felt flattened. I had made it through the weekend, and then got hit by some sort of sinus/cold situation. I had muscle aches too, and I could only wait three days of barely being able to move before returning to urgent care. We have a wonderful facility associated with our local hospital and the university where John teaches, and since I'm between family doctors due to the new insurance it is my go-to for everything except migraine. I got a different doctor this time, and he was also very sympathetic. I described my symptoms, particularly the sinus pain and how it was exacerbating my migraines, and that Sudafed wasn't working. He diagnosed me with probable influenza and a sinus infection, and prescribed Amoxicillin and – what do you know? - Prednisone. For the sinus inflammation. 5 days, again, but this time two 20 mg tablets per day.
Prednisone for sinus inflammation
Once again, the Prednisone was a huge help. The bricks of pain in my cheeks and forehead felt diminished immediately, and I spent all of Christmas Eve cleaning, organizing, wrapping, throwing together additional gifts, and generally feeling fantastic.
Burst and taper therapy
With the former burst and taper therapy, the initial high dose “burst” would hit me so hard that the side effects were nearly unbearable. My face would redden and be painful to the touch, and I wouldn't be able to sleep. I do think that it occasionally helped break a bad migraine cycle, but similar to DHE (a rescue intra-muscular injection which I no longer use, partially due to its lack of availability), it was unpleasant to nearly intolerable. I am hoping maybe a five day course of 20 mg tablets, either two or three times per day, could be something that might decrease my ER visits, and I feel grateful that the other health situations I had re-introduced me to the drug and showed that 20 mg tablets didn't cause the uncomfortable side effects I'd had in the past.
Prednisone for migraine
Prednisone has long been a common treatment for intractable migraine and rebound headaches. Like all medications used for migraine, it is a virtual life saver for some; for others it doesn't work or merely reduces the pain during the course of treatment rather than breaking the whole migraine. Recent research has shown evidence that corticosteroids are not effective long term, and using them has risks and side effects, so if this is something you might like to try, make sure to do research and ask your doctor, neurologist, or headache specialist lots of questions to determine whether it might be a good option for you.
Talking to my neurologist
I myself see my neurologist next week, and I plan to ask him for a prescription I can keep on hand for migraines I'm unable to break with my current home treatments and rescue medications, particularly since I have had to visit the ER so often and seem to be out of the statistical norm in a few ways already. Here's hoping!
**Update: my neurologist did give me a Medrol burst and taper pack, but it didn't seem as effective as the 20 mg Prednisone. I am keeping it in mind as something to talk to my new family doctor about in March!
Can you tell when a migraine attack is coming?