The Uneasiness of Feeling Better
Now that Aimovig has been released and dispensed to those with migraine disease all over the country, more of us than ever may find ourselves, all at once, facing that uneasy sense of awareness that lack of migraine is becoming noticeable. Do you dare mention it? On Facebook, or just to support groups or a chosen few online friends? Or just to closest family? Having been involved in three separate clinical trials for CGRP antagonist medications, I have experience with that feeling of wondering whether I'm really better. Could it be placebo effect from expecting the relief? Or optimism as a result of being involved in a study (or being prescribed an exciting brand new drug)? If the drug is causing me to feel better, will it last? Will there be any unwanted effects?
Brief relief from Botox
The first time I received Botox in 2002, before it was approved for migraine (but my neurologist was already recommending it), I did get immediate relief following the very painful approximately twenty injections into my temples, forehead, and neck. I didn't know that it was the only time such treatment would work; I never got relief from Botox again, even over ten years in the future when the technique had been perfected and FDA approved it to treat chronic migraine. After receiving my first injections of Botox in 2002, however, I was giddy because of having so much pain-free time, waiting for prickles and warning aura that never came, not having to miss any work. But soon, I found myself sinking into a severe, confusing depression that lasted a few weeks.
Trying to understand the depression that followed pain relief
Later, I thought that the depression had been from my brain's adjustment to no longer dealing with severe pain every day. Why would my brain chemistry react like that? Certainly I don't enjoy suffering. I am not a doctor or scientist but have had migraine disease for forty years, and my interpretation is that during pain, our brains respond and defend themselves any way they can, releasing endorphins and other neurotransmitters to decrease discomfort and to try to provide calm and relaxation. There are also physiological effects of pain like increased heart rate and blood pressure. With a sudden lack of pain to deal with after years of constantly battling it, maybe something rushes in to fill that void... something like, perhaps, emotional pain.
A confused brain trying to adjust
Depression and anxiety caught me off guard a few times during my clinical trial process, and I have talked to a few individuals who were prescribed Aimovig and have had a decrease in pain but an increase in depression. Could it be a side effect of the drug, they wonder? I don't believe so. The only side effects found so far are tenderness at injection site and constipation. I truly believe that in those with chronic migraine, a treatment that works could produce feelings of depression at first simply because the brain is confused, and trying to adjust. In a sense, then, the depression is a side effect of no longer having severe daily pain. And for me, it passed.
Waiting for the shoe to drop
When I have experienced the strange “healing brain” depression, it has never lasted longer than three weeks. Sometimes I still have depression and anxiety that come on like an attack, and usually at those times I realize that I have stacked triggers. Without the CGRP antagonist I'm currently on, I may have had to endure a severe migraine attack instead. I treat myself gently, get extra rest, and the depression passes in a day or two.
Another source of depression could be the worry with an apparently effective new treatment that the relief can't possibly last. We've all been through that: a new preventative that you think is providing relief, and you tell everyone and are so excited, but then after a few weeks the improvement you thought you had disappears. The disappointment is sharp; we feel betrayed and angry at ourselves for even hoping. Too many of those experiences lead us to stop believing that anything will ever work. Now, lack of pain isn't met by relief and excitement, but wary acknowledgement and dread of when it will end. Because relief has always ended before. So by setting yourself up for that disappointment, you are protecting yourself from it. But that defensiveness can result in sadness rather than enjoyment.
Feeling all the feels
If you have been prescribed Aimovig and have felt some decrease in migraine attacks, the emotions you're feeling will likely be all over the map. Elation, gratitude, fear, denial, sadness, confusion... those and any other feelings you're having are completely understandable. Allow yourself to feel those emotions, even the uncomfortable ones. Talk to your family, your doctor, and be kind to yourself. Get extra rest, keep up all your supplements, drink plenty of fluids, engage in activities you enjoy, which you now have more time for. If you are not yet feeling any relief, don't despair. There are two dosages; are you on the lower one (70 mg), and could you go up to the higher dose? It could also take some time to work, or the improvement may be slight. But don't give up.
New treatment may be worth the try
I have definitely experienced short-term depression upon partial relief of chronic migraine. It is strange to consider a lack of pain not immediately providing joy and freedom, but relief is relief, and over time my brain and body did adjust, allowing me to realize the full impact of a life with fewer migraine attacks. Based on my own results, I do highly encourage those who have the appropriate profile (heavy episodic or chronic migraine that has proven resistant to treatment) to talk to your doctors about trying Aimovig. Results may be almost unnoticeable at first, appearing more gradually, so that three months on, you realize you've needed less acute medication. Or you may see swift improvement. Or it may not work at all. But regardless, it is definitely worth a try. And if you do experience depression that scares you or leads you to wish to hurt yourself, make sure to let a professional know immediately, no matter what might be causing it. You are not alone!
Have you ever experienced depression during a period of fewer migraine attacks? Are you trying Aimovig? Let us know in the comments!
When it comes to planning vacations or other events where travel is required, how much does migraine factor into your decision-making?