A migraine revelation all about my nose.

I cannot remember a point in my life when there wasn't a dull ache somewhere in my head. And after years of suffering through the pain of a migraine and coming to accept it as part of my life, I found out that the answer may have been right under my nose the whole time.
Well, actually in and behind it.
Let's back up first, though.

By the time I was 13 years old, I was diagnosed with chronic migraines and had started taking heavy duty medications to treat the pain that accompanied them.  See, my mother has suffered from migraines for all of her life. She was diagnosed with chronic migraines about the same time that I was. There were multiple milestones in her life when she was told that her migraines would stop, but they never did.  I am the youngest of six children, five of us girls. Including my brother, every single one of us has experienced a migraine at some point. Some of us experience them more frequently than others, but I was the only one to be given the chronic diagnosis/label/stigma along with my mother. Two of my sisters experience them regularly, but not enough to be chronic.

When I was 15 years old, I went on the pill to control my dysmenorrhea and was also told this would help with my migraines. It helped, ever so slightly, but any little bit feels amazing.
I spent the entirety of high school just coping. I was a straight A, honor roll student who participated in the drama club, chorus, Tri-M honor society, National Honor Society, All State Chorus, and held down a part time job. Having a migraine just became a normal part of my life. I was very ill informed about what I could do to help my migraines besides "drink lots of water and take your medication."

At some point during my latter years of high school, I was prescribed an anti-convulsant in hopes that it would lessen the severity/frequency of my migraines. It did, but all along I couldn't help but think that I didn't want more medication. I saw the vicious cycle that it created with my mother. Her medication caused high blood pressure, so she went on a medication for that, which caused weight gain, which gave her joint pain, so she went on a medication for that, which gave her more migraines, and on and on and on.  I was a high school student with a 504, preventing my school from withholding my credits due to days missed because of my migraines.  By the time I was 16, I was taking Keppra daily as a preventative (in addition to Nadalol for a heart condition, birth control, and daily allergy medication), and listed Zofran, Relpax, and Percocet among my abortive and rescue medications.

I stayed at home for college, opting to attend a County College as a part of the NJSTARS program (meaning that I attended county college at no charge due to my academic standing in high school). During this time, I decided that there had to be something more I could do about my migraines. I started reading up online, and found out about rebound migraines. I spoke to my doctor and was switched from Percocet to Fiorinal. This is something I maintained helped me immensely. The Percocet had actually been hurting more than it helped. Sometimes the "withdrawal" headache that followed the next day was worse than the initial migraine. I was also becoming more and more uncomfortable with the amount of medications I was taking. The Keppra made me gain weight (and I was a teenage girl who already had a history of eating issues). I was able to convince my physician to reduce my dosage from 3 Keppra per day (1500mg) to only 2 (1000mg).

For awhile, that was where it stopped. I had started to accept that I would probably always have a headache on the verge of becoming a migraine. What else was I going to do? My doctor didn't have any answers, and I had already experienced all of the CAT scans and bloodwork that I thought would hold answers.

I got my Associate's and transferred to a 4-year university. My new school held a policy that if you missed more than three classes, your professor reserved the right to drop your grade by one full letter. This was an issue. Thankfully, as a Speech Pathology major, my professors were all understanding and I never experienced this issue. They also became used to me sometimes wearing my sunglasses during class.

During my 5th year of school (yeah, my transfer adviser screwed me over and told me I had to take classes that I didn't need) I started applying to Graduate Programs in my field, as I need a Graduate degree to practice. All through school, I not only held down a part time job, but worked my butt off to graduate Magna Cum Laude. Even though I did well on my GREs, had stellar references, and was academically outstanding, I found that I wasn't accepted into any programs for Graduate Studies.  I was devastated. I remember crying, thinking that my life was over because I now had a degree that I could do nothing with in my chosen field.

I'm a determined young woman, but that didn't stop me from being heartbroken. However, I picked myself back up and resolved to apply again in a year. I decided to take the opportunity that had been presented to me, and see if I could find any alternative treatments that would help my migraine. Over the next year, I worked at the same part-time job (although they scheduled me for as close to full-time as they could without actually MAKING me full-time), and frequented many migraine blogs, informational sites, read books about migraines, tried crazy remedies, and started my own Tumblr blog to track my journey (http://healthpillow.tumblr.com).

I found very few things that really helped me, but found some ways to cope with my migraines. Things that made me, personally feel better when I had a migraine, or that perhaps shortened their duration. Exercising worked, juice fasts didn't. I had bloodwork done to rule out celiac disease (which I don't have), but found that I was severely B12 deficient. I (not so consistently) practiced yoga and found that it made me feel better. It's something I have to make more time for in my life.

I focused on trying to identify and eliminate triggers. I carrying my Nalgene bottle at all times and made sure I was hydrated. I didn't skip meals. I tried to take a few minutes each day and unwind to try to reduce my tension and stress levels. I avoid MSG like it's my job. However, it was no surprise to me that I can't control my hormones during my period or the weather. Barometric pressure has always been a huge trigger for me, and as mentioned before, going on birth control helped with my migraines, but never eliminated my menstrual migraines.
I reapplied to Graduate School and was accepted to all of the schools I applied to this time around, but opted to stay closer to home and attend Graduate School in New Jersey, where I'm currently a student.

In May of 2013, before leaving for my summer job as Head Counselor at a camp in Western Pennsylvania, I had a scan of my sinus cavities done. In addition to my migraine (and SVT) I've always had allergies and seem to be prone to colds and sinus infections. I wanted to see if there was any kind of issue with my sinus cavities that I should be concerned about.
Imagine my surprise when I was told two things:
1) I had a small mucous retention cyst in my right maxillary sinus cavity.
2) I have a deviated septum.

I am 24 years old, and never knew that I had a deviated septum. It's very slight, and has never been an issue for me. I decided to make an appointment with an ENT when I got home from camp to find out more about the cyst. I was concerned that it might be more than it appeared to be.  More surprises were on the way though.

This ENT also treats my mother and we played 20 questions about my migraines at the start of the appointment. He was quick to confirm for me that the cyst was absolutely nothing to worry about. He scoped my sinuses and gave me some information about why I may be getting sinus infections so frequently.  The deviated septum was the highlight of the appointment though.

Turns out that my septum (which is deviated ever so slightly to the left), is positioned so that it presses on the nasal turbinates located behind my septum. My doctor likened it to someone pressing their fingers into your arm. It doesn't hurt, but if that pressure remains for long enough, it starts to ache. And if they press harder it still doesn't "hurt", but the pressure builds and builds, and you can start to feel the tension in other places.  Turns out this is (probably) exactly what was happening in my head. Your nasal turbinates are lined with the same mucosal lining as your sinus cavities. When these swell, it causes that extra pressure and causes what's called a Contact Point Headache. For someone who is already genetically predisposed for migraines (they run in my family) this can serve as a trigger. This lining swells when you're sick, but also when there is a large drop or rise in barometric pressure and also around your period.
DING DING DING.

So my ENT told me to go to the store and pick up some Afrin (which he says is horrible for actual nasal problems, but wonderful for performing this at home experiment) in order to do "the Afrin test". Whenever I started to feel a migraine come on (aching behind my eyes, dizziness, etc.) I was to use the Afrin according to the box directions. If the swelling of the turbinates was truly the cause of my migraines, the Afrin would reduce the swelling and help with the pain.
I admit to being incredibly skeptical.
About two days later, I felt that familiar ache and tingling. I used the Afrin and waited.
The migraine never came.
I still took two Advil (regular strength) to help with the pain, but I was amazed that the pain faded away. Over the past two and a half months, I have repeatedly done this. Looking in my migraine journal I have only had 3 full blown migraines since I started using this method. I suspect they were mostly due to dehydration, sleep issues, and stress.

I have been able to stop a migraine in its tracks with a few puffs of Afrin, and to this day, I'm still astonished that it works. I went for three entire weeks without a full blown migraine (a few false starts that were thwarted by the Afrin). I cannot remember the last time I was that pain free. When I spoke to one of my friends about it he said, "Do you even know what to do with yourself without the pain?" and the answer was, "No." I'm so used to the ache and being disabled by a pain that I can't explain and that no one can see, that I've had to teach myself to function without it.
So I will return to my ENT and find out where I go from here. I know that I have two options:
1) Medication and sprays to control the swelling and help continue to prevent migraines has I have been (the Afrin will soon stop working).
or
2) Surgery. I can have a septoplasty done to straighten my septum. He would also shave down my nasal turbinates a bit to reduce the likelihood that they will continue to abut and cause a Contact Point Headache.

I know that I will have a big decision ahead of me, but it's something that still need a lot of answers about. I rely on my voice for many things, and I'm tentative about a surgery that could pose a threat to my vocal functioning. Then again, living with migraine isn't an option anyone really wants to face. After I meet with my doctor and he gives me more information, I know I'll have a lot to think about and a huge decision to make. I know that there are certain other things that can cause my migraines, as evidenced by the fact that I've still experienced some attacks even with the Afrin. However, fewer migraines are better than suffering every day with the pain.
I went 24 years without even knowing that I had a deviated septum, and not 4 months later, I found out that it's a root cause of my migraines.

Migraine is sneaky, but my story only proves that you need to explore every possible cause of it. Even when you think you've exhausted all of your options, you may stumble over an answer when looking for something completely different. I had begun to see migraine as something that I'd never live without, but now I'm looking at the possibility of greatly reducing my instance of migraine. If this works, it won't be gone for good, but even one pain free day is worth the world to me.