So, I've spent the last few months trying to remember how I used to deal with migraines. Let me give you the background: WARNING--the following includes a discussion of medical and menstrual issues. Be forewarned! I take no responsibility if you find something gross.
I have an enormous family history of migraines. I was doomed from conception, I think. Both parents, both maternal aunts, one paternal uncle, 3 of 4 grandparents. My younger sister has them too. My brother's just now reaching puberty, so we'll see. Anyhow, at about 17 I started getting my debilitating headaches. I got what are commonly called cluster headaches, which tend to focus around one eye or the other with particularly sharp, stabbing pain. Strangely enough, although 90% of migraine sufferers are women, 95% of cluster sufferers are men. That makes me all kinds of a statistical anomaly. After a couple of tries, I ended up treating them with prescription strength Naproxen (Aleve came out OTC about a year or two later, if I remember right). I was taking 1100 mg per dose, and I might take up to 4 doses with a single headache. My headaches mostly coincided with particularly stressful periods in my life, so I wasn't doing anything preventative other than working on relaxation techniques and stress management. To give you an idea of how frequent they were, the care package from my grandmother when I went away to college included a box of Tylenol samples and a box of Advil samples (she worked at that time in a pain management clinic).
I got involved with my husband and started taking DepoProvera for birth control (it's the shot once every 3 months). I got my stress under better control, and I quit having headaches. In fact, the bottle of Naproxen my parents ordered shortly before my wedding (because they had better prescription coverage than my husband at that point) was still half full on our fifth anniversary when I threw it out. Every rare once in a while I'd get a bad headache, so I'd take a bunch of ibuprofen and go to sleep.
In December, I switched birth control to the NuvaRing. I wanted something more quickly reversible, because we might decide to have kids in the next couple of years. Depo can take up to two years to "wear off," especially if you've been on it as long as I have. So, I got my periods back (not a big plus, immediately), and I started having headaches again. They were migraines, although right now I couldn't tell you if they were clusters or not. I wasn't taking notes, just meds. December I was under a lot of stress, putting out job applications. January, I had just had a big fight with my husband. February, there wasn't anything particularly big going on, so I was able to finally rule out coincidence. Went to my doc, he gave me a prescription painkiller to start taking a few days before my period to head off the worst of the headaches.
March came, and I dealt with two little migraines (5s on the 1-10 pain scale). I was feeling a little worn out from everything going on, including scheduling some job interviews. Had a cold a bit, then I got the mother of all migraines. I threw up. (And I rarely even get nauseous with headaches.) When I closed my eyes, I could see stripes and flashes of white light. (I've never had auras or any of the other visual effects of migraines like tunnel vision or any of that.) This was a 9 on the scale, and only because I know breaking my arm hurt more. If it had been a sharp pain, this headache would have been a 10. I had a friend take me to the ER, because I didn't feel capable of driving and my husband was out of town on business. My head hurt so much that I didn't even notice that they tied the tourniquet too tight when prepping me for an IV. I didn't really care till I saw the bruise the next morning. They gave me drugs for the pain and the vomiting and sent me home.
I followed up the next day with my regular doc. He sent me for an MRI the following day. I didn't think to tell him that I was claustrophobic. I told the folks at the MRI clinic, but they didn't give me anything. I spent an hour in that damn machine, and that was just about all I could take. The only thing that kept me lying still was the prospect of having to do it all over again. My doctor has since promised that if we ever have to do that again (and he doesn't anticipate needing it) he will write me a sedative. Anyhow, it turns out that I had a mucus cyst in my sinuses. So he put me on big doses of antibiotics, because apparently the swelling of the cyst was pushing on some nerves or blood vessels and causing all the mess of that super-headache. But we do know "It's not a tumor" (yes, you have to read that in the Arnie voice). And it's not any anatomical problems like an aneurysm or a stroke.
I went back today for the post-antibiotics follow up. It became the mid-antibiotics follow-up when I told him I didn't feel much different and that I'd gotten a similar but much less severe migraine the day before. I'm on amoxicillin for another 10 days, and then I go back again. The problem is, partly, that I'm back around to my menstrual cycle again, so the question is, are these headaches because of hormone levels, or because of the cyst? So, I've started a headache diary that I'll take back with me in 10 more days. If you are a fellow sufferer, check out the diary at WebMD's headache center. It's a pretty comprehensive list of symptoms and possible triggers.
Anyhow, I should get to bed, because sleep is one of the treatments, and lack of sleep one of the triggers.