Today turned out to be a great day.  It started at 5:15am when I woke up with the beginnings of a migraine. I decided that I would not be letting a migraine steal my joy and went to all out war.  I'm happy to say I won as defined by having the shortest migraine I have ever had (6 hours from 5:15am - 11:15am) and no migraine hangover.  I figured this formula might help someone, and so here's how it all went down.

Oh disclaimer.  This is like the longest post ever.  In fact, it should probably be a small little book.  For that reason, I am WAY TOO lazy to really proofread it so, blame any errors on my migraine brain and not my IQ!

Ok... Probably best to start with a little history of my migraines.  Until the age of 28, I could count how many headaches I'd had my entire life and would probably have some fingers left over.  But one night, while about 7 months pregnant, I was working a shift in the psychiatric emergency room.  Suddenly, I got very sick.  I couldn't put my finger on what it was, but I knew I wasn't right.  I knew I couldn't finish my shift and I knew I couldn't drive myself home.  One of the ER technicians who was getting off at 11pm just happened to live in my neighborhood and drove me home.  He talked the entire time and I just remember an overwhelming sense of nausea with every syllable that came out of his mouth.  I came home, went to bed and woke up the next morning having no idea what had happened.

About 4 years passed and I was in a meeting at work.  The same feeling came over me -- something was wrong although I had no idea what.  As everyone was talking, my nausea throbbed and grew and throbbed and grew.  I went to the bathroom and the rest is history (let's just say God bless the cleaning crew).  I called my cousin, asked her to come get me and told her to bring a plastic bag with her in case I had to puke again.  When I got in the car, she took one look at me and said "You have a migraine."  At first I balked, but then I put on my doctor's hat -- photophobia (sensitivity to light) yep... phonophobia (sensitivity to sound)... yep...nausea...clearly... headache?  Nope.  But I knew she was right.  Somehow, this was a migraine with no headache.  She gave me an Imitrex, I went to sleep and woke up the next day just fine.

After that day, I began to have migraines very predictably once per month each time I removed my Nuva-ring.  Sudden onset of feeling all the way wrong associated with severe nausea in response to lights and sounds.  Only occasionally did I ever get the throbbing headache.   Once I put two and two together, I switched birth control methods and went for more than two years before the next migraine took me out.

Migraines resumed once I changed jobs.  The new job, while exhilarating, was absolutely crazy.  I worked the longest hours under the most stressful conditions on the least amount of sleep with not enough time to eat or drink enough water.  It felt like internship all over again!  Mix in frequent flights to the West Coast and it apparently was the perfect formula for migraines.  I began having them so frequently that I had bottles of Excedrin migraine on my nightstand, in my car console, in my desk drawer and in every briefcase and purse I carried.  Eventually, I had to step it up and get my own prescriptions of Imitrex and Zofran.   I downloaded a migraine app to help me identify my triggers and found them to be altitude and dehydration.  One day, as I was sitting in my office with my sunglasses on, a colleague came in and said "migraine?"  She went on to tell me how she had finally figured out that she gets her migraines not while she is under stress, but after her stress has been relieved.  At the time, I just logged it as an interesting tidbit o' information, but over time, I realized I had the same pattern.

Well, by the grace of the good Lord above, the conditions of my job changed, and I came to have the very reasonable, very fulfilling and meaningful position I currently have as the Chief Medical Officer for a behavioral health company.  The opportunity to work from home fell in my lap, and immediately added 10 hours that I used to lose to commuting each week, time for yoga each day and flexibility to turn my work-life balance into a life-work balance.  Life has been so good, and migraines mostly disappeared.  Like, I might get a migraine once every 4-5 months if it's even that frequent, and usually after a high-stress time resolves.  And so that brings me to today.

I've been dealing with a particularly stressful situation for about the last 3 months.  I noticed it had been interfering a bit with my sleep, but otherwise felt I had been managing it pretty well.  Last night, it all came to a head and I finally was able to lay down what felt like a 300 pound burden I'd been carrying.  I felt so incredible relieved.  My husband said to me -- "You know you're going to have a migraine tomorrow, right?"  I chuckled and said "Yeah, I should go ahead and take 800mg of Motrin tonight before I go to bed."  But I didn't.  I went on to have the BEST night's sleep I've had in 3 months.  And then I woke up at 5:15am with that not right feeling.  My first thought -- Dammit!   I hate it when he's right!

Now, because my migraines start out so vaguely, and because  they come so infrequently, I still don't always recognize them.  This means, I typically delay initiating the formula.  Well, today, I knew better.  So here's what I did:

1.  I immediately took Ibuprofen 800mg.
2. I put on the blackest sunglasses I could find, even though the sun had not yet risen.  I knew I needed to cancel the 5 appointments I had scheduled today, and that I would have to look at the lit screen of either my phone or computer to do it -- and I knew that the light was going to make the migraine pop.
3. I Googled "Yoga by Adriene for Migraines" and found a 30 minute headache video.  At the end of it, while laying in Srivasana, Adriene said "You may feel some emotions."  I thought it was a strange thing to say, but I tuned in to my breath.  The initial emotion I felt was peace and relief.  I know that was in response to having laid down my burden the night before.  The second emotion was confidence -- I felt like I was kicking the migraine's butt for the first time ever, and that made me feel proud.  The third emotion surprised me.  It was tears.  Like, straight up sadness.  Honestly, I was surprised.  I was going to choke it off because I really didn't have time for it, I thought it might make the migraine worse, I thought the kids or Joel might walk in and see me lying in corpse pose crying (I mean that would be really weird!), but I literally just the day before had been on a soapbox about doctors being human and needing to cry sometimes, so I decided not to be a hypocrite, and I let the tears come.  And boy did they come.  I cried, and I cried and I cried (I couldn't help but put in the link to the song -- it's a great song!).  I cried for my brother.  I cried for my family.  I cried for the family of the children who were lost.  I cried for myself.  And then I felt better.  And I felt proud that I had let myself cry.
4. I cooked breakfast by candlelight with black out shades on.  While I usually don't eat that early (by this time it was 6:30am), I knew that a migraine with hunger headache a la mode was not a good idea.  I ate a well-balanced breakfast.
5. I made what was supposed to be a cup of coffee --specifically for the caffeine.  I'm not a coffee drinker -- in fact I really only drink a little coffee with my cream and sugar, but I know that caffeine constricts blood vessels in the brain and reduces migraines, so I made a cup.  Or, so I thought.  Turns out what came out of the Keurig was chai latte with extra milk and sugar (it was dark! and I had on shades!).  So that was a nice surprise and still gave me the caffeine kick.  Sad news is it made my migraine worse.  Pretty much, being hot makes the migraine worse, so drinking a hot cup of chai latte was a bad idea.  Next time, I will take a migraine tablet that already has the caffeine in it.
6. I drank a bottle of water.  Dehydration is my migraine's biggest supporter.  Not today dehydration!  Not today!
7. I text my cousin (yes the same one) and asked her to bring me an Imitrex.  Just as an aside -- is the past tense of text, text?  Or should I have typed texted?
8. I sent texts/emails (while wearing my blackout shades) and cancelled all of my appointments.  Again, I'm thankful that at this point in my life I am an administrative physician.  Had a clinic full of patients been scheduled, I don't know that I would have let myself take this step although it turned out to be one of the most crucial, in my opinion.
9. I took a poop.  Now, I know you're like, really?!  TMI!!!  And yes, it is.  But it's important.  My migraines are always associated with both upper bowel (nausea) and lower bowel symptoms (I'll leave that one to your imagination).  This is not surprising since migraines and the bowel share the chemical Serotonin.  Anyhow, I mention the poop because I made it work in my favor.  Our toilet is in its own little room.  I turned off the lights and kept on my black out shades.  Being behind two closed doors completely shut out the sound of the kids getting ready for school.  It was cold, which remember helps my migraines.  It was like an amazing little migraine poop sanctuary!
10. I asked my husband to take the kids to school.
11. By all accounts, up until this point I was #WINNING.  And then I decided to take a shower.  On some level, I knew it was not a good idea.  I like my showers scalding hot and I know that heat makes my migraines worse... Nonetheless, I convinced myself that a hot shower would be relaxing, and therefore helpful.  I lit candles and jumped in.  I immediately felt like I had been thrown into a horror movie.  The flickering candles were like strobe lights and my nausea throbbed with every step of their evil little undulating dance.  The water hitting the floor of the shower sounded as loud as Niagara falls.  The hot steam felt like it was suffocating me.  Needless to say, I cut the shower short.  Clearly, the shower will NOT be on the list next time around.
12. My cousin arrived with the Imitrex which I took and climbed in the bed.
13. An hour later, I woke up (had to pee thanks to the caffeine) and as soon as I sat up BAM!  the actual headache punched me dead in the eyeballs.  I must admit I was shocked.  Until that point, I felt like I had been winning the battle.  I started to feel discouraged like maybe this migraine really was going to steal my entire day.  (Mind you, it was still only 8:30am).   So I took another Imitrex.
14. To combat my feelings of defeat, I created a mental gratitude list.  I included my husband for knowing me well enough to warn me that today would be a migraine day, my children who were extremely quiet while getting ready for school, my cousin for having a stockpile of Imitrex, my family for helping me lay down the 300 pound burden the night before.
15. I went back to sleep for 2 1/2 hours.  I woke up to my Mom at my bedside who had come to check on me (love her!).  When I sat up and peeked over the edge of my sunglasses, I didn't puke.  I ripped those suckers off with enthusiasm and sure enough, my migraine was gone!  It was 11:00am.  For the record, that is the SHORTEST migraine I have EVER had!!!!!  I literally felt like breaking into song I'M ALIVE!!!!! (click the link, it's an amazing song), but I knew better than to celebrate prematurely. The battle wasn't over because although the migraine was gone, the migraine hangover was definitely in full effect.
16. I went for a one hour acupressure session.  When it was over, so was the hangover.  Ha!  Take that migraine!  In your face!!!
17. I wore my blackout sunglasses for the next 8 hours.  Since as they say an ounce of prevention...

And that my friends, is the 17 step method I took to kick my migraine's butt.  It was a stellar combination of support system knowing my triggers, medications, yoga, support system, environmental control, did I mention support system? and acupressure.  Does it get any better than that?!  I think not 🙂

From knowing your triggers, to maybe picking up a couple of strategies that you hadn't tried before or learning from my mistakes about those things to avoid (i.e. hot showers and hot beverages), hopefully something in this post will be helpful to someone.

I'd say the best thing about today (well, maybe second to the migraine actually going away in the shortest time ever) was actually feeling like I don't have to be scared of migraines.  That is a really big first, and one that I won't soon forget!