Feeling hot hot hot

This last week has been a rollercoaster. I’ve been hurtling headlong between mania and migraine, and it’s exhausting. Here’s a quick rundown:

Sunday – migraine
Monday – migraine
Tuesday – rest, plus activity. Overnight migraine
Wednesday- migraine
Thursday – migraine
Friday – recovery day, ‘cos everything is broken. And fatigued. And tense. You see where this going, right?

I finished work Thursday evening after a busy and productive day in the office. A normal working week for me means Thursday in the office, and the rest of my allotted hours spent working from home. The process of getting ready, walking to work, being around other people – communicating, listening, giving advice, sorting out any issues, as well as being subject to light and heat conditions, noise and light which I can’t control – is pretty fatiguing, but I really enjoy Thursdays. It’s the day when I provide the most “added value” – quick catch ups, bits of advice here and there, and plenty of social interaction.

Yesterday was hard going though. Not through any fault of my colleagues, who are genuinely lovely people and really accommodating, but mostly because my brain was active, my motivation was high, but my body was screaming at me from start to finish. And, as many others will attest to, if your body is screaming at you, most treatments can be about as effective as putting a sticking plaster on a broken leg. You’re doing something about it, but it makes absolutely no difference. I can’t take ibuprofen because it would interact negatively with my other medication, codeine can be a temporary fix but leaves me very fatigued when the effect wears off, and paracetamol works about as well as throwing a snow ball at the sun.

If I catch the symptoms early enough, my Imigran nasal sprays can head the worst symptoms off at the pass. However, the window of opportunity is very narrow and, if you miss it, the relief is very limited. And you should only take 1 every 24 hours. Therefore, as you start to pick up the warning signs of an emerging migraine – and particularly if you are having a multi-episode week like this – you have to try to assess whether or not this migraine will be severe enough to necessitate a nasal spray. Get it right, and you might escape the worst of the symptoms. Misjudge it, and you could be finding yourself completely incapacitated a few hours later, and unable to do anything about it, because that Imigran spray was your one shot, and you blew it.

Fortunately there are a few simple options which can reduce the worst of the symptoms. To go back to my earlier analogy, that sticking plaster might not heal a broken leg, but it might prevent the nasty cut on the leg from becoming infected. Equally, chocolate might help with the shock. A bit of reassurance might soothe the anxiety. You’ve still got a broken leg, but at least some of the other factors have been managed.

Eliminating sensory stimulus is a good start: lying down in a darkened room (not particularly practical in an office, admittedly), putting an eye mask on, utilising the noise cancelling headphones, eliminating scents, wrapping up in something warm and fleecy to help you feel safe and cocooned from the outside world, and anything else which helps to lessen the anxiety and stress caused by the heightened impact of external stimuli. As proven on Wednesday though, none of the above is practical if you get a sudden onset of symptoms whilst driving to the petrol station through rush hour traffic.

Other tactical responses which can help me to chip away at the towering edifice of symptoms include:

Chocolate and Coca Cola (serotonin and caffeine can help ease headache pain temporarily, but will probably have a negative impact when the effect wears off)
Cold packs applied to the temple and the base of the skull
Applying pressure to the temples
Applying pressure to the hollow areas at the base of the skull and between the vertical neck muscles. – 10 seconds on, ten seconds off, and repeat for what feels like hours
Pinching the flesh between your thumb and first finger
Breathing deeply, consciously focusing on breathing in through your nose and filling your lungs with oxygen, and then breathing out through your nose – if nothing else, it’s a distraction and may release some of your body’s tension
Avoiding any kind of movement, particularly movement involving rotation of the neck
Masturbation (again, not practical in an office environment). This may only be possible if you are able to move without being hit by waves of pain, and weren’t brought up in a Methodist household (sorry mum, sorry God)
Taking a really hot bath

Looking for some hot stuff

If I’m in the pain stage of a migraine, even the thought of a hot bath is enough to make me feel nauseous. I get an approximation of Red Ear Syndrome – chronic illness really is the gift that keeps on giving – particularly as a premonitory symptom and during the pain stage, so the application of heat at this point is only going to make things a whole lot worse.

However, if I am past the intense pain stage – but experiencing other symptoms such as stiffness, joint and muscle pain, vertigo, aura, dizziness, fatigue etc a hot bath can really help. The treatment appears to have a twofold effect: easing tension in the head, neck and body through the application of intense heat and – bit of a no brainer this one – baths are pretty soothing. So as long as I’m not in intense and debilitating pain, and/or am not experiencing red ear, a hot bath can help with a range of secondary symptoms.

If you aren’t familiar with Red Ear Syndrome, by the way, some of the symptoms are fairly common in people who experience Vestibular Migraines. Case studies have indicated that Vestibular Migraine may be linked to the way that balance works in the inner ear, which is a key factor in vertigo and dizziness, which can be set off by RES. Dizziness, vertigo and balance issues are crucial symptoms presenting in cases which are diagnosed as Vestibular Migraine. Additionally, RES more commonly appears on the left side of the head, which is where my migraines tend to originate.

So what happens? You get a hot ear, which colours deep red. It is painful, plus any swelling caused by the heat can trigger dizziness, vertigo and nausea. The pain (and heat) can spread into the cheek, forehead, and the occiput (base of the head and skull).

Up the junction

This is where – if you are me, anyway – things get interesting. The occiput, plus C1 and C2 vertebrae, basically represent the part of your body which is most active in head and neck movement, rotation and flexion. Together they form the Craniovertical Junction, which is where your brain transitions into your spine (I don’t really understand that bit, but then I’m not a neurologist) and the section of your body which moves more than any other part of the body.

CVJ abnormality can result in the following symptoms:

Pain in the temples, behind the eyes, and/or in the ears
Radiating pain up the head
Sensitivity to light
Nausea
Dizziness
Fatigue

These, of course, are all symptoms of Vestibular Migraine. To throw some more ingredients into the pot, the nerves connected with the C1 to C3 vertebrae control sensations to the top, sides and back of the head – if you have Botox treatment for chronic migraine, these are the primary sites where the injections are delivered, to inhibit neurotransmitters from these areas sending pain messages to the brain and to decrease hyper-reactions to external stimuli (light, sound, noise, movement) which can trigger migraine.

This is interesting to me for one particular, and fairly significant reason. Approximately 11 years ago I was treated for severe neck and back pain. A course of intense physiotherapy resulted in the following discovery: my C2 vertebra was displaced, misaligned by a factor of approximately 90 degrees. A couple of asides to this may assist in building a picture:

1 About 12 months previous I had been treated for labrynthitis, an inner ear infection causing intense dizziness and vertigo.

2 Before my physio could get anywhere near my vertebrae, it was necessary to undertake several highly intense sessions where he manipulated the muscles in my neck and shoulders in order to release the excessive tension and muscle stiffness. In essence, my muscles had tensed so much – and semi permanently- that they formed a solid barrier around the CJV. Which is handy, because it may well have protected my spinal cord from permanent damage. Every cloud, and all that.

When I get a severe migraine, my body goes into self defence mode, and all of the muscles around the bad of my skull, neck and shoulders become incredibly tense (amongst other things). This tension exacerbates migraine symptoms, and the hot bath releases some of that tension, which provides an element of symptom management. But my ears do get quite hot. Because there’s no such thing as a silver bullet, or a panacea, for migraines. On the plus side, who doesn’t love a nice hot bath?