About my migraines

Since my early 20s I’ve been getting visual auras without a headache several times a year. I still get them in my late 50’s and they still occur without a headache. In my 40s I started to have migraine headaches without an aura. My migraines are always left-sided and if I don’t treat them, I will develop sensitivity to light and nausea. Luckily, my migraines are not at all disabling because they remain mild for hours, so I have plenty of time to take 100 mg of sumatriptan, which works very well. The tablet works within one to two hours. When I want to have faster relief, I take a 6 mg sumatriptan injection. This usually happens at night when I want to go to sleep and I don’t want to wait for the pill to start working. I can’t fall asleep with a migraine, while for some, sleeps actually relieves the attack.

I am not happy about having migraines, but they do not interfere with my life and give me a better understanding of what my patients are going through. Also, I try to subject myself to treatments I offer my patients. I do not need to take a daily preventive medicine, such as topiramate or propranolol or Botox injections. However, since Botox is very safe, I did inject myself with Botox once to see what it feels like. It was not very painful, but obviously everyone has a different pain threshold (here are video 1 and video 2 of me injecting patients with Botox). I also gave myself an intravenous infusion of magnesium, which did make me feel warm, but had no beneficial effects since I am not one of the 50% of migraine sufferers who are deficient in magnesium.

The next thing I decided to try is a nerve block. Nerve blocks are injections of a local anesthetic, such as lidocaine or bupivicaine to numb the nerves around the scalp (here is a previous blog on nerve blocks). It is somewhat surprising that numbing a superficial nerve under the skin stops a migraine, which we know to originate in the brain. For the same reason a lot of scepticism greeted me at medical meetings over 20 years ago when I gave lectures on Botox for migraines. Now we know that although the migraine process begins in the brain, peripheral nerves send messages back to the brain closing a vicious cycle of brain activating the nerves and nerves feeding back pain messages into the brain. Disrupting this circuit with a peripheral nerve block for short-term relief and with Botox for long-term prevention seems to be very effective. Nerve blocks can be effective when drugs are not or when drugs are contraindicated because of an illness or pregnancy.

Sometimes, blocking the occipital nerve at the back of the head works well, but other patients need nerves blocked in their temples or forehead. Since my migraines are always localized to the left temple, I decided to give myself a block of the temporal branch of the left trigeminal nerve. The nerve block helped one of two times I tried it. Obviously, I do not recommend DIY nerve blocks or teach patients how to do it, but I did encounter one patient who learned how to give himself an occipital nerve block before coming to see me. There might be some exceptions, such as for people living in remote areas and who do not respond to any other treatments, or in not such distant future, for those traveling to Mars.

The next treatment I will try is a sphenopalatine ganglion block. I will describe this treatment in my next post.

3 comments
  1. Dr. Mauskop says: 11/29/20152:40 pm

    It is not unusual to have worsening of migraines for a week or two after the injections – about 10% of people injected with Botox experience it. Three weeks is a bit too long, but I’ve seen a handful of patients who take that long to begin improving. What I do see very often and what was seen in large Botox trials for migraine, is that each subsequent treatment is more effective than the previous one. This is more likely to happen if you do not wait more than 12 weeks between treatments and, if the insurance company allows it, a 10-week interval can be even better.

  2. Adam says: 11/29/20152:03 pm

    I can’t tell you how much I appreciate you sharing your own personal experience with migraines. Your blogs have helped me very much this year-my migraines transformed to chronic about a year and a half ago. I have tried every possible preventative- some did give me relief of migraines but the side effects were too unbearable. Right now I am on 3rd round of Botox. Round one I had severe migraines for 2-3 weeks after the injections and then I was migraine free for 5 weeks. Second round was not as successful but I think it was due to some stressful events in my life at the time. My third round I had severe migraines again for the first two and a half weeks. I am almost at the 3 week mark and finally the last two days I havent had a migraine. I am praying that it is the Botox kicking in. Have you had other patients report it taking 3 weeks after getting injections for the Botox to work? Thank you again for all you do in the migraine community!!

  3. Anonymous says: 11/12/20152:44 pm

    Thank you so much for sharing your own experience. I love your blog, and for those of us who feel misunderstood, even by the medical community, for our condition. Many times, I feel the doctors I’ve been to don’t “get it.” It’s really helpful knowing

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