A New Start?

It's been so long since I last wrote anything here, you might have guessed the migraines are less of an issue than they used to be.  I still get them but much less frequently and less intense.  Maybe its the amitryptyline which I continue to take mainly to get a good nights sleep.  Maybe its approaching 70; they're supposed to diminish with age aren't they?

From now on I'm going to use this blog to get the trials of modern life, which could well give anyone a migraine, out of my system.  If they really do trigger one I'll be sure to record it.  Maybe the blog needs a new name: I'll see how it goes.

Today a minor irritation with a happy ending to get things off the ground.  Renewing Home Insurance over the phone can be a trial but Saga have a fairly humane approach and at the end of the process they offered their (new?) Home Response as additional cover.  It sounded interesting and I nearly went for it, but at the price (£60/year quoted) I hesitantly declined.  Half an hour later having read more about it I thought I ought to have it so phoned back to enquire further.  This time, I was quoted a special offer price of £30/year and of course signed up willingly.  Was the original agent obliged to quote £60 and then noted on my file that this was too much?  Curious.

First for a while

We'd planned to go out for the day last Wednesday, but a migraine arising in the night and lasting 24 hours put a stop to that. It was the worst since going back onto amitriptyline, but these are not as bad as those earlier in the year. I'm convinced the drug is making life easier, at least for now. I have to admit I had been eating rather a lot of fruit in the preceding days.

Today I awoke with a headache which paracetamol eased. Fingers crossed.

If I get several more I guess we'll be upping the dose again for another few months respite. I'm told 70 mgms is normal so my 10 mg can be doubled if need be.

and another one

I almost forgot to record it, but last Saturday, 11th July I woke up with another bad one. Naproxen and paracetamol together, which gave some relief once, failed this time. So I sat it out, literally, and by Sunday morning it had faced to manageable proportions.

Amitriptyline Update

Last Sunday was my first bad migraine since going onto Amitriptyline in early June. This is progress and I can probably cope with one a month if that's how it stays.

My husband points out that in the week before Sunday, feeling confident and craving fruit, I started eating apples and strawberries again and after a couple of days without ill effects overdosed (as he puts it) on nectarines.

I'm off fruit again for now but maybe an apple a day would be a more sensible approach!

Back on amitriptyline

After a clear week on Propranolol, I suffered a series of what I first thought were classic migraines (4 in two days) but these had very little headache associated. I went back to the doctor and he took me off Propranolol (visual disturbance and headache are amongst the listed side effects!) and re-sold me on amitriptyline which is now well accepted as a successful migraine prophylactic.

Being about to go on holiday and in need of sleeping better this was quite welcome. So, I'm back on 10mg amitripyline at night, sleeping well, but have had two common migraines since starting the course on May 26th. These seem to be reduce in intensity by a combination of Naproxen and Paracetamol.

Apparently it will take a few weeks before any improvement can be expected. The downside so far; dopy mornings feeling unsafe to drive, but this I'm told will wear off.

Decision time

I decided I could not start taking the Topiramate yet. If the Propranolol I took a few years ago stopped working because my use of Solpadiene simultaneously reduced its potency (as the consultant had told me) then I should try Propanolol again now that I'm off the codeine. My GP was happy to agree with me and so I started a course of propranolol on May 15th. So far so good...

An undeserved hangover

We went to a smashing 65th Birthday Party in the village on Saturday night complete with large bonfire and  fireworks.  Plenty of food and wine, although as always I was the only teetotaller in the room.  This is never a problem for me; I don't need alcohol to get merry, but I often suffer the following morning with a hangover worse than my husband's.  Sunday morning was no exception and a full-blown common migraine erupted in the early hours.  We had family coming for Sunday lunch, so lying down in a darkened room was not an option: it had to be fought.  Naproxen proved useless again and really upset my stomach.  Could it have been triggered by  party-food or elation? Neither explanation would be acceptable, but maybe the few spoonfuls of chili on an otherwise bland plateful was a mistake.

It lasted through Sunday night and all-day Monday (spent in a darkened room) despite another go with a Naproxen and Omniprazole taken together early in the day.  It's shadow was still there on Tuesday morning but by lunchtime I was back to normal.

A pair of classics, and then...

I had a relatively manageable classic migraine on Monday, took a Naproxen, felt better, but suffered stomach pains such that I decided Naproxen was no longer a good idea.

Today's classic stopped my going out this morning because I decided to take nothing stronger than paracetamol. I was feeling almost normal by the evening and we went out for an enjoyable Chinese.

During Thursday night I felt strange and by Friday morning had a full-blown common migraine of the sort that has followed Chinese food in the past. I had to take something so doubled up the ulcer treatment and took a Naproxen, apparently without relief. During the afternoon it became manageable and we went out to the cinema in the evening as planned. So, not as bad as in the past, but by most counts, 3 in a week.

Another one

Yesterday I woke up the headache and numb arm and decided to take one of the naproxen.  It worked well for about 2 hours and then the headache returned with a vengeance.  I'm allowed 3 a day if I double the ulcer treatment while I'm taking them but I decided to stop at one and tough it out.  The day was not as bad as the last migraine day, and while I slept OK last night, the "dagger" part of the headache was still there this morning.  So I took another naproxen and things eased sufficiently to allow a trip to the supermarket in the morning.  These painkillers are better than nothing and if they don't kill the headache they certainly kill the ever-present arthritis pains!

If I get another inside 10 days I'll need to think seriously about starting the topiramate.

False Alarm?

Last night I had some of the symptoms of a classic migraine arriving: feeling of elation followed by a numb left arm and visual disturbances. I went to bed expecting the worst, but despite not sleeping well, woke today without a headache. Now, at 9pm nothing has yet developed.

I got the Naproxen and Topiramate prescription from the neurologist today but as the Topiramate were in capsule form and I was supposed to take half a 25mg tablet to start with, I asked the pharmacist to replace them with tablets. These should arrive tomorrow. The Naproxen are to take if I get a severe headache which would normally have me reaching for the Co-codamol. I also have extra Omeprazole to take along with the Naproxen so that my gastric problem is not exacerbated.

Whether or not I start the Topiramate immediately or wait and see what the headache frequency is as I come of Co-codamol remains to be decided (by me!)

Cold Turkey

I woke up with a migraine, or maybe codeine withdrawal symptoms if the neurologist is right, at 3:30 am on Saturday. Not yet having the medication which he thought would reduce the suffering of avoiding co-codamol, I decided to avoid it anyway and spent the day in a darkened room with the severe headache waxing and waning until it became more bearable in the late evening. We'd booked to see "Australia", but I couldn't make it. Slept well that night and had a nice day on Sunday including lunch out at the Old Butchers in Stow: a fine restaurant, full to the brim.

Back Again

The migraines did not go away: I just began to feel that writing the blog was keeping the problem more alive than it should be. Since June 2007, I've had fairly regular migraines despite taking tight control of the diet, and the sleepless nights have been fairly common in the absence of amitriptyline. The only medication which offers any headache relief remains co-codamol. A couple of weeks ago I had a really bad classic migraine which left my left arm feeling numb for several hours and worried me sufficiently to go and see my GP. She refererred me to a neurologist and the appointment came through for last Sunday a.m.

The self-proclaimed headache specialist gave me a thorough check-up, and wanted an account of the progress of the migraines since they started at the age of 12. He turned out to be a fan of amitriptyline and anti codeine-containing analgesics. I haven't got his letter summarising the diagnosis and treatment yet but the first thing he wanted to do was to get me off co-codamol. Even at the rate of no more that 4 tablets per migraine, and a migraine every 7-10 days, he suspected that I had become dependent on the codeine and was suffering from codeine withdrawal symptons after a week without any. The new regime will involve a three week course of an NSAID to allow coming off codeine without too much pain, a doubling of the ulcer-preventative to stop the NSAID aggravating the ulcer problem, and then a new anti-migraine prophylactic in conjunction with a minimal dose of amitriptylene to improve sleeping. I'll provide the details when I get the letter.

Mixed Messages

I suppose the fact that I'm not thinking of writing this as regularly as I used to means the misery really is less than it used to be. However immediately after writing "Better Times" I had less intense than normal but nevertheless unpleasant common migraine. Maybe the very act of focussing on the blog is triggering something! A horrible thought.

Yesterday I had to cancel a day out with a friend because I awoke with another common migraine and felt incapable of driving. It did not last past lunchtime but I began to think that the minor liberties I'm taking with the diet are likely to be causing these more frequent attacks. These liberties are mainly sating my craving for fruit by risking muffins with currants and dates and also an apple pie. I've also been trying a little potato salad and this afternoon had some blackcurrant jam for the first time since starting the diet. More sinfully perhaps I had a chicken baguette for lunch at a cafe on Tuesday and this turned out to be really nice - far spicier than anything tasted in the last few weeks. (Surprisingly this did not upset my stomach.) I could argue that rather than taking liberties, I'm adding back foods in a controlled fashion to see whether they have any effect. Unfortunately, everything I add back seems to have an adverse effect.

Looking back to April when I first came off amitriptyline, there is however no doubt whatsoever that I feel heaps better. Equally theres no doubt that the "heads" are less troublesome both in frequency and intensity. Sleep patterns continue to improve, and while I still get up between 5am and 6am most days, it is a pleasure to be up, often in the garden, on these still calm summer mornings.

For the last 3-4 days the gastro problem has been better so maybe the persistence with Zoton is paying off.

Better times

Shortly after writing last Thurdsay's post I had a classic migraine; the full aura and a few hours of subsequent headache and sickness, but as I've recorded previously, these are minor events compared with the common migraines which in recent times have been the main source of misery.

Since Friday its been a very good spell, with clear head and somewhat reduced stomach pain. I saw the doctor today, and while he had hoped for better results from the Zoton, he's asking me to stay on it for another six weeks prior to reducing the dose by half for a fortnight and then stopping.

Normal again?

It's a week since I last wrote and I'm trying to remember the details. Overall I'm now pretty convinced that the diet is the key to the reduced frequency of migraines. I've had one relatively minor migranous event in the last seven days, and this hangover-like incident followed a very nice three-course meal out at a good restaurant this Tuesday. I woke up with a bad head on Wednesday morning early, took 2 Solpadienes and by lunchtime it had faded. I also ate out on Saturday night and while there were no immediate ill-effects I feel this in some way contributed to "going over the top" with Tuesday's meal. In neither outing was it possible to avoid some of the no-no items in the migraine diet, and I feel while I can take the occasional risk*, two within the same few days leads to trouble. This was the case on the cruise, and once over the top I need a few days of careful eating to detox and get back to normal.

Looking back at the early days of coming off amitriptyline, I realise how everything seemed magnified in the first few weeks: all the little worries and concerns were amplified to the extent that I was really depressed and could not see the point of not starting to take it again. I seemed to be screaming silently all the time. It was a true addiction and one that I am now well rid of. Dare I say I feel normal again - mentally, and at the moment the migraine frequency and intensity is lower than it has been for ages.

Sleepwise, things are still disturbed. Some nights I get through without sleepers and others I don't even though I've taken some. I suppose I feel things are getting better but very gradually: either that or I'm less concerned about sleeping less.

One new issue - I hesitate to add - is a recurrence of the ulcer symptoms I suffered from about 15 years ago. The doctor has decided to put me back on Zoton for a month to see it this controls the unusual "ache" which is not burning and not ordinary indigestion. When I first had this someone said these symptoms were migraine related. Now I wonder if they're migraine-diet related.

* By "risk" I mean some gravy with the main course or a dessert with some summer fruits in. Alcohol, citrus fruits, chocolate, cheese and all the other common triggers never pass my lips.

Up and Down - again

Nothing developed on Monday and despite the cold and sore throat it was a good day. Monday night was the best night for weeks, sleeping right through until the 7am alarm without any chemical assistance. Once again on Tuesday evening I thought something was developing and took 10mg of Temazepam to get off to sleep. Unfortunately I woke at around 3am with a headache and couldn't get off again. Once again I took two Solpadeines and once again they worked quickly so that Wednesday was a clear day. These heads can't be migraines, so I must assume they're related to the cold symptoms and hence easily cured.

I woke early Thursday (4am) and decided to get up and do the ironing. Tired all day but once again free of migraine, the 12th consecutive clear day.

Catching Up

This is a compilation of several days, having taken a holiday and having been unable to keep the blog up to date.

Wednesday - 9th May

I'm feeling unbelievably tired because I'm still waking up between 3 and 4 am and failing to get off to sleep despite taking 10mg of Temazapan. When is it going to get better? I've been falling asleep during the day whenver I sit in a comfortable chair: should I be forcing myself to stay awake until bedtime in the hope of getting more rest at the right time? Can this still be amitriptylene withdrawal or is it the menopausal sleep problem I suffered from before starting amitriptyline for migraine and finding it made me sleep better? What will happen during my holiday which starts on Thursday with flight to Venice? My husband was dealing with the same questions at 9pm on the internet and had discovered that women suffering sleepless nights after withdrawal were taking the occasional 10mg of amitriptyline as a sleeping tablet with immediate good effect. We agreed that I would try this tonight and take the tablets with me to Venice.

Thursday 10th May

I had the best night for ages, amitriptyline-fuelled, and my husband had one of the worst. Apparently at about 3 am he was awakened by me chatting in my sleep and twitching regularly - Rapid Molly Movement sleep he called it - and this kept going for a couple of hours before I woke up and he finally drifted off to sleep again. I felt very groggy and spaced out for most of the morning, which was no bad thing because we flew to Venice. Here the hotel was so hot (air conditioner putting out more sound than cool) I doubt if either of us would have slept well under any circumstances. In the event, 10mg of Temazepam were useless.

Friday 11th May

We revisited St Marks Sq. in the morning, discovering it had lost a lot of its charm in the last 10 years, thanks to its increasing popularity and an attack of graffiti. Spent the afternoon touring around the city in a vaporetto and had a quiet dinner in a pleasant restaurant just north of the Rialto. The hotel room was a little cooler having kept the sun out all day and having complained about the noise at breakfast.

Saturday 12th May

Moved on to Dubrovnik, arriving Sunday am after another great nights sleep on 12.5mg amitriptyline. Once again very groggy and dopey during the morning. Must reduce the dose to around 6 mg to see if it still works without the "hangover" the next morning.

Sunday 13th

A day out in Dubrovnik and Cavtat. Slept well with 10mg temazepam.

Monday 14th

A day at sea - heading for Turkey. No medication, no headaches and a good night's sleep. What's going on here? I'm also eating a wider range of foods due to the inability to control my intake while eating only in restaurants.

Tuesday 15th.

Kusadasi, Turkey. I'd decided against taking the tour to Ephesus in view of the heat and difficult walking conditions. Just as well, a migraine started in the afternoon, but I managed to keep going until bedtime, taking a walk around the port area of Kusadasi. Needed a temazepam and woke up with a worse head in the morning.

Wednesday 16th

Santorini, Greece: Solpadienes taken to keep going - went ashore but the queue for the cable cars was about 2 hours long so I returned to the ship after an hour on the shore below Fira. Things improved in the afternoon and evening, but I decided to go to bed with an amitriptiline - about 8mgms this time.

Thursday 17th

Corfu, Greece: Feeling better so I had a look round Corfu town which was quite disappointing. Apparently the rest of the island is quite beautiful.

Friday 18th

A day at sea heading back to Venice. Feeling OK until the evening when another headache started.

Saturday 19th

I've often wondered what it would be like if I had to spend a day travelling with a migraine, not being able to collapse in a chair and try to chill. Today I found out. It was very grim, waking up with it, having to trudge round Padua - the last of the planned tours - taking it to the noisy airport, nursing it on the flight home, and finally taking it to bed when we got back home that night. 16 hours of continuous motion, boat, coach, trudge, coach, plane, bus and car while feeling like death. I really was very brave, and felt I really deserved my 12.5 mg of amitriptyline.

Sunday 20th

Woke up groggy but with a clear head, determined to get back onto the migraine diet.

Sunday 27th

As I write this in the evening of 27th May, but for one nocturnal headache (midweek) which responded to a couple of Solpadienes, I can say its been a good week back in the relative peace
of our Warwickshire village. I've been getting increasingly tired due to waking up early every day, and have to admit to taking about 6mg of amitriptyline on Tuesday night for some respite. Tonight I might do the same. For the last couple of days I've been fighting a sore-throat and a cold, which I guess is not helping. Nevertheless I am feeling a little migranous for the first time in a week.

Up and Down

Had a couple of good days, Saturday being great enough to make me think I was finally getting on top of things. On Saturday night I went out for a meal at a friends house in the village with the usual trepidation related to what I might have to eat. The meal seemed fine, excellent in fact, but I can never be sure that the homemade soup or sauce doesn't contain something I'm trying to avoid.

At 4 am Sunday I woke with the start of what I thought would be a day of nausea and headache, and things deteriorated until I took 2 Solpadeine at around 8 am. As with the last episode, the tablets dulled the headache considerably and whilst feeling drained and wobbly, I was able to get over to see the grandchildren and have an enjoyable afternoon but for the full aura of a classic migraine coming on at about 4pm. As in the old days of mainly classic migraines I could feel it coming before the aura started, but as with the other recent classics, they seem to follow a common migraine, and their post-aura headache is more manageable than it used to be. I guess my system is still a bit haywire after the drug withdrawal.

I digress

My husband has been treated over the last 10 months - on and off as the NHS schedules permit - for a suspected kidney stone. After his initial collapse in the small hours of a July Saturday, I took him to Warwick Hospital A&E where the initial diagnosis was either aneurism or kidney stone; later refined to kidney stone after X-rays and a urine analysis, the latter containing blood and signs of an infection. No stone had showed up on the X-rays, but as some stones only showed on an ultrasound scan, and as the ultrasound scanner had broken, he was told to see his GP and get referred to a urologist. This was done, and in October he had the first ultrasound scan which showed a 6.4mm (!) stone, probably uric acid based, in the left kidney. The consultant (November) recommended lithotripsy and this was done in January. In March a second ultrasound scan was due but postponed on the day of the appointment. He finally had the scan in early April, and no sign of a stone was found. Conclusion: the lithotripsy had been successful and the stone had been shattered and passed. However he was still suffering from fairly constant low-level pain in the bladder area, and having to pee much more often than was normal.

He went back to the GP who said that if the stone had been passed, the pain and frequency should be diminished, so he should really phone the Urology dept. and demand to see the Consultant, not the specialist Urology Nurse who had dealt with the case since the first 5 minute session with the Consultant back in November. Our GP was clearly unhappy with the Nurse Led Urology unit and argued that a nurse did not have the skills to deal with complex cases.

Phoning Warwick Hospital Urology Dept is a task best tackled on a full stomach and a free day because it often takes the best part of a morning to get as far as the answering machine. This milestone was reached and a message left by about 11am, and to everyones surprise the Nurse called back at about 4pm. Here the story takes a dramatic turn. Could he come in for X-rays tomorrow - say 11 am? Of course he could.

On arrival the Nurse greeted him before he had chance to sit down and a full one hour consultation later he had been given another Ultrasound scan, a prostate examination, a urine flow rate test, forms for an immediate X-ray, a blood test, a urine analysis, a prescription for a course of tablets to help increase the urine flow rate (Contiflo XL - 400 micrograms) and an appointment for a review of the results of the X-rays one week later.

From the US scans, urine flow and my husband mentioning that he had had Benign Prostate Hyperplasy (BPH) for about 15 years, she proposed that he could well have stone fragments blocking the urethra where it was being narrowed by the oversize prostate. Hence the urethra relaxing medication which might help the fragments to pass. She also recommended giving up strong coffee and drinking cranberry juice instead. If an infection showed in the urine sample, antibiotics might be needed later.

One week later at 11am sharp, he was back with the same Nurse comparing the X-rays from last week with those taken by A&E last July and concluding that there was very little difference. We still await the blood and urine test results and an appoinment with the consultant, but I have to say at this point that we seem to have had excellent service from the Nurse Led Urology unit. More later...

In the Monet again

Today dawned bright and clear and while I missed the sunrise by an hour or so, I'd left yesterday's Heironymous Bosch behind and emerged in a Claude Monet landscape.

This afternoon however, on the way home from a nice outing to Stratford-on-Avon I had the full aura of a classic migraine for half and hour followed by the usual headache, which in comparison to the common migraine "killer" is gentle and managable. This common-classic one-two has happened on several occasions, and while the classic migraine headache continues this evening, if I wasn't writing this blog it would hardly be worth mentioning.

A medication-free day, however for lunch in Stratford I could do no better than an egg mayonnaise sandwich from Marks and Spencer: the mayonnaise being a no-no for the migraine diet. Swift retribution in the shape of a classic? I doubt it.