Jo Elvin’s migraines cause 12 hours of tortuous vomiting and pain. What brings on these episodes?

The introduction is also posted on Spotify as a podcast by “Gerry at The Health Equation”

You can search Spotify for “Gerry at The Health Equation”

Or use the link below

https://podcasters.spotify.com/pod/show/gerrygaj

Below is the specific link

Gerry Gajadharsingh writes:

Much of my clinical work is focused on complex patients and the diagnosis and treatment of Headache & Migraine can often fall under that heading and so we offer a special interest Headache & Migraine Clinic at The Health Equation

Headaches are a prevalent clinical issue seen by Osteopaths, GPs, and Neurologists, with primary care seeing approximately 4.4 out of 100 patients per year for headache-related concerns. Headaches can manifest as pain in the head, face, jaw, or upper neck, varying in frequency and severity.

Migraines, a primary headache disorder, are notably intense and disabling, without head pain in some cases. Globally, migraine ranks second among leading causes of years lived with disability. Approximately 15% of the US population suffers from migraines, posing a common and debilitating challenge for primary care providers (PCPs). Alarmingly, despite its prevalence, migraine often remains undiagnosed, with about 1 in 10 patients presenting headache-related complaints to PCPs, of which 75% are diagnosed with migraine

I have observed with numerous complex patient presentations, including those related to headache and migraine, that multiple factors can contribute to the symptoms. Beyond the typical triggers for headache and migraine, a comprehensive understanding of these factors often yields additional therapeutic solutions for these debilitating issues. Treatment can then be tailored to address these underlying problems, often complementing the patient’s ongoing conventional medical treatment.

Migraine stands as one of the most prevalent human diseases, characterized by its chronic nature and hereditary predisposition, which heightens sensitivity within the nervous system over time. While headaches are a primary symptom, migraines also encompass a myriad of other manifestations, impacting daily functioning with variable intensity. The condition’s aetiology remains elusive, though it’s believed to stem from abnormal brain activity affecting chemical pathways, blood vessels, and neural signals.

As our understanding of migraine’s pathophysiology deepens, it becomes evident that this neurological disorder entails recurrent episodic attacks, rather than merely sporadic headaches. With a global prevalence of approximately 1 in 7 individuals, migraines afflict 15% of the UK adult population, contributing to over 100,000 absences from work or school daily.

Migraine exhibits a notable gender disparity, affecting women two to three times more frequently than men, with a lifetime prevalence of 33% in women and 13% in men. While it can manifest at any age, migraine is most common between 25 to 55 years, with around 8% of sufferers experiencing chronic migraine.

The economic impact of migraine on the UK economy is substantial, amounting to £8.8 billion annually in lost productivity. Additionally, various medical conditions, including depression, anxiety, fibromyalgia, PoTS (postural orthostatic tachycardia syndrome), and sleep apnoea, heighten susceptibility to migraines.

Moreover, about two-thirds of individuals with chronic migraine endure medication overuse headache (MOH), a phenomenon where the excessive use of acute treatments like triptans or over-the-counter painkillers leads to daily headaches, exacerbating rather than alleviating symptoms.

The majority of headache is primary (such as migraine). Primary headache is the best validated within this classification system of the International Classification of Headache disorders (ICHD), there are numerous descriptions of headache and multiple subsections, leading to over 100 classifications of different types of headaches, in fact you’d probably get a headache reading it!

Secondary headaches are precipitated by another condition or disorder, local or systemic and serious causes of secondary headache are uncommon.

Like with many complex health problems, accurate diagnosis of headache types remains elusive for many individuals and therefore treatment and outcomes very mixed.

Common headache types often warrant clinical diagnosis and can be effectively managed in primary care settings. However, for specialized advice on headache diagnosis and management, consulting a neurologist with expertise in headaches or a GP with a special interest (GPwSI) in headaches is recommended.

In some cases, utilizing a headache diary can aid in the diagnosis of primary headaches. Patients are advised to diligently record key details for a minimum of 8 weeks, including the frequency, duration, and severity of headaches, any associated symptoms, medications taken for relief, potential triggers, and the relationship of headaches to menstruation.

Migraine is frequently misdiagnosed as a sinus headache, highlighting the importance of accurate diagnosis and appropriate treatment. Research indicates that a significant proportion of individuals initially diagnosed with sinus headaches are later found to have migraines. These misdiagnoses underscore the need for increased awareness and education regarding migraine symptoms and treatment options.

Individuals experiencing headaches may harbour concerns about the possibility of a brain tumour. However, in non-emergency situations, current data suggests that the likelihood of discovering serious secondary pathology in patients with isolated headaches and normal neurological examinations is comparable to those without headaches.

While normal imaging may provide short-term reassurance and reduce subsequent healthcare utilization, especially within the first year, its efficacy diminishes in individuals with anxiety and depression over time.

Additionally, there’s a notable risk of uncovering incidental findings in 6-15% of patients, which may not necessitate further management but can heighten anxiety and potentially impact insurance coverage or premiums.

Therefore, the decision to pursue imaging for headaches and migraines should be carefully considered, weighing the risks and benefits, rather than solely seeking reassurance for the patient.

Successful migraine management typically involves a multifaceted approach, as recommended by the American Academy of Neurology and the American Headache Society. This may include a combination of abortive medications, preventive medications, neuromodulation devices, biobehavioural therapy, nutraceuticals, supplements, complementary and integrative treatment modalities, and biofeedback. Prevention is key in migraine management, with preventative measures recommended for patients experiencing six or more migraine headache days per month, as per the American Headache Society Consensus Statement.

The specific blog that my comments relate to was published recently in the Times and gave a story about how debilitating migraines are and how hit and miss treatment can be.

The individual involved is likely to be suffering from cyclical vomiting syndrome/abdominal migraine, which is a variation of one of the types of Migraine, often called disorders of gut-brain interaction.

One of the highly effective tools we utilize at The Health Equation is capnometry, which allows us to measure patients’ breathing behaviour. Additionally, heart rate variability monitoring provides insights into their autonomic nervous system response. Many of our patients exhibit breathing pattern disorders and autonomic nervous system dysregulation, particularly those suffering from headache and migraine.

https://www.thehealthequation.co.uk/heart-rate-variability-hrv-and-capnometry/

https://www.thehealthequation.co.uk/diagnosis-management-of-headache-migraine/

The Times

Tell them about the spew bowl,” my husband, Ross, said as I sat down to write about my migraines.

This is your first clue that this is not a glamorous read. It’s revolting.

I had planned to write this a day earlier and guess what? I lost the entire day to a migraine. I woke up at about 3.30am with the dreaded pain and wasn’t well enough to even sit up until 7pm. Yet again I had to tell a friend who was counting on me that I had to let her down. My family went about their day pretending I didn’t exist, which is how I like it. When I feel that horrible, I need to be left well alone. Not only do I hate anyone seeing me in that state but the fact is, if someone walks into the room and I have to tell them, “No thanks, I don’t need anything,” that much activity is enough to make me be violently sick.

If you haven’t had a migraine, you probably don’t really understand them. I must stress: this is how they are for me. Having discussed this with many other sufferers, it seems migraines can be as individual as fingerprints. They’re fascinating, really. Total f***ers but fascinating, I will grant.

I don’t know why I get them. No one does. Everyone’s best guess is they’re hereditary: my father suffers from them, as did both my grandmothers. One of my two brothers gets them. I feel deeply guilty that my 19-year-old daughter now gets them too. One of my earliest memories is, at six years old, waking up from a bad dream where my head hurt and cute little cartoon characters kept spinning me round and round at random intervals. I’d never had a headache before and I didn’t understand why that morning, I just couldn’t bear to lift my head off the pillow. It was the beginning of an affliction I would be dealing with for my entire life.

The first sign of trouble is if I wake up and feel as if someone has just smacked me right across the forehead with a metal bar. I take a moment to lie there and feel utterly miserable because I know this means I’m in for a hell of a few hours — 12, minimum, but often lots more.

Instinctively I always feel the need to make my head cold. I need, at the very least, a cold wet flannel to put across my eyes and forehead. Or an ice pack. But that means I’m going to have to get out of bed, and the second I make a move the pain will shoot around my whole head — behind my eyes, making the back of my neck pulsate with pain, my shoulders too. Standing up will also trigger a vertigo attack that has a direct effect on my stomach. If I so much as twitch a finger at this point, I will need to make it, sharpish, to the toilet bowl.

The vomiting is torturous. The physical exertion makes my head hurt more. I normally make about two or three frantic trips to the bathroom to view the contents of my last meal in its entirety.

The worst thing about the throwing up, though? Long after there’s nothing left to jettison, my stomach’s still stubbornly purging. I can spend hours lying there trying to sleep but every 20 minutes or so the nausea and retching have me running to the loo again.

Indeed, this dry-heaving has become such a routine, hours-long part of the whole process that I’ve taken to doing something that disgusts my family. I keep a bowl under the bed — the aforementioned “spew bowl”. Every 20 minutes or so the stomach flips anew and I have to hurriedly sit up and reach for that bowl.

A doctor explained the sickness to me years ago and, while I’ve forgotten the science, fundamentally this violent vomiting is because the body goes into panic mode. The brain and stomach agree that there’s something evil afoot and decide the best course of action is just to expel everything. And, reader, I’m afraid I mean everything. So another delightful part of the migraine deal is that usually there comes a point where I’m running to the loo, spew bowl in hand, because now I’m exploding out of both ends.

Yeah, it’s chic scenes all round.

Every time I lie back down I pray that this is the time I will fall asleep because that is the thing that tends to settle my stomach. Until my stomach has stopped going crazy, there is no way I can do what I have been desperate to for hours: take some strong painkillers. Not even the tiniest sip of water will stay down when my stomach is in this panic mode.

In the 1990s a doctor prescribed me some anti-nausea medication, but there was a catch — they were suppositories. I cried the first time: how much indignity must the migraine sufferer bear? But when I realised they cut the whole hellscape down to maybe two hours instead of 14, I became very pro-suppository, and a suppository pro. And then they stopped making them and it was back to migraine marathon hell.

So I lie there, trying and trying and trying to relax. But my stomach is flipping and my head is really hurting. It’s hard to describe how unbearable the pain is. A few years ago I read an essay that suggested that the most painful thing a human can experience is a bullet wound. Number two? A migraine.

Lying there trying to sleep off the hurt and the hurling, my brain fixates on the strangest things. Like song lyrics: I once spent ten hours unable to think of anything but “the world moves on, another day another drama, drama/ But not for me, not for me, all I think about is karma” from Taylor Swift’s song Look What You Made Me Do.

I’ve also developed an awful compulsion: biting the living shit out of the inside of my mouth. Recently this led to painful ulcers that stopped me eating properly for three days.

Sleep comes when my body is utterly exhausted. I just have to wait until the point where my body is so tired from the energy expended in all of this and I finally drift into a fitful sleep. Sometimes the pain is still prominent in a dream. The worst is when my stomach is still going nuts and the recurring dream is people trying to force-feed me, which rouses me to be sick again.

Otherwise I wake up, usually about two hours later, and I can tell instantly if my stomach has calmed down. It feels as if I’ve won the lottery. I can now put water into my dehydrated body. I can finally turn onto my side; resting for that long in one position means my back is now howling too. My head is still sore, but the pain has waned and — hallelujah — I can take some painkillers.

I won’t be headache-free for hours to come. But I can now contemplate a dry piece of toast and a cup of tea. The next day I’ll still have some pain behind my eyes; I think this is dehydration. I will feel odd and kitten-weak all day.

Migraines get defined as headaches. The pain originates from and centres around the head, yes. But they’re not headaches. I get a lot of tension headaches and I can take Nurofen, keep it down and carry on with my day.

What I truly hate the most about my migraines is not the vomiting — it’s the impact they have on those around me. I hate it when my head turns me into a terrible wife, friend and co-worker. I’m sure I have exasperated many people over the years, even when, at the same time, they felt sorry for me. But it’s not just a headache.
A version of this article first appeared on My Goodness! From Jo Elvin; joelvin.substack.com

The lowdown on migraines

  • About ten million adults in the UK suffer from the condition. There are 190,000 migraine attacks in England every day
  • Migraines are the third most common health condition in the world and more often diagnosed in women than in men. Hormone fluctuations are thought to be a factor
  • Almost a quarter of women in the UK suffer from migraines, compared with 12 per cent of men

 An episode usually lasts between two hours and three days. Triggers include stress and environmental factors such as changes in pressure, bright sunlight, flickering lights, air quality and smells

  • There is no cure, but preventive medication such as topiramate and sodium valproate — anti-convulsants used to treat epilepsy — and beta blockers can help. As can acupuncture and cutting back on caffeine
  • Chronic migraines are headaches for at least fifteen days a month, with migraine symptoms during eight of these, for three months or more. Specialists may recommend Botox injections, thought to block neurotransmitters that carry pain signals
  • Research from the Migraine Trust found that 60 per cent of sufferers felt the condition had a significant impact on their relationship; 71 per cent said it had a substantial effect on their mental health