12 January 2007

My First Migraine

Oh how the mighty can be brought low . . .

I worked several nights in a row until yesterday, my first day off. So I pretty much just stayed up Thursday with only a short nap, to get back on a daytime schedule. As usual, I went to Karate on Thursday night, and got myself nice and dehydrated. Foolishly, I decided the best product with which to rehydrate was an otherwise excellent IPA from the Hood Canal Brewery.

I woke up at 4AM with a mild-to-moderate headache, and could not get back to sleep. Over the ensuing four hours, the pain gradually increased until I had a full-blown migraine. (note to medical types -- no, not a true vascular headache, since it wasn't unilateral and throbbing, but with all the accoutrements of the migraine, including photophobia, phonophobia, vomiting, etc.) The pain was exquisite, rippling across my skull in little flurries and surges, like a cold fire. By a large margin, it was the worst pain I have ever felt. I have been generally healthy, with only occasional back pains and minor surgical procedures, so I admit that I am rather naive when it comes to serious pain. I would rate it as an "8 or 9" on the infamous pain scale. I am tempted to call it a "10" except that I can imagine the pain being worse. And being a rather central pain, there was no escaping it. When I hurt my back, if I lie still, it eases. The pain in my head was one of those that you can't ease and wind up sort of writing around continuously trying to get away from it.

My Darling Wife, being one of the perhaps three faithful readers of this blog, was entirely convinced this was an extension of "My Bad Week" and that I was experiencing an extremely ironic head bleed. That thought had crossed my mind also. She adamantly wanted me to go to the ER. I couldn't bear that prospect -- I felt the car ride alone was likely to be lethal, but also the horrible idea of being seen by my partners and colleagues in that wretched state was deeply offensive to whatever shreds of dignity were left to me at that time. Also, I knew to a certainty that this was not meningitis or a hemorrhage, and didn't want to argue with one of my partners about a spinal tap. In my pain addled-state, I had difficulty explaining this to The Darling Wife, who harumphed in annoyance and left to take the kids to school, leaving me with a grumpy threat that I would be in trouble if she came home and found me dead.

In the end, ibuprofen and Gatorade turned the tide and I started to improve. I'm twelve hours out and have only a dull ache which hurts but is no longer incapacitating. Fortunately, today was my day off. Unfortunately, I had hoped to get some stuff done, but oh well. Lord, I hope this was an isolated phenomenon. I will firmly resolve that I will no longer drink beer after Karate (and I only had one, by the way, so I would not call this a hangover). For now, I will rejoice that it was brief and self-limited and accept this and my recent back troubles as fate's attempt to give me some sympathy if not empathy for the migraneurs and back pain folks that pass under my hands.


  1. Wow, Doc. Sorry you had a rough night. I've had a few of those headaches, too. It's the kind of headache where you think you have to die before you can get better.

    Stay well. MJ

  2. If IO listened to Olberman I'd have a headache too.

    Hope you're better.


  3. You need to go get a CT scan. You know better than that. No migraine history + worst headache ever = CT and LP.

    On a related note, I debated with myself whether I should go to the ER for my headache that I was pretty sure was from my bad tooth. Finally it got so bad that I too was thrashing around banging my head on the desk, with tears pouring down my face as I drove 100+ MPH all the way to the ER at 3 am. My root canal was at 8 am, but I just couldn't wait.

    After my root canal, the headaches were gone.

  4. Doc, hope you're feeling better.

    Scalpel - holy cats! Where do you live that you could drive 100+ MPH?

  5. Get a scan , dumbass!
    You have a wife - if it was just a migraine , then take prn tryptans -
    you should know better.

  6. Scalpel - Oh come now. It wasn't a Subarachnoid and we all know it. It wasn't sudden onset; it gradually progressed in severity -- this is highly uncharacteristic of a SAH. Everybody is allowed to have a "worst headache of their life" -- some more than once -- and not everybody needs a CT/LP. Now if you have a thunderclap headache that is the worst, it's different.

    Anon 7:42 -- you can drive 100 mph at 3AM most anywhere. I do it regularly (well, occasionally), but perhaps that is a topic for another post. But scalpel lives in Texas, and as we all know, there are no laws there, so it's easier for him. Not that's I'd recommend doing 100 in pain. You need to concentrate when you are going that fast.

    Thanks all for the well wishes.

  7. The guy with the aneurysm in my recent post had a headache for two weeks before it got worse and he had his seizure.

    One of my partners recently had a vertebral artery dissection which gave him the gradual onset of the worst headache of his life. It wasn't even seen on the CT scan, only the MRI.

    Just sayin'.

  8. Gee, thanks for the reassurance.

  9. It is truly bizarre to cross over from doctor to patient - no question about it. But there are times when you just have to go on in . . .

  10. Pain, fear, and uncertainty are like little yapping dogs nipping at our ankles. I might give them a kick every now and again to drive them away, but I don't really care much about them.

    My )our) real enemies are death and disability.

  11. Ouch.

    Physician, heal thyself. Or rather, note that thou cannot.

    The way I look at it, even if you're the best damn mechanic in the world, you can't see the engine when you're sitting behind the wheel.

    What would you do if a patient came to you with the exact above scenario ?


  12. Scalpel is right bout "identifying the enemies-" disability and death.

    I have a handicapped teenager and I'm a physician. My days at work, I sit on this side of the desk, my days off I often sit on the other (patient's) side with my daughter. It has been a real lesson in humility and in our interdependence even as physicians. I tell specialists, 'Talk to us like you would any other patient and family. Don't assume we know anything.'

    Sometimes I hear something I would not have known that way, and it's easier on the other family members if we don't just 'talk shop.'

    I had to give up the attachment to the MD identity. Sometimes you have to bite the bullet and just do that.

  13. I've had a constant headache for close to three years. The third anniversary is coming around April 16th '07. I'm on Fentanyl and take Morphine for breakthrough pain/migraine, but the headache is never completely gone.

    I'm one of those people that lives in fear of being mistaken [again] for 'drug-seeking' and won't bother going to the ER when I hit a 9'er; that rates inability to communicate & instinctually rocking myself back-and-forth w/ weeping eyes.

    Sorry to hear you were visiting my side of the tracks. ;) I hope you are feeling better.

  14. I really hope you're ok.Oh,I'm the angry migraineur that now scalpel has listed on his "medworm listings" what crap.
    Anyway,I guess he's telling you to get a scan because you are in the medical field.The rest of us who aren't are just fakes,drama queens,drug addicts,scum.
    Even though I have relatives from doctors,nurses,and am educated myself,he was nice enough to point out how I made errors in my post.
    Which of course any moron knows that someone with chronic migraine,high level migraine,this is not unusual.
    I'm glad that you get sympahty from others in your field...too bad those like scalpel can't find that for patients they treat in the er.


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