I'm looking forward to the weekend, during which I won't tempt fate, I promise.

Since Wednesday's ER visit, I haven't had that much pain. I'm having a sinus migraine right now, which is actually pretty intense, but it doesn't have the same grinding down effect as the more traditional one.

I've taken triptans at the onset--and the onset has been slow enough I've been able to catch it--and they seem to be doing their job.

That's huge. I've had two days of almost being like a normal person, although I am skittish around loud music and other potential triggers.

In which reprieve, however temporary, is well-received

Went to the ER last night. Yes, you're counting right--I just got out of the selfsame hospital on Sunday. But Tuesday and Wednesday mornings I had woken up with a wicked headache--woken up by the pain. That's extremely rare for me. All told, I think I had less than two hours awake over the 36 hours in which the pain was less than a 5 out of 10.

So much is variable. The dilaudid hit me like a ton of bricks this time, but they didn't put me on physiological monitoring.

My migraine specialist said I shouldn't let the headaches blossom as long as the last time, but he also proved to be unreachable all day, so in order to nip the pain...well, it was way past budding time...I went to the ER. His plan was to avoid the ER with more DHE, but I don't think it works.

What they see as progress is me lying down. That always helps. But I can't live in my bed. Just this Sunday after 36 hours of DHE flushing I went home--and had my next migraine maybe 5 hours later. Not success in my book--I can probably achieve that by staying in bed all weekend without the needles.

Get to us earlier!

Easy for you to say, Mr. Migraine Specialist Man. When I go to the ER after four days of the same migraine, I feel like I'm folding early. That's what I did this past Friday, but instead of decreasing in intensity (either much or little) it decreased and then spiked.

Which meant they transferred me from that ER to a hospital where the specialist has admitting privileges and I got the DHE flush again. Tiresome, boring, cold, hot, just...not a fun way to spend your weekend.

Does it work? Hard to say. Lying down for two days has its own minimising effect on my migraines. I was discharged at about noon, and got my next migraine by six. But it was small and mostly responded to Maxalt.

Mostly.

The upshot of the visit:
a) He wants me to ping him (how? he's so very unavailable) before the ER to see if we can do the DHE as outpatient before dilaudid, etc come into the picture
b) Namenda again
c) Increase Depakote to 1750mg/day

We shall see. My fingers are crossed Namenda-wise, and I'm back on the Mg and the riboflavin, just to see how things go.

Ah, where to start? A week of multiple ERs, and not a little stress.

This particular migraine started on Thursday. Since I get about a migraine a day it might seem strange that I call some continuous and others stop and start anew. Basically, it's about the characteristic of the painful parts--are they consistent with the previous painful parts--and the characteristics of the less painful parts--are they pain free, or merely pain-lite?

Monday I tried to go to the ER. I tried to go to two ERs, but neither of them would give me much in the way of painkillers nor the other stuff in my recommended cocktail. The first ER gave me 1mg dilaudid intra-muscularly, and 25mg of Benadryl. Seems he only wanted to give me two things, and once I told him that dilaudid made me itch he took the anti-emetic off the bargaining table and replaced it with the anti-histamine.

Effect on my migraine? Sweet FA.

The second ER--well, there's a theory that I shouldn't have told them it was my second ER. But I hold onto the conviction that if I tell them everything they'll be able to treat me more knowledgeably.

Maybe not these guys. Absolutely no way they could give me more than 1mg of dilaudid. I'd never be given SIX. I told him to check my records from the last visit, but he said they didn't write things like that down.

Eventually he got through to my GP and my migraine specialist, and was willing to go as high as 2mg.

Effect on my migraine? I lied and went home.

By Wednesday I couldn't go into work. Thursday I got a last-minute appointment with my GP who called the migraine guru and not just had the explicit protocol put in my files for two hospitals, but also called one of the ERs and told them to expect me.

Push comes to shove, going to the ER alone is horrible, but I didn't have much alternative. It took them some while to bring me in, and the doctor who saw me seemed flabbergasted at the dosage, and even more flabbergasted that I've had up to 10mg in one visit. They hooked me up to all sorts of monitors, gave me the cocktail of medications, and lo! It was like unto a beam down from the heavens.

I got my brain back. Oh, a loopy brain until the dilaudid wore off, but a clear one. Ugh. Way too much work and took way too much time.

It's funny--when I go with my normal escort, I tend to get enough medication. When I don't, it becomes a crapshoot. I wonder if he'd be flattered to hear that?

Enquiring Minds...

I have a Google News alert set up for "migraine" (I used to also have one for "Whedon", but I soon learnt there's neither enough time nor enough interest to read those every day). There's not that much new, all told. Lots of regional "migraines are very bad--you don't realise that" stories. Which is true. I mean, I've been having them since I was in the single digits, but it's only in the last 5-10 years that I found out there migraine specific abortives, never mind prophylactics.

And the ER thing? Within the last year. How I wish I could un-know that. Not even sure why.

Tonight's Google Alert led me to The Migraine Action Association, a UK-based group. I'm poking around idly, and I notice their membership page. Pay? To be part of a migraine group? I pay upwards of $100/month on meds, $75/ER visit, $250/admission. I can't imagine paying more money voluntarily.

And I'd like to think the things they learn are disseminated outside their borders.

I don't know. It seems like buying more migraines--their graphics, for instance, do a damned good job of evoking the headache I'm already having. The better they are, the worse I feel.

I didn't end up stopping the magnesium--the upset stomachs are less constant, perhaps because I'm making sure not just to eat when taking it, but increasing the yoghurt in my diet as suggested by random websites.

Syncope is not uncommon with migraines

Oh, yay?

It means paying much more attention to how I get up. I can't even begin to think about how it will affect my desired physical activity. I just can't.

I don't know how much changed as a result of today's visit with the migraine specialist.

My Depakote is to increase, and he wants me to take Celebrex with my triptans, right away, and see if that makes a difference. He's considering a second admission, this time with more DHE, and aggressive Namenda right afterwards.

Oh, and more steroids.

The most palpable (for non-literal interpretations of the word) change is his insistence that ER doctors page him if they disagree with his protocol, certainly before trying to argue with me. Much appreciated, let me tell you. He knows I have to be given all the meds together, up front, instead of trying a bit and trying another bit and ending up giving me more in the end.

Let's just hope his communication skills are good.

Follow up in three months.