Category Archives: Health

Shoulders, Migraines, and Drugs (oh my)!

During the past few years, I have been working with my doctor and other specialists to treat my ongoing medical conditions better, particularly migraines and chronic shoulder pain, but also others.  Here I wanted to keep a record of what I/we have discovered, and I hope it may be of use to other people perhaps with similar perplexing symptoms; HOWEVER please remember that if you are experiencing any of these things for yourself – consult your doctor.

Migraines
For the past 12-24 months, I was taking a prophylactic drug called Pizotifen to prevent the onset of migraine, and Migraleve (a combination of Paracetamol, Codeine and an anti-emetic drug) to relieve symptoms.  This combination had not successfully reduced the occurrence of migraine to any acceptable level.

Following further discussion with a new doctor at my GP surgery, and a referral to a pain clinic (see shoulder info below), the prophylactic has been changed to amitriptyline, and the reliever has been changed to sumitriptan (trade name: Imigran).  I am in the process of reducing the Pizotifen, with the intent to stop it completely.  I may also take Migraleve in addition to the sumitriptan during an attack, if the symptoms do not abate.

This new combination appears to be working much better than the previous, and I will continue to monitor this with my doctors.  We (my doctors and I) have also identified a potential link to my shoulder pain – see below.

Although I have still had a number of migraines in the past few weeks, both at home and at work, I have been able to treat them much more successfully; the severity has generally been less and the treatments have counteracted the symptoms faster.  In most cases I have been able to continue to function and deliver work both in the office and when working from home, even when suffering a migraine attack. Which is a great improvement!

For some very informative presentations regarding migraine, I’ve found this short series of video clips presented by an American MD Craig Blackwell:

1 – Experience; what you see and feel:

2 – Clinical; Aura, distinctions from other neurological conditions

3 – Mechanism; What’s going on in the brain

Chronic Shoulder Pain
Following the appointments and investigations that I have had in the past 5-6 years with my GP, the Orthopaedic surgeon, the neurology department, and most recently the Pain Clinic, we have made some conclusions which have begun to explain my chronic pain (which still does not have a full diagnosis, but the picture is becoming clearer).

Up until recently, the treatments for my shoulder consisted of Naproxen, an anti-inflammatory drug and analgesic for muscular pain (this replaced Diclofenac; which I was previously taking, but has been discontinued for long-term pain due to the increased risk of heart-attacks), and courses of physiotherapy. I was also prescribed Omeprazole, which is a stomach-protecting antacid type drug to alleviate side-effects of the Naproxen.

Following the various investigations by Orthopaedics, and Neurologists (also a nerve conduction study), I was referred to a Pain Clinic. Here the specialist doctor recognised that the pain I am feeling is neuropathic in nature, rather than skeleto-muscular, and has replaced the Naproxen with another drug called Gabapentin (trade name Neurontin), designed more specifically to treat neuropathic pain. I have been slowly building up the dose of this new drug to an effective dose.

For info, Gabapentin is NOT an opiate derivative, and does not therefore have the related risk of addiction, etc. I now very rarely take the Naproxen (unless I have period pain), and will shortly no longer require the Omeprazole for my stomach.

The specialist described how it is likely that my neurones either have an existing predisposition, or have been re-programmed over several years to activate and send pain signals, when they should be sending regular sensation signals to my brain. To help with both the pain itself, and to begin to re-train the neurones, I was issued with a battery-operated TENS machine to try (Transcutaneous Electrical Nerve Stimulation). This device I was advised to wear every day, all day if required, and run an electric current between the electrodes on my skin around the shoulder/neck/back area. This has helped greatly to manage particularly the referred pain that extended from my shoulder all the way down to my fingertips, and has helped to prevent much of these incorrect pain signals from going to my brain. I have found this to be a very helpful device, and have purchased my own TENS which I wear almost every day at work and at home.

Of course, now having used the TENS for a while, my skin has become irritated, so I’m having to reduce how much I use it..

Following on from this conclusion, that the pain in my shoulder was neuropathic, the specialist also linked some of the pain sensations in my arm to be extensions of my migraine symptoms. This phenomenon is also described in the migraine presentations, linked above, as the “sensory aura” – i.e. similar to the visual aura but instead of there being an electrical “storm” in the visual cortex of the brain, this occurs in either the sensory or motor cortices. (I have since confirmed this to be the case: I also occasionally experience inexplicable pain in my other “good” arm which lasts for several hours at a time, and as I already deal with a lot of pain on a daily basis, I hadn’t regarded this as a significant event. This happened a couple of weeks ago, after my pain clinic visits and as an experiment I took a sumitriptan migraine reliever pill. This pain then subsided during the following 30-60 minutes).
Therefore, the specialist also changed me from the Pizotifen (a gradual decrease before coming off completely) to the Amitriptyline as the prophylactic which not only is prescribed for migraine, but also for chronic pain conditions.
Overall, these changes to my medications will combine so that I am taking fewer total drugs in order to treat these multiple conditions.

Other notable conditions and events:
The long-term conditions above have contributed to a continual decrease in my general mood, over the past 10-20+ years. Only very recently had this fact come to the fore as I had hit a few particularly low points, and then spoken to my doctor. Idiosyncrasies in mood and behaviour tend to be quite common in the family history, and only a few months ago did I come to the conclusion that this is not the “norm”. I am now being treated for low-mood/depression, and have had a short course of CBT (cognitive behavioural therapy). This has helped to stabilise my mood, so that I am much more able to cope with day to day activities.

Also constant pain, and recurrent migraines, lower my mood further – by being under better control just helps to keep my whole life in better order.
Also I’m asthmatic… breathes deeply! *phew*!

Advertisements

Shoulder Pain – Migraine?

Interesting.
I have been doing my research of late with regard to my migraines. At the same time, I’ve been looking into what may be causing my constant and intense shoulder pain (which doctors and surgeons have yet to diagnose or explain; after SIX YEARS).

This evening I was suffering an inexplicable pain in my good arm, not unlike that of bad days with my bad arm. It was really beginning to bother me, and then I also started to get a headache. Not wanting to write off my Friday night, I took a migraine drug just in case. My headache has eased off AND my arm has stopped hurting.

Now I was reading recently about the different ways a migraine aura can present itself. There is the often talked about visual disturbances and partial blindness; but I also found out about sensory aura.

A sensory aura presents itself as “phantom pain” often in the upper limbs and extremities. That sounds familiar. Could it be that my “shoulder condition” is in fact more closely related to my migraines? Could I have been suffering persistent migraine symptoms for six years straight? I’m beginning to wonder.

Good job I have a science background and can research these things for myself. So far the medical professionals haven’t come up with the best explanations as of yet. Although I give some credit to the representative of a pain management clinic I’ve spoken to, who has recently suggested treating my two conditions simultaneously and more appropriately.

Hopefully some progress will begin to be made.

To be continued…

My struggle with migraines

I just wanted to write a short update (well it started out as short) to describe how suffering with migraines interferes with having a normal life. I’ve had an attack today, and as it happens it’s Migraine Awareness Week, which is run by the Migraine Trust at migrainetrust.org. Quite frankly, migraines are the main reason that I have missed more than my fair share of days at work (something which I am constantly in trouble for).

Put simply, migraines ruin my life.

A typical attack can occasionally be preceded with very minor symptoms, like light sensitivity, which if I notice early enough (sadly I don’t very often) can sometimes mean I take my medication in time to stave it off. Most of the time, however, I wake up with huge sections missing from my field of vision. I.e. I am semi-BLIND. These “missing” sections actually resemble the grey static that you used to see on TV (before the digital age, that is) – with black and white geometric patterns zig-zagging their way around the edges.

At the same time, I feel incredibly nauseous (the whole world is after all moving, flickering and flashing), sometimes I am actually sick, and I have a headache so bad that I wish I could knock myself out to avoid feeling the pain.  The headache itself is usually behind and around one or other of my eyes (it can be either, and it can move from one side to the other and back during the course of a single attack), down the side of my face, and down my neck.  I have a numbness/tingling sensations in my extremities; notably my hands, feet and tongue.  I also get very scatty-brained, and can not properly form a sentence or organise my thoughts to communicate coherently (both verbally and written – I’ve got into trouble saying and doing the wrong things that way also).

Emotionally I feel like I’m letting myself and everybody down, my work colleagues, my friends, my family.  When I try and talk to people about my condition it comes across as me winging or moaning, and I end up pissing people off.  Consequently I feel very worried, upset and angry at the same time as having the physical/medical symptoms, and I can end up being on the defensive, and can come across as aggressive.  It’s never my intention.

I have a plethora of drugs which are an attempt to manage this condition.  I take pizotifen every single day as a prophylactic, and I have both sumitriptan (Imigran) and Migraleve to relieve an attack. They don’t always work.

Finally, in general I feel the need to shy away from friends, be distant to work colleagues, ignore a large number of my family; because after all “if you don’t have something nice to say, don’t say anything at all”. Even before starting my MBA studies, now finished, I didn’t have much of a social life. Staying inside and studying was actually not the problem, but a sort of solution to the fact that I didn’t want to risk going out with people. Going out and having a good time releases endorphins in the brain – and that’s one of my (many) triggers. Having fun can bring on an attack. Lucky me. That’s why I stay in.

For more information on this condition please take a look at the Migraine Awareness Week pages and the Migraine Trust FAQ.

I am the walking dead!

Since the last time I posted a quick update, I quite literally haven’t stopped!  I’m essentially doing 7 days per week, what with work work, university homework, business trips, classes.. etc.  Consequently, I feel somewhat like the walking dead!  I don’t know what is going on!  Or what day it is.  (What day is it? Anyone?!)

Continue reading I am the walking dead!

The Shoulder Mystery

For a long time now, I’ve had a strange shoulder condition which has been giving me pain and discomfort. For the longest time, I had very little help or support from doctors, and have basically had to just “get on with it”. Slowly, I’ve started to get some answers, although it’s still a work in progress. For those who are interested, here’s the story so far…

Continue reading The Shoulder Mystery