Some lessons are hard for me to learn. In my first chemistry class we watched a safety video that repeatedly proclaimed “hot glass looks like cold glass.” 20 years and 8 chemistry classes later and I’m still regularly burning my fingers on pyrex in the kitchen.
Yesterday, I worked several hours while the intensity of a migraine gradually increased. I was trying to be ready for an important meeting I couldn’t reschedule and trying to make up for previous days lost to migraine. I ended up missing the meeting and leaving myself unfit for work today.
When a migraine attack begins, a patient is advised to take a triptan as soon as possible. Delaying reduces or eliminates effectiveness. But! Taking more than 1-2 per week leads to medication overuse headache – where the migraine always comes back as soon as the drug wears off. Even a one-off use increases the likelihood of another migraine shortly afterwards, so I have to rest for a full 2 days after taking a triptan or I induce another attack.
Any day I have a migraine is lost time. Even when the pain is mild and I don’t take a triptan, I’m quite limited in what I can do, both because of the symptoms of the migraine and because not resting almost always makes the migraine much worse or longer.
The calculus of when to take a triptan is hard, especially when you get many migraines.
If a migraine is going to be short and the pain relatively mild, I shouldn’t take a triptan. But I don’t know either of those things when a migraine starts. I don’t know if I’m going to have level 4 pain or level 8 pain, if it’s going to last 5 hours or 3 days. I know I’ll have at least 2 migraines in a week; I know I might have 7. I can’t take a triptan for every migraine. I can’t risk the agony (and potential ER visit) of not having a triptan option for a bad migraine. I know that the longer I wait to take a triptan, the less it helps, but that breaking even a days-long migraine enough to rest deeply can interrupt could become a weeks-long attack.
So, if I take a triptan for a migraine, I lose at least the migraine day and the day after. If I don’t rest both days, I will then lose at least an additional day. If I don’t take a triptan for a migraine, then I might lose one day, or I might lose weeks.
I made bad decisions this week about triptans, and I made bad decisions about resting this week.
On Wednesday, I woke up in the middle of the night with a migraine, bearable. I laid awake for a few hours until the worst passed, then slept til morning. I didn’t realize it then, but I should have taken a triptan right away.
I woke feeling better, but not well. I got to work even though I was foggy and stupid and struggling to accomplish anything. I should have spent the morning resting.
I was quickly overwhelmed with fatigue and spent much of the afternoon in mild pain and unable to do much but nap. I should have taken a triptan that afternoon.
Thursday, I woke at my normal time in manageable pain, but slow and foggy again. I started working and the pain escalated quickly. I had a meeting that day I didn’t want to cancel and I had work to do to prepare, so I continued on, slowly. And then it was too bad to stay upright and I’d had a migraine for 2 days. I should have taken a triptan.
I rested for several hours while the pain escalated and finally, finally, took a triptan. The pain decreased and I slept for much of the afternoon and all night.
And now it is Friday and I am still in a fair amount of pain and I cannot do much at all today without causing things to be worse.
So, I will put aside my frustration at the slow pace of my PhD and finding answers to the questions I’ve dedicated myself to. I will put aside the disappointed expectations of my advisor and colleagues. I will put aside my fears of never being able to hold a job or support my partner financially. And I will rest.