Me, Myself & Migraines

Libby Smith

5th Year Student, University of Nottingham

People who know me, and even those who don’t, probably know the following about me:

1. I’m welsh

2. I get migraines

The first is because I’m fiercely patriotic and will bring it up any chance I get (apologies to my housemates for my behaviour on match days). The second is because when my migraines were at their worst, I’d be taking 2 or 3 days off placement some weeks, and that sort of thing rarely goes by unnoticed.

I was diagnosed with migraines in second year, and it was hardly a breakthrough – my mum and granny have suffered with migraines for as long as I can remember, and as soon as I got my first, I knew that I’d lost this particular round of the genetic lottery (my sister is unscathed). As medical students, you can probably recite the symptoms: throbbing, unilateral headaches, nausea, vomiting, photophobia etc etc. What people don’t understand however, is that it’s not just a bad headache; it’s as if someone’s turned on a tap and drained you of all your energy whilst repeatedly kicking you in the brain. My friends and family can tell when I have a migraine, sometimes before the headache even kicks in. They’re better at picking up the little ques than I am: the exhaustion, the non-existent appetite (which is a huge red flag for someone as persistently snacky as myself), the aversion to strong smells, the permanently half closed, sensitive and sore eyes. Most of the time I wake up and I “just don’t feel right”. And to add insult to injury, to pour salt on the wound, to kick a man when he’s down: if the migraine was a particularly bad one, or if the stress behind it hasn’t been addressed, I get what I’ve coined a “migraine hangover”. The “I just don’t feel right” feelings described above can persist into the next day, vanquished only by sleep.

Back in second year, the migraines were a once a month sort of thing, though they upped their ante come exam time and I ended up sitting my REN exam in the throes of a migraine, squinting at the ROGO screen so as to reduce the pain the blinding white screen was causing my eyes. Mercifully, after exams my migraines settled down to rearing their ugly head only once a month, and I could deal with that. A day off every four weeks is allowed in my opinion.

I should also mention that I became a pretty frequent visitor to Cripps Health Centre in my quest to find a medicine that would treat my migraines. Paracetamol and ibuprofen didn’t come close, neither did high dose aspirin, or over the counter anti-migraine tablets, and finding a triptan that didn’t make me feel even worse was no mean feat either. The first triptan I tried, sumatriptan, made me confused and drowsy, made my nose and scalp burn in a pins and needles sort of way, and I had to make sure I was within 15 minutes of a bed before I took them because I’d have to sleep through the worst of these effects. Thankfully, after much trial and error, I’m now on frovatriptan, which isn’t perfect, but at least I can take them and still function, and rather importantly, they can get rid of a migraine.

And then along came third year, more specifically CP1. I had gone through a breakup in the November just prior, so wasn’t in the best frame of mind (and now, with the benefit of hindsight, the no sleeping, no eating and complete anhedonia was likely depression). I wasn’t expecting CP1 to be all rainbows and fairies, however I also wasn’t prepared for the paralysing anxiety and panic attacks, the stress of which catapulted the frequency of my migraines from a manageable once a month to a crippling twice or thrice a week. Couple this with the fact that the sumatriptan made me feel ten times worse, and the foggy day after the migraine before, and I was looking at being effectively out of action for 3 or 4 days a week. Rather understandably, this didn’t have a soothing effect on my stress levels, and so the cycle perpetuated.

I was lucky enough to find a teaching fellow who I trusted, and with his support, started getting help.

I then went on the fun explorative journey of finding a preventive drug for my migraines. I tried beta blockers, which might as well have been sugar pills for all the good they were doing (and rather interestingly had no effect on the anxiety I didn’t know I had at the time). I was then put on pizotifen, which made me so unbelievably drowsy that I was drinking 4 coffees a day just to stay awake and was still asleep by 9 (and yes that much caffeine probably wasn’t good for the anxiety, panic attacks or migraines). Only after months of suffering did I finally tell my GP that I’d been diagnosed with social anxiety and panic disorder by a therapist I’d been seeing on the down-low, and asked if he thought an anti-anxiety would help. I’m still ashamed that I found it so easy to talk about a physical health problem (my migraines), but tried and failed to tell my doctor on several occasions about the therapist I was seeing with Trent PTS, because of my own internalised stigma with mental health issues. Now whether it was the CBT or the sertraline that finally did the trick I don’t know, but as soon as I was in control of my anxiety, my migraines dissipated once more.

I’m now into CP3, and although I still get the odd migraine, and they will likely become more prolific as we head towards the dreaded 5th year exams, I’ve never felt more in control of my body and my health. I finally understand my migraines, what triggers them (sorry alcohol but we cannot be friends come March), and how to best ease my stress and anxiety. Those 18 weeks of CP1 were the longest, most gruelling weeks of my life, and I’m not going to shy away from the fact that I was closer to quitting than anyone knows. But now I’m on the other side, I couldn’t be prouder of myself (c’mon, if I can’t blow my trumpet who will?), and I feel ready to face whatever else medical school has to throw at me.

And so, what have I learnt from this year long saga I hear you ask?

1. It’s ok to not be ok

2. See your GP sooner rather than later, and let them in on the whole picture

3. Tell someone in the university. Anybody – welfare, a friend, a clinical fellow – at the end of the day there is a little bit of wiggle room where you can sort your health out, but people need to know before they can help you

4. No matter how much I try to deny it, alcohol is a sure-fire way of making sure I’ll get a migraine the following day (no clear links to chocolate and cheese though thank god) - find your triggers and work around them

5. A headache / mood / food diary will help you make sense of it all

6. Everyone is going through something, you may notice, you may not, but everyone is human, and illness is a part of life

7. Those gel eye masks you can put in the fridge are an absolute GOD SEND

8. If you need to take some time out, medical school will be exactly where you left it – you have one body and one mind - don’t you dare neglect them.

As always, if you want to share any of your experiences at medical school with us, email us at welfarehub.nottsmed@gmail.com or fill out the form below. If you’re struggling with any other issues, have a look at our website to find some resources that may help you including our CRISIS page.