Migraines and a career in medicine

[neulite]

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I am currently a premed and third year graduate student working on my PhD. I have chronic migraines (or chronic daily headache CDH) and have had them for about three years now. I was wondering if there are any med students or, more importantly, any residents out there with migraines. If so, have they affected your progress? What have you done to reduce the attacks due to stress?

BTW, I have tried ALL preventative meds (beta blockers, topiramate, other seizure meds, SSRI's) and some have worked but with too many side effects. I am currently trying butterbur and feverfew (herbs).

I have been able to deal with them through grad school but given that my [potential] future will be more demanding with my time I was wondering if anyone out there has been able to adapt.

Thanks.

 

[Sondra]

I have them, but not nearly often as you do. I find that I feel one coming on every weekend when I have a test looming. The hours that I spend in bed seem to zap my time. My school hasn't been very understanding. When I have a headache, they tell me to come to student health, they give me a pain shot and tell me that I should feel better soon. Those shots don't make me feel better, but they do help me to sleep when I have a headache. 90% of the time, my migraines are helped with Zomig, but the other 10%, I stay miserable for days.

 

[Depakote]

I am currently a premed and third year graduate student working on my PhD. I have chronic migraines (or chronic daily headache CDH) and have had them for about three years now. I was wondering if there are any med students or, more importantly, any residents out there with migraines. If so, have they affected your progress? What have you done to reduce the attacks due to stress?

BTW, I have tried ALL preventative meds (beta blockers, topiramate, other seizure meds, SSRI's) and some have worked but with too many side effects. I am currently trying butterbur and feverfew (herbs).

I have been able to deal with them through grad school but given that my [potential] future will be more demanding with my time I was wondering if anyone out there has been able to adapt.

Thanks.

To start, I'm just going to request that we keep this thread away from providing medical advice. Go ahead and talk about your lifestyle and coping habits, but please refrain from providing advice that the OP's healthcare provider should be doing.

Now that that's out of the way... I'm just in my first year of med school so I expect the worst is still ahead, but i've had migraines for the past 13 years. I won't say that they aren't giving me a little trouble, but I don't think it's negatively impacting my performance.

What I did:

First of all, I finally found a good prophylactic medication and dosage by working with my neurologist. But I also made a number of lifestyle adjustments at his recommendation. I gave up caffeine which had a huge impact.

Ideally I'd be getting more sleep and I'd be on a regular schedule, but that just isn't happening with the amount of studying I'm doing. So the headaches are a little worse than they were, but it is still not that bad. (we'll see how years 3 and 4 go... trying not to even think about residency at this point)

As for stress, that was more of an attitude adjustment. I am under lots of stress but I just don't let it get to me. That is a little hard to do some times, but if you can put things in perspective then it really helps.

 

[crunchymilk]

I suffered from awful migraines for several years, tried all the preventitive and abortive medicines and none of them worked. On june 24th, I started dieting / exercising everyday and I haven't had a single headache since. I've also lost 55 pounds 😉

worth a shot

 

[Ashers]

I get anywhere from 1-6 migraines a week, and I've had them since I was 7yo. I'm an M3 now, and I just have to keep imitrex with me at all times.

When I actually have time to exercise, I probably have fewer, like during studying for boards, I didn't have many, but I was running, biking and playing tennis. On OB/gyn, I came home from work, read and slept. I was on the higher end of my normal. My optomotrist was the one who told me I need to go see a neurologist soon. So I'll be doing that to try to manage them more.

I also try to watch what I eat -- not just as in calories, but I know that more than 4 candy pumpkins will trigger a migraine, so I try to not eat that many. I also try to stay away from too much caffeine and stuff with lots of sugar/chocolate. It's a sad existence, and sometimes I just really crave chocolate and sugar, and I try to eat it slower and spaced out, so I can try to prevent a headache.

Enough sleep is also important for me. Sometimes I can't help it, like when I'm on call. I know when I'm post-call I'll have a migraine. That's one I can't do too much about. However, most other days, I get 8 hours of sleep, and M1 and M2 year, I almost always managed to get 8 hrs, unless I was too anxious about something, which wasn't too often.

 

[artaxerxes]

you should try some alternative therapies. At least you don't have cluster headaches🙁 apparently that stuff drive people to kill themselves.

 

[neulite]

I didn't expect to get so many answers, thank you for the responses. I've done/am doing just about everything you guys have said and it has helped me get this far in my graduate career, as I said before. They're not the biggest hurrdle of mine but I didn't want them to prevent me from pursuing what I want to do. Thanks for letting me know there are others (statistically there had to be with some 3-5 million suffering, some are bound to be med studets, residents, or attendings).

I've been to many neurologists (my future career hopefully) with no luck, suffice it to say that Relpax (a triptan) is always in my pocket. I don't care what people say, the discovery of the triptan family of drugs was the best thing since someone made crack with cocaine and ether. In all seriousness, no other agonist does it for me like the those, and with the introduction of frovatriptan with a half-life of 26 hours, med school may not be one continuous migraine.

Thanks again you guys!

 

[PeepshowJohnny]

It's interesting, but a lot of med students tend to have certain types of diseases, migraines being one of them (GERD, Asthma/Allergies are others). Migraines are a pain in the ass, but you should be able to manage.

My advice was going to originally be make sure you're seeing a good neurologist so you're not misdiagnosed, but you're already doing that and you're a tough nut to crack.

 

[elfish]

I suffered from awful migraines for several years, tried all the preventitive and abortive medicines and none of them worked. On june 24th, I started dieting / exercising everyday and I haven't had a single headache since. I've also lost 55 pounds 😉

worth a shot

you've lost 55 pounds since june? holy S**T

 

[Ashers]

It's interesting, but a lot of med students tend to have certain types of diseases, migraines being one of them (GERD, Asthma/Allergies are others). Migraines are a pain in the ass, but you should be able to manage.

My advice was going to originally be make sure you're seeing a good neurologist so you're not misdiagnosed, but you're already doing that and you're a tough nut to crack.

In a path lecture about skin, the lecturer asked how many people had allergies, eczema, itchy skin in general, etc. He said that a high proportion of type A personalities tend to have them. He didn't say why though.

As for migraines the 26 hour t1/2 triptan sounds good. The 1st 24 hours on either side of step 1 and during the test, I had 5 individual migraines, so I went way over the recommended imitrex dose. Most of my friends are amazed to learn that I have so many migraines, and I find it "normal." That's only because I've dealt with them for so long, and people absolutely refused to treat me until I was 17 (because that was the age imitrex was approved for use).

 

[WantsThisBad]

I am currently a premed and third year graduate student working on my PhD. I have chronic migraines (or chronic daily headache CDH) and have had them for about three years now. I was wondering if there are any med students or, more importantly, any residents out there with migraines. If so, have they affected your progress? What have you done to reduce the attacks due to stress?

BTW, I have tried ALL preventative meds (beta blockers, topiramate, other seizure meds, SSRI's) and some have worked but with too many side effects. I am currently trying butterbur and feverfew (herbs).

I have been able to deal with them through grad school but given that my [potential] future will be more demanding with my time I was wondering if anyone out there has been able to adapt.

Thanks.

Do you smoke? If you do then quit.

 

[neulite]

Yeah, I have them WAY to often. With no triptan use I get them about 5 times a week (note: >15/month is considered "chronic"). I also understand what it feels like to rely on the use of imitrex (or relpax in my case). I realize this is hardly the place to discuss migraine therapy but if you do an article search there are a couple articles that compare the efficacy of each triptan with each other. Imitrex was at the bottom in terms of side effects and efficacy.

In any event, I did quit smoking, I work out, and I try to eat as healthy as I can. I attribute the frequency of my attacks to my thesis/dissertation and being a premed. Hopefully I can find some meds that prevent them without comprimising my future (this was not the case with topiramate, which caused me to have transient memory problems...something I DONT want in med school...the medicine, however, was the MOST effective unfortunately).

 

[pagemmapants]

I get both migraines and almost-daily headaches (yes, I can tell the difference between them) and what I've noticed is that keeping track of my triggers helps me to recognize when one is coming and help to prevent them. It seems pretty obvious, but you can't imagine the difference made when I realized that too much sleep causes headaches for me, as does not getting enough exercise. Caffeine (it appears) has no (or very little) effect insofar as triggering headaches per se, but caffeine withdrawl appears to be a sporadic trigger.

I use imitrex (when I have it) and excedrin migraine (when I don't). Usually imitrex can head off the really really bad migraines when I start getting the tunnel vision (9 out of 10 times) but when it's one of those annoying mid-level non-migraine headaches nothing works on a consistent basis, but at least I can function through those whereas I can't during the migraines.

 

[ssj27krillin]

imitrex = wonder drug

 

[Depakote]

Guys...

This is getting a little close to medical advice for my comfort. I don't want to close this thread so, again, please refrain from discussing specific prescribed treatments that would best be left to the OP's healthcare professional.

Thanks.

 

[ssj27krillin]

we're just saying what works for us and not saying what the thread starter should do.

 

[polycon7]

Perfect thread! I'm currently in the middle of my first block of exams as an MS-1 and last night I had the WORST migraine ever! I've only been having migraines maybe for the last 4-5 years and get them once every few months but it becomes more frequent when I'm stressed. I found that caffeine and sugar are the big no-no's in trying to prevent my migraines. But what did I have this past weekend to try and stay awake for studying? Yup...caffeine and too much chocolate. So I ended up taking a 3 hour nap last night after popping some pills. Luckily, the migraine subsided by this morning just in time for me to take a couple exams. I really don't get them as frequently as the OP, but I get worried that it will become more frequent through the years of medical school and then residency due to lack of sleep and lifestlye changes.

 

[odrade1]

Relating what you do (and what drugs you take) does not constitute giving medical advice. Giving medical advice takes the form:
For your (medical problem) X, you ought to do Y.
Where Y is anything besides "see a doctor."

I have a mild headache every day, serious headaches (requiring medicatino or a nap) 2-4 times a week, and an incapacitating migraine min 1 a month, with a frequency that is increasing. I try to
sleep appropriately,
manage stress (meditation and cognitive therapy have helped me),
eat regularly (disruptions in my eating schedule sensitize me to headaches),
keep sinus medicine, advil, excedrin, and Relpax with me

Really for me the key has been maintaining good overall health, avoiding certain triggers, and recognizing when I am having a headache to head it off before it gets crazy. I can't afford to take Relpax daily prophylactically, since my insurance only covers about 4$ a pill, and they cost ~15$ a pill. I manage my sinus pain and serious headaches with sudafed and ibuprofen, then if I don't see improvement (or if I get an aura) I will take what my doctor gave me (relpax), per her instructions. Even if I am out of relpax, I can manage ok using OTC drugs + meditation. Getting away from noxious stimuli is important for relieving my migraines. I am usually able to return to productivity within 2-4 hours, if I can get to a quiet, dark room and meditate.

So far, my grades are good & my headaches haven't prevented my from completing my work. If you are sensitive to stress, be forewarned that med school is full of it & you will need to be able to manage that stress in an efficient (and legal) way. Be aware that your migraines could get worse. My mentors swear to me that their migraines increased when they were residents, then reduced in severity and frequency once they were through with training. I haven't had any troubles myself, but I do get the impression that I would have more sympathy and leniency from the school if I had cancer or lupus (as two of my classmates have) rather than a mysterious claim to incapacitating pain. We (including my more ill classmates) are sort of expected to suck it up and get it done, regardless of our situation.

Best of luck to you. I certainly understand how debilitating migraines can be, and how you may be concerned about school. (At least my headaches respond to treatment!)

 

[MsKrispyKreme]

I was wondering if any of you mentioned your migraines in your secondary applications (as an answer to those "adversity" questions). I was wondering how adcoms would look upon this. 😕

 

[Depakote]

I was wondering if any of you mentioned your migraines in your secondary applications (as an answer to those "adversity" questions). I was wondering how adcoms would look upon this. 😕

definitely not.

In general, you don't want to give schools a reason to question your fitness by putting medical issues in your application unless it is something that absolutely must be addressed. You also have to consider that admissions committee physicians tend to only have seen the worst of XYZ diseases unless they happen to be a specialist in that field. If you discuss your migraines, they might not understand that you are highly functioning or that your migraines are well controlled. They might think of that case of the woman with 3 debilitating migraines/week they saw in their neuro clerkship and decide there is no way she could have made it through med school. Even if it's not a conscious decision, it might create an unconscious bias.

For adversity essays, I'd try to discuss something that you've triumphed over, not something that is going to continue to pop-up throughout your medical career.

 

[anavistas]

My mom has headaches always ,there is no single day that she doesn't have it but the intensity varies.She managed to get her Ph.D late in her life changing her field form science to humanities.She didn't have any problem in the first 2 years, but things changed when she wanted to work on her thesis ,it was terrible she couldn't concentrate ...and at last it took her 8 years to write it!She was near being fired from Ph.D....
I don't think your headache is that painful comparing to her...she was taking like 6 Acetaminophens some of the days.Anyhow I really can't imagine how you people do it!I've had mild headaches few times in my life and I couldn't do anything but sleeping.
I hope people like you who have experienced this pain choose fields like pain medicine or neurology and help others fight it.

 

[AlbaMD]

I was wondering if any of you mentioned your migraines in your secondary applications (as an answer to those "adversity" questions). I was wondering how adcoms would look upon this. 😕

I wouldn't mention migraines on the secondaries - unless, of course, they are so debilitating that they impair your ability to function in an unusual way. Otherwise, they are just an unpleasant part of your life that you have to deal with - and that is not going to go away.

For a record, I suffer from migraines; get them about once a month during good times and several times a month during bad times. They have landed me in the ER before. When I don't have migraines I have almost daily or daily headaches and the amount of medicine I take for them is no joke. Still, I did not want the adcoms to view this unpleasant but persistent part of my life as something that may interfere with my ability to study and/or be a successful physician. I have to live with migraines and not let them mess up my life - and so there was no reason to present them anywhere as something out of the ordinary.

Oh, and having migraines made me seriously consider neurology as potential future career 🙂

 

[Nanon]

My mom, who was a reproductive endocrinologist & ob/gyn in the USSR and is an internist here (in NJ, if that matters at all), has severe dibilitating migraines 2-4 times a month, and has ever since she gave birth for the first time 27 years ago. This is her situation: migraine meds make her hazy for at least 48 hours, and she gets a rebound headache every time, without fail. She scheduled her residency (when to be on call/not) based on when she'd have a migraine (they tend to be hormone-related, but progesterone hasn't helped her for whatever reason), and she'd deal with side-effects of meds if she needed to, as long as she could take at least 12 hours off afterward to have her rebound headache. A ****ty way to live, but as long as you know how your individual body works with these things you could probably manage somehow.

Also, are you a woman? If so, have you tried supplementing with progesterone (if your migraines are at all hormonal)? If not, you might want to talk to an endocrinologist or GYN about that

I had really bad classic migraines, sometimes several times a week, during my last year in ugrad. Then I got pregnant, and they pretty much stopped (ohthankgod!). Amazing how much more productive I am. Anyhoo...

Here's what helped me:

1. Salt and caffeine together. A regular customer of mine when I was waitressing gave me this advice, and it turned out he was a neurologist. It really helps, but only if you do this right away. My rx is potato chips and a diet coke.

2. NO BOOZE until you have several weeks of no headaches.

3. Lighting is important. In retrospect, I think that bad patch I had was in part due to the fact that I was in a dimly lit computer lab most of the time that year, but sometimes I get them when I'm out in bright light.

4. Eye strain is important. I have fewer migraines when my lens rx is correct.

5. Hydration is really, really important.

6. At least 1 REM cycle a night, on a schedule, is really important.

7. This might surprise you: Take it easy with the cardio exercising. Try to do a lot of your weight management through diet. I find that the more cardio I do, the more headaches I get.

8. Learn to manage stress, for real. Let go of stupid stuff as soon as possible. Take anti-anxiety drugs if you have to, or see a psychiatrist, or both. One of my favorite quotes right now addresses this directly:

"Finish each day and be done with it. You have done what you could. Some blunders and absurdities no doubt crept in; forget them as soon as you can. Tomorrow is a new day; begin it well and serenely and with too high a spirit to be cumbered with your old nonsense."
-- Ralph Waldo Emerson

Words to live by.

S.

 

[polyoma40]

As fellow premeds... have any of you guys been on topamax?? Its a GABA agonist... so it also serves as an anti-epileptic.

My neurologist tried to give it to me for prophylatic prevention of migraines... but I'm worried it'll interfere with my studies.

I figure it might work for most of the population thats a technical worker or secretary or something but not for a professional student.

Anyways my doctor didn't really seem to care at all :^/.... but yeah has anyone been on that drug and found it to interfere with studies? I think I'd rather be in pain than be on a GABA agonist. whats it like?

 

[Depakote]

As fellow premeds... have any of you guys been on topamax?? Its a GABA agonist... so it also serves as an anti-epileptic.

My neurologist tried to give it to me for prophylatic prevention of migraines... but I'm worried it'll interfere with my studies.

I figure it might work for most of the population thats a technical worker or secretary or something but not for a professional student.

Anyways my doctor didn't really seem to care at all :^/.... but yeah has anyone been on that drug and found it to interfere with studies? I think I'd rather be in pain than be on a GABA agonist. whats it like?

I haven't had any problems with cognitive function while on it. Without delving into medical advice, personally, it's been the best prophylactic migraine treatment I've had.

 

[AlbaMD]

As fellow premeds... have any of you guys been on topamax?? Its a GABA agonist... so it also serves as an anti-epileptic.

My neurologist tried to give it to me for prophylatic prevention of migraines... but I'm worried it'll interfere with my studies.

I figure it might work for most of the population thats a technical worker or secretary or something but not for a professional student.

Anyways my doctor didn't really seem to care at all :^/.... but yeah has anyone been on that drug and found it to interfere with studies? I think I'd rather be in pain than be on a GABA agonist. whats it like?

I've been on gabapentin for over a year, and it hasn't interfered with my studies at all. It is an anti-epileptic as well. Granted, despite being similar in structure to GABA it doesn't seem to affect GABA receptors... but I've never heard of gaba agonists that are used in migraine prophylaxis interfering with anyone's studying. It will reduce the excitability of the brain that leads to headaches, but that's about it. And since your doctor is not worried about the side effects neither probably should you.

 

[Ashers]

I'm on a low dose of dopamax er... Topamax. I had word finding issues with Topamax at a higher dose. It's cut down the number of migraines I get.

There are always more options, just be sure to talk to a doctor about it. I've had lots of doctors say that they wouldn't ever put a med student on Topamax.

 

[Depakote]

I'm on a low dose of dopamax er... Topamax. I had word finding issues with Topamax at a higher dose. It's cut down the number of migraines I get.

There are always more options, just be sure to talk to a doctor about it. I've had lots of doctors say that they wouldn't ever put a med student on Topamax.

Lol. Maybe that explains why I so rarely ever do better than a "pass"... (I wish, I'm just not a gunner at heart)

I get a double-take when I tell docs what dose I'm on. (It's quite high, but damned effective.)

 

[Ashers]

Lol. Maybe that explains why I so rarely ever do better than a "pass"... (I wish, I'm just not a gunner at heart)

I get a double-take when I tell docs what dose I'm on. (It's quite high, but damned effective.)

lol. I actually stopped my higher dose right before starting pharm. I didn't want to go into that class with word finding issues (for 3 months I couldn't remember "bug repellent" -- I'd say stuff like "bug bite preventer." It was weird. Then in conversations, I'd sometimes stop and think for words.). My pharm class has essay exams, so I figured it'd be a good time to decrease. My grades didn't change though. 😉

 

[Depakote]

lol. I actually stopped my higher dose right before starting pharm. I didn't want to go into that class with word finding issues (for 3 months I couldn't remember "bug repellent" -- I'd say stuff like "bug bite preventer." It was weird. Then in conversations, I'd sometimes stop and think for words.). My pharm class has essay exams, so I figured it'd be a good time to decrease. My grades didn't change though. 😉

hmm. food for thought. I'll have to keep that in mind.