Pursuing surgery with migraines

[txfisher]

Hello,

I'm very interested in surgery, but I am concerned that my history of migraines (with visual aura) would make it a poor choice. While they are well controlled with prophylactic treatment, having only had 1 in the past year, I am still worried that one could happen the OR. Does anyone have any experience with this? I'm not so much worried about the headache, because mine aren't that severe, but more about getting the aura.

Thanks

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[surgres88]

Hello,

I'm very interested in surgery, but I am concerned that my history of migraines (with visual aura) would make it a poor choice. While they are well controlled with prophylactic treatment, having only had 1 in the past year, I am still worried that one could happen the OR. Does anyone have any experience with this? I'm not so much worried about the headache, because mine aren't that severe, but more about getting the aura.

Thanks

Don't think you have to give-up on surgery just yet, wait until you get to medical school, see if you can handle the OR without it triggering migraines. You will do this for sure in M3 year, but if you should be able to see if the OR triggers your "aura" during m1-m2 year. I think Atul Gawande's book, Complications (not 100% but I think this was the book) talks about surgeons with issues, maybe you can find a little inspirational story for you.

 

[Winged Scapula]

I have migraines without aura.

I've only actually had a few during residency and most of them came when I wasn't good about the prophylaxis, was tired and very stressed.

What is key, is not whether you can be a surgeon (you can), but to identify the triggers and be diligent about taking your prophylaxis (which sounds like it works for you). My program was good as one of the Chiefs also suffered and one night he covered for me while I was on ICU call. The pharmacist would also give me Phenergan and Imitrex when I asked, if I didn't have any.

Interestingly, the WORST migraine I have ever had was about 2 months ago and I was literally on the floor in the office vomiting between patients. I even had to leave the room with one and puke. I had to cancel my afternoon patients. This has never happened to me in the OR - at least not since medical school (when I had to leave to vomit in the scrub sink).

 

[Solandri]

This is something I've been wondering about too. I have migraines with aura that have a seriously terrible effect on my field of vision. I've always found aura very difficult to describe but I found this picture a while back that does a decent job at getting the idea across (it's almost uncomfortable to look at):

Anyway, I've had the migraines since puberty and medicine doesn't help much. Never had any kind of identifiable trigger and only get one or two a year so prophylaxis isn't worth it. I have Imitrex injections but they only seem help cut down how long they last but don't help with any other symptoms (nausea, light/sound sensitivity, pain).
So I only get a couple per year but when I do, they're bad. I am somewhat considering surgery, think could this be a problem?

 

[JackADeli]

...wait until you get to medical school, see if you can handle the OR without it triggering migraines. ...you should be able to see if the OR triggers your "aura" during m1-m2 year...

Agreed

...I found this picture a while back that does a decent job at getting the idea across ...had the migraines since puberty and medicine doesn't help much. Never had any kind of identifiable trigger and only get one or two a year so prophylaxis isn't worth it. ...only get a couple per year but when I do, they're bad. ...think could this be a problem?

During medical school, I knew a spectacular, world-class surgeon. This individual was color-blind & dyslexic. Somehwere along the way they must have done a self-assessment and made their decision. There are manic-depressives/bipolar individuals that also face similar lines of question. There are epileptics that face these questions. Hell, there are probably "ice-road truckers" that ask similar questions!!!

Sure, it could be a problem. For anyone considering the question, the answer is "yes" it might be a problem but it might NOT be a problem too. We are unable to answer your question though. It will be up to you (+/- neurologist/PCP/FP) to see what your clinical experiences are during med-school. Then take a serious look at yourself and your health and make an honest self-assessment.

Do you think it would be safe for you to be a comercial airline pilot?(rhetorical). If you are blinded with your migraines.... you need to assess is an "attack" going to mean late to clinic/cancel clinic OR could that mean you are incapacitated while you have a gravely ill patient/your doing a AAA/a carotid/a CABG/etc... Then decide accordingly. Ultimately each individual must be honest with themselves. You must recognize you individual particulars and how it can potentially effect and/or endanger your patients. It must not be self-denial.

 

[MossPoh]

How long does the aura last before things go into full swing? I only ask because I do get a bit of an aura with mine and then I get freakishly productive for about 3 hours before it kicks in to the point of me being paralyzed in my bed and/or vomiting. I have seemingly random triggers. One day it'll be smoke. Another time it'll be a beer while watching t.v. and some other time it could be something as random as an electronic device with a high pitched noise.

If it is once a year then I wouldn't really worry about it too much either way. Just be aware of what is happening like any other time. If you are worried about it while in the OR then you should be worried about it when you're driving, exercising, or whatever else. I feel your pain though. They do suck and it is something people don't really understand. I had one that didn't give me the normal warning and I was stuck in a puddle of vomit on a sidewalk in London with nobody to help me for about 20 minutes.

 

[deleted263296]

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