First I want to say that it is good to know there are others that can relate, and I wish you all the best in your journey to find relief. I also want to mention that I have come to find that many of my migraine issues are hormone related and I will be getting into some specific details with the hopes that it will help others.  In that, I would like to consider fair warning has been made to any who would not necessarily benefit from learning about "the finer points of womanhood".  

 I have experienced headaches as long as I can remember, dating back to childhood and progressively worsening after getting my menses as a teen.  About 15 years ago I learned about PMDD (premenstral Dysphoric Disorder), and that my mother, maternal aunt and grandmother similarly suffered with PMDD and migraines before there were ever added to the diagnostic handbooks.  My mom finally found relief 15 years ago at which time she had a hysterectomy, which is something I'm not quite prepared to do. 

Over the past 15 years ago I have persistently worked at trying to address these issues, first with OTC brands, then with supplements such as St. John's Wort, only to find my underlying symptoms would persist to one degree or another.  Then 12 years ago I turned to a Psychiatrist, which was where I learned about PMDD, a fairly new disorder per diagnostic and insurance standards of the time.  Relieved to discover I wasn't crazy, I was able to partially benefit over time with the treatment of psychotropic medications.  However, I have not been able to find complete relief given abreactions to many of the medications; but I do know that without any psychotropics I experience greater difficulty.  Currently, a combination of two psychotropic meds works best for me, which is Effexor and Prozac.

Over this same period of time, I have also tried to avoid what would seem to be triggers, but found what I thought to be triggers didn't always cause migraines.  Changes in diet and dietary supplements have helped, (ie. dramatically decreasing sugar and carbs, eliminating alcohol, as well as adding supplements for cleansing my digestive and urinary systems) to one degree or another.  However, other complicating factors such as allergies, psoriasis, GURD, recurrent bladder problems, and overall a very sensitive body (ugh!) have made finding a balance a significant challenge finacially and emotionally. 

I believe I have obtained benefits from taking a wholistic approach.  Chiropractics are my mainstay given degenerative disc problems in my neck, massage is great, I've even tried accupuncture, and many types of energy work, but insurance does not cover the later.  Then there are the series of eye exams over the years to insure eye strain isn't causing my headaches (it was not until this year that I was finally diagnosed with migraines). 

Over the past 4 years my migraines have become increasingly worse making life extremely painful.  Currently I experience 4-5 migraines a week with the exception of days 7-14 of my cycle.  I'm a Clinical Social Worker and love my job, however, making it through 3 hours of work without a migraine has become what I call a "good day".  The rest of a migraine day means tolerating excruciating pain, disorienting auras, intolerance to light, sound, smoke (I've never been a smoker) and other smells.  Then there is the nausea, irritabillity, depressions, lack of energy, and difficulty concentrating, with the additional severe menstral cramping during the first two days of my cycle "for a little icing on the cake".  I try to make the most of it with a very generous sense of humor, a wonderful, supportive boyfriend, and an overall determination that things will eventually get better.  I started my current job 15 months ago and even with the most sparing use of sick time, it of course has dwindled.  In addition to underperformance on a day to day basis just barely doing the mininum to get by on a migraine day, I have found myself dreadfully behind in paperwork.  I'm fortunate to have wonderful co-workers and a job that allows me some scheduling flexibility for doctor appointments, I'm just really tired of all the doctoring.  It seems there is no coordination on care within the specialty areas, and frequently doctors discount anything that is not from a "qualified health provider".  So, my journey continues, but first a little more history, just in case you are not thoroughly bored yet :)

After 2-3 years of difficulty conceiving, I sought fertility treatment through an OBGYN (2003-04) with no results.  However, this did leave me with a clearly diagnosed perimenopausal issue.  In paying closer attention to my cycle, migraines, etc., I decided to more carefully explore things from a hormonal perspective.  As we all know, life happens inbetween doctoring, so things can get set aside.

 While finding some clinicians willing to accept that hormones could be one of the underlying causes, I never really felt there was enough infomation out there for even them to give me a comprehensive picture.  In appreciating their efforts and taking "what worked" from the recommendations with me, I continued the search.  So just last month I was turned away by an Endocrinologist after being on his wait list for 3 months, only to be told he "doesn't deal with hormonal issues".    

Clearly abortive medications like Imitrex and Midrin have been "lifesavers" and I do not wish to seem ungrateful, but what about preventative treatment?  Well, while it may be controversial to say the least, as well as unsupported by many physicians and insurance companies, I have found Botox to give 8-10 weeks of pure peace (ie. no migraines).  In 5/06 I read an article about the treatment of migraines with Botox, but found it was not commonly being used in the US.  After extensive research I was able to find a Dermatologist and pay out of pocket, but found I had to clearly had to request it for cosmetic purposes.  I decided since I was 41 years old, that if nothing else I might look a bit younger, however I was so relieved to discover it did so much more.

Since this meant $500 out of pocket I was not able to continue with it and turned to the aforementioned neurologist in the fall of 2006.  When I explained to her my success with BOTOX she noted insurance would never cover and seemed to disregard my finding.  So I gave her recommendations a try for 8 months, and finally wore myself out while going through the trials.  Desparate to regain a reasonable level of functioning I decided to take out a loan and go back to a Dermatologist for "cosmetic" Botox.  However, I continued my battle with the insurance company to authorize it for another 3 months, and just recently it was approved!  I'm still pinching myself...lol

If it were not for my local eye doctor and his clinic that coordinates with surgeons twice per month to bring "Botox Clinics", I would have been out there flappining in the breeze.  He proved to be willing to repetitively take on the insurance company writing two lettler and making phone calls on my behalf, and I this only after having been seen by him once for an eye exam!  I can't adequately express my gratitude, but I will do my best:) 

There is an adjunct I started about 2 months ago after stumbling upon it on the internet.  It is a supplement call Progest50 that targets the drop of estrogen after a womans 15th day of her menstral cycle.  I have found some additional relief in that PMDD symptoms do not seem as severe, the number of migraines has decreased by 20-25%, and the intensity of the migraines has dimished noticably.  I'm still hoping to see continued benefits with this product.  Currently, Imitrex works well for 2 of 7 days in a week, but sometimes requires Midrin for total effectiveness as additional doses of Imitrex in the same day hasn't helped.  I join the many sufferers that are very concerned regarding the availability of Midrin or any of the generics.  I also live in a rural area 3-4 hours from any major hub and have no migraine specialist in the area.  The neurologist I saw for 6 months added Midrin to the Immitrex my GP prescribed, however she prescribed Topamax and Lamactil which weren't right for me.   

So I continue in my efforts to make it through each day I am challenged by migraines, and totally savor the days and/or partial days without symtoms.  I would appreciated any feedback, questions, or comments from others on this site.  Hopefully we can find some insight and comfort in all of this from one another!

Sincerely,

Karen