Severe migraine pain- in hospital

[HomeTutor]

Sat in hospital with my poor daughter (19) who is having the second horrific migraine in 48 hours.
Shes currently hooked up to IV painkillers and a saline drip because of the amount of vomiting.

Over the years we've tried anti sickness drugs, naproxen, codeine, rizatriptan, nasal sprays, daith piercing, cut out 100% of chocolate, artifical sweetness and scented candles.

She takes an antihistamine daily for allergies and is on the progesterone mini pill as we thought it might be hormone related (she also had bloody awful periods with sickness and severe pain).

Starting propranolol tomorrow.

What else can we do? I cannot stand seeing my kid in so much pain she wants to tap out of life. Her job is at risk as she is unreliable when the migraines hit she has about 20 mins warning before the vomiting starts.

Will try anything. I wish it was me 😔

There’s a criteria but is she eligible for Botox for migraines? The criteria is migraine for more than 15 days a month & no response to 3 or more treatments. From your post I’m not sure that she would be because it looks like you’ve only tried one medication. There are others available. Is she under neurology? If not push for referral.

Poor girl
Mine was ibprofen, dark room, tiger balm on my forehead and under nose.
Her's must be hell.
Are the atihistimes strong enough?
I hope her employer can be abit more considerate - if not bugger them.
I had full bloods, scan after it became regular issue and alot of sick days.

Her employers are brilliant- but she works with children on a strict ratio. Zero hour contract. When the migraines hit whilst with said children, they are left unattended and thats just not safe or easy for anyone to deal with. Likelihood is, they just wont add her to the rota much and I fully understand why 😞

Poor kiddo is in and out of sleep whimpering in pain, numb down one side and drip still going 😩

Will look at botox. Will happily pay for it

Bloods done and all okay.
GP are brilliant, but because its all oral meds (apart from the nasal spray), the vomiting stops anything working.

We thought we had cracked it last year as she only had 3 all year. Now shes had 5 in the last few weeks and I cant describe how painful they are. Off the charts, and shes a tough kid.

A colleague suffered terribly with migraines and had immunotherapy. Initial appointment was private, then treatment was moved to NHS. It was life changing.
I've copied and pasted the following -
Immunotherapy for migraines primarily involves the use of monoclonal antibodies (mAbs) that target Calcitonin Gene-Related Peptide (CGRP) or its receptors, which are proteins known to trigger inflammation and pain in the brain. This preventive treatment significantly reduces both the frequency and severity of migraine attacks.

Do try the Botox if you can afford it but make sure it’s a medical professional not aesthetic. Botox for migraine is between 31 and 39 injections every 12 weeks. I’ve been having this for a couple of years now and it has helped. I used to get a lot of migraines where I’d be vomitting every 20 minutes for about 6 hours and diarrhoea too. I still have chronic migraines but haven’t had a vomitting one for some time now.

Is she on any preventative medicine for migraine? If she was on them previously which ones has she tried?

Maxalt - is a Triptan that you dissolve under your tongue and acts very quickly.

I have 10mg wafers and can double up at the first signs of a migraine. The key is to get them in before the migraine develops. I usually have one wafer, a large drink of water and a sleep for 30 mins and this wards my migraines off.

Can't stress enough though that they need to taken at the very second you notice warning signs, otherwise they are not as effective. As they are sublingual vomiting doesn't affect their efficacy.

Edit: dyac

Thank you thank you all!
Will ask for everything suggested.
So far no prophylactic treatment, just painkillers etc for early onset pain relief/reducing severity. Of which none are working.

Drip is sooooo slow. Her veins are tiny for some reason so its taking hours

Trying propranolol from today.

Will also ask for maxalt

Seems Maxalt is a brand name and we've tried it. Didnt work 😪

Try swapping to
the combined pill. I tried the mini pill for hormonal migraines, it didn’t help. The combined pill seems to have helped.

Is it definitely migraine and not cluster headaches? Ask gp to refer to neurology to rule them out.

Sumutripan?
She has my full sympathy I dont usually get the vomitting but have recently had back to back unbearable migrane this sumtipan worked for me.

I have found my docs don't care much about it.
I think you will have to push for referral op

Oh the poor darling.

I have migraines but nothing like that. Hugs to you both.

Just a word of encouragement on the prophylaxis front. They started me on Propranolol after a 3 day stint in hospital with severe migraine and it has literally changed my life. I can still get the odd one rearing it's ugly head, but I take a sumatriptan straight away and I can even carry on at work.
I started off with 20 mg X2 a day and that was 20 years ago and am now on 80mg, modified release once a day. Good luck to your poor daughter and I really hope the propranolol is as effective for her as it was for me. My GP told me that they can even go up to 160mg a day.

Have you considered cranial osteopathy? My daughter is only 9 but had several quite debilitating migraines . She had several sessions with a cranial osteopath and (touch wood) hasn’t had one for nearly a year. I hope your daughter feels better soon.

Nobody in their right mind is going to prescribe the combined pill for a migraine sufferer 🫣 it’s a non-negotiable contraindication as it would put her at unacceptable risk of VTE.

Can I recommend looking into a low histamine diet - everyone has histamine in their bodies and all foods have histamine but to varying degrees. Strawberries, bananas, tomatoes, chocolates, aged meats (like ham, bacon and aged steaks), mature cheeses and other things are high in histamines, some food groups are histamine liberators ie they release histamine from the body.
Increased histamine causes vasodilation so more blood flow in areas and can trigger headaches / migraines.
If she was on the diet for two weeks she would know within the two weeks if it helps.
For interest she is already on a H1 antihistamine people with histamine issues end up on a second H2 antihistamine.

Does stress make these migraines worse? Or is it the heat. I would be also trying to find causes and triggers. Maybe she might have to look for a less stressful job as working with children can be stressful.

@WetBanditsmy GP has because my migraines are hormonal. Stop the periods, stop the migraines.

😖😖 GPs make some questionable decisions around contraception, IME!

And replace them with a stroke…

Im sorry to hear this. I am a chronic migraine sufferer and have been for years. They are currently somewhat under control thanks to the following: I get a preventative called vyepti administered at the hospital every three months (I’m in France not sure if they do this in the uk), have 3 monthly Botox injections at the in between point of the vyepti, take magnesium daily. Never drink alcohol, not even a sip as this is a bit trigger for me. Avoid doing intense cardio exercise as this also triggers but try to exercise regularly.
For me, the only triptan that really works is Relpax. It is very effective for me. Life changing really!

I’m so sorry. Poor thing.
My dd has been a lot better since she went on the Yasmin mini pill.
I noticed there are a lot of American migraine specialists on Tik Tok. It might be worth looking on social media.

Ok, she's really at the beginning, meds wise.

Preventatives that can be tried:
Propanolol
Metoprolol
Topiramate
Amitriptyline
Nortryptiline
Candesartan
Lisinopril
Gabapentin
Sodium Valproate
Pizotifen
Flunarizine

If she has migraines with aura they won't recommend the combined pill. If the migraines are hormonal, then taking frovatriptan daily two or three days before her period and the first couple of days during her period can help.

Sumatriptan can be given as an auto-injector. You get 6 injections in a little case.

Does she have prochlorperazine for the sickness/nausea? It's buccal so it sits under the lips and absorbs through the gums.

The crgp inhibitors can be helpful. There are quite a few now. I've tried Ajovy, Aimovig, and Rizatripan without success, but Ategopant (Aquipta) seems to be helping.

If I were you, and you can afford it, I would get an appointment with the National Migraine Centre

https://www.nationalmigrainecentre.org.uk/online-booking-request/