Chronic Migraines: Seeking Relief from Severe Headaches at Night

Increasingly severe headaches, requiring sitting up to sleep at night?

Hello Dr.
Jiang,
I have been experiencing frequent migraines since high school, usually starting on the right side and spreading to the entire back of my head.
When the pain is intense, I often vomit, and I have all the typical symptoms associated with migraines.
In the past, medication was effective for my headaches, but now, during severe episodes, I need to go to a clinic or the emergency room for an injection of pain relief (in my arm muscles) to alleviate the pain.

Starting around September or October of last year, I began to experience headaches almost daily.
Previously, I would buy three boxes of pain medication each month, but that increased to three boxes every two weeks, and now it has escalated to four boxes every two weeks.
When I have a headache, I cannot sleep; lying down makes the pain worse.
During intense pain episodes, I often suffer continuously for 3 to 5 days, which is not only painful but also prevents me from sleeping or focusing on my work at the computer.

In May of this year, there was a day when I fell asleep sitting on the couch.
This was the first time I was able to sleep during a severe headache, and surprisingly, when I woke up, the pain had significantly decreased, although it returned once I started moving around.
Over the next few days, I experimented a few times; if I had mild pain before sleeping, as long as I sat up to sleep, I would not have a headache in the morning (previously, if I lay down to sleep, I would wake up in severe pain).
On Friday and Saturday nights, since I have the next day off, I would lie down to sleep, and sure enough, the next day I would start to feel pressure in my head, and unfortunately, it would escalate into severe pain again.

I know that sleeping while sitting is not good for my spine, but the headaches are so debilitating that I have no choice but to continue this way.
The reason I am reaching out is that I am truly distressed.
Over the years, I have consulted various clinics, and they have only prescribed pain medications and muscle relaxants, which have not been effective.
I would like to ask Dr.
Jiang if there are any other treatment options I could try or possible underlying causes for my condition.
Thank you for your assistance!

Nini, 30~39 year old female. Ask Date: 2024/08/02

Dr. Jiang Junyi reply Neurology

Dear Ms.
Ni,
You mentioned that "since high school, I have frequently experienced migraines...
I have visited several clinics, and they all prescribed pain relievers and muscle relaxants." Your symptoms may need to be considered for Chronic Daily Headache, defined as having headaches on at least 15 days per month for three months or more, with each episode lasting four hours or longer.
If your symptoms align with Chronic Migraine, defined as having headaches for more than three months, occurring on more than 15 days per month, and lasting more than four hours each day, with at least 8 of those days diagnosed as migraines, it is recommended to consider pharmacological treatment for Chronic Migraine, which primarily includes two approaches: preventive and acute treatment.
Oral preventive medications include serotonin agonists, anticonvulsants, beta-blockers, calcium channel blockers, or antidepressants, which need to be taken long-term.
I am not sure if you have received such treatment before.
Neurologists who specialize in headache medicine are more familiar with these conditions, and I suggest you seek out such specialists.
Thank you for your inquiry.
If you have further questions, feel free to discuss them!
Wishing you good health and peace,
Dr.
Jiang Junyi
Hua Medical/Tao Medical

Reply Date: 2024/08/02

More Info

Chronic migraines can be a debilitating condition, and it sounds like you have been experiencing significant challenges with your headaches for quite some time. Your description indicates that your migraines have evolved over the years, becoming more frequent and severe, which is concerning. It’s important to address both the immediate relief of your symptoms and the underlying causes to improve your quality of life.

Firstly, it’s crucial to understand that migraines can be triggered by various factors, including stress, sleep disturbances, dietary choices, hormonal changes, and environmental factors. Given your history of migraines since high school and the recent increase in frequency and intensity, it may be beneficial to keep a headache diary. This diary should track the frequency, duration, and intensity of your headaches, as well as any potential triggers you notice, such as specific foods, stress levels, or changes in your sleep patterns. This information can be invaluable for your healthcare provider in determining the best course of action.

You mentioned that you have been relying on pain medications and muscle relaxants, but they have not provided sufficient relief. This situation is not uncommon among chronic migraine sufferers, and it may indicate that your migraines have become more resistant to standard treatments. In such cases, a comprehensive approach is often necessary. Here are some potential treatment options that you might consider discussing with your healthcare provider:
1. Preventive Medications: Since your migraines have become more frequent, your doctor may recommend preventive medications. These can include beta-blockers, anticonvulsants, or certain antidepressants that have been shown to reduce the frequency and severity of migraines.

2. CGRP Inhibitors: A newer class of medications called CGRP (Calcitonin Gene-Related Peptide) inhibitors has been developed specifically for migraine prevention. These medications can be administered via injection and may provide relief for those who do not respond well to traditional treatments.

3. Lifestyle Modifications: Incorporating lifestyle changes can also be beneficial. Regular exercise, maintaining a consistent sleep schedule, and practicing stress management techniques such as yoga or meditation can help reduce the frequency of migraines. Additionally, staying hydrated and avoiding known dietary triggers (like caffeine, alcohol, and certain aged cheeses) can also be helpful.

4. Physical Therapy: Since you mentioned that sitting up to sleep alleviates some of your pain, it may be worth exploring physical therapy. A physical therapist can work with you to develop exercises that strengthen your neck and shoulder muscles, which may help reduce tension-related headaches.

5. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, chiropractic care, or biofeedback. These methods can help manage pain and reduce the frequency of migraines for some individuals.

6. Neuromodulation Devices: There are devices available that use electrical stimulation to help prevent migraines. These devices can be worn on the head or placed on the skin and may provide relief for some patients.

7. Consultation with a Specialist: If you haven’t already, consider consulting a headache specialist or a neurologist who focuses on migraines. They may have access to more advanced treatment options and can provide a more tailored approach to your care.

It’s understandable that you feel frustrated and overwhelmed by your situation, especially when it impacts your ability to work and enjoy life. Remember that you are not alone in this journey, and there are various avenues to explore for relief. It’s essential to communicate openly with your healthcare provider about your symptoms and treatment preferences, as this collaboration can lead to better outcomes.

In conclusion, chronic migraines can significantly affect your daily life, but with the right approach and treatment plan, it is possible to manage your symptoms more effectively. Don’t hesitate to advocate for yourself and seek out the care that you need to improve your quality of life.

Similar Q&A

Understanding Chronic Migraines: The Impact of Sleep Patterns

Hello, Doctor You. I would like to ask you about something. For the past month or two, I have been experiencing habitual migraines (on the left side) almost every day as soon as I wake up. Previously, the pain would start two to three hours after waking up, but recently it has la...

Dr. You Shunjie reply Psychiatry
Based on your letter, it seems that your habitual migraines have been troubling you for the past month or two. Common types of headaches can be classified as neurological, tension-type, or vascular, and it can be challenging to make a clear diagnosis based solely on description; ...

Chronic Insomnia and Headaches: Seeking Neurology Insights

Hello doctor, I have been experiencing chronic insomnia and migraines. I work in a labor-intensive job, and during my teenage years to early twenties, I was addicted to online gaming for a period of time after school and work. However, I haven't played for the past six or se...

Dr. Gao Chunde reply Neurology
Regarding the issue of migraines and the right eye, you can consult a neurologist. I find it difficult to understand the trigeminal nerve, but the physician will be able to assess it during the consultation and provide you with recommendations and treatment. If necessary, relevan...

Managing Chronic Headaches: Tips for Relief and Medication Guidance

Hello, Doctor: For the past few months, due to work requirements, I have been working 12-hour shifts every day as an accountant, which involves a lot of mental calculations. I feel like my mind is constantly working, accompanied by headaches, blurred vision, and sometimes sharp p...

Dr. Gao Chunde reply Neurology
Based on your description, it is still not possible to directly determine the type of headache, whether it is primary or secondary, common migraine, tension-type headache, or another specific form of headache. Therefore, I cannot provide you with direct relief methods. It is reco...

Managing Migraines: Tips for Better Care and Sleep Balance

Hello Dr. Lin: A family member of mine frequently suffers from migraines, and I haven't found a better way to care for her. I can only tell her to rest more, but I'm also concerned that too much sleep might affect her health. Recently, she mentioned that she has become ...

Dr. Lin Zijing reply Neurology
Migraine is the most common type of headache disorder, with the highest prevalence occurring in individuals aged 35 to 45 years. Women are three times more likely to suffer from migraines than men. The characteristic feature of a migraine is severe, pulsating pain localized to on...