Monday, August 10, 2020

Neurology Appointment

On Friday, I had an appointment with my neurologist about my chronic migraines. I’ve been going to the Dartmouth-Hitchcock Headache Clinic for nearly a year now. The initial visit took about two hours’ worth of questions. My doctor did a full medical history, especially concerning my headaches and completed a neurological exam. She decided that I would start taking the Emgality injections once a month. It usually takes 2-3 months for the medicine to get into your system and start working. I was on Emgality for 6 months. The frequency of the headaches did improve; I went from having a headache every day to having 3-4 a week. For my neurologist, a 50 percent decrease was insufficient progress, so it was decided that I would switch to Aimovig, another injectable that I took every 28 days. With the Aimovig, I saw no improvement; in fact, I went back to having a headache every day. Not only was it ineffective against the migraines, but the side effects were excruciating. Aimovig is known to cause severe constipation, and some days the stomach cramps were worse that the headaches. Maybe that’s TMI, but I am just being honest.


When I met with the headache clinic’s nurse practitioner on Friday, I discussed the issues with her, and she determined that I would be taken off the Aimovig. However, since I did not respond sufficiently to the Emgality and the Aimovig was completely ineffective (both medicines are calcitonin gene-related peptide inhibitors), she believed that the third CGRP inhibitor, Ajovy, would likewise be ineffective. Furthermore, the anti-seizure mediation that has proven effective for migraine prevention is also out of the question because they all contain sulfur, and I am allergic to sulfur-based medicines. Therefore, the next option is Botox injections. There is one problem though. Aimovig has a half-life of 3-4 months, so it will be a while before my digestive tract returns to normal.

My first Botox treatment is scheduled for September 21 and should take about 20 minutes. The doctor will give me 31 injections in seven key areas of the head and neck. Each injection will contain small amounts of Botox that will go into shallow muscles in the skin. According to what I have read, it can take up to six months to see the maximum benefit from Botox. I will have to drive down to the clinic, which is about a 50-minute drive, every twelve weeks. The appointments cannot start for at least another month because it will take at least a month for the insurance appeals to be approved, hence the September 21 date. We already know that the insurance company will deny the initial request for the procedure. They have denied all of the migraine medications I have been prescribed, and my doctor has had to make appeals. Thankfully, all of the appeals have eventually been successful.


The fact that the procedure has to be appealed to the insurance company and is not automatically granted is one of the greatest failings of the healthcare system in the United States. Thankfully, Obamacare did require health insurance companies to cover preexisting conditions. Before the Patient Protection and Affordable Care Act, i.e. Obamacare, was passed in 2010, most insurance companies would not pay for my migraine treatments because I had previously been diagnosed with migraines. I cannot understand how it is legal in the United States for an insurance company, whose claims officers do not have medical degrees, to determine if you can have the treatment that a doctor prescribes. This is, in my opinion, the greatest failure in the healthcare system.


When I was young, I had frequent migraines, but I do not remember having headaches every single day. Since I have been an adult, I have a headache nearly every day, sometimes they would be so debilitating that I could not function. Through all of it, I was expected to continue my studies in college and graduate school. I was expected to work through the pain. If I took off every time, I had a migraine, I would rarely be able to work. Even if I took sick days for the most debilitating migraines, I would burn through my sick leave within six months. 


I have soldiered on. I’m not saying that for sympathy; I am just stating a fact. Besides the migraines, I have suffered through some pretty awful treatments. When I was on Elavil, an antidepressant with sedative effects, I suffered from night terrors. If you have never experienced night terrors, you are very lucky. In my experience, I would wake up, but I could not emerge from the nightmare I was experiencing. My mother always told me she would have to fight me to wake me up, and it was very upsetting for her, as I would be screaming for her but never know she was already there. This was a very traumatic experience for a kid. I’ve already told you about the depression effects caused by Ativan. Those were just two of the preventatives. When I took the triptans to relieve my headaches, I often felt like I was having a heart attack with severe chest pains and arm pain. The one time I tried Imitrex, it intensified the headache so much that I dropped to the floor and just cried. Sometimes, the treatment is worse than the chronic migraines.


So, I will try the Botox. I pray that it will give me the relief I crave. I don’t know what other options are out there. I feel fortunate that I have the Headache Clinic at Dartmouth-Hitchcock nearby. There is one at the University of Vermont too, but the one at DH is considered the best in the area.



Anonymous said...

Good luck Joe with the Botox.
May you become headache free and look ten years younger.

naturgesetz said...

I can't imagine suffering through all that for all those years. Here's hoping the Botox finally works.

Anonymous said...

Joe, Here's hoping for the best. As ever, Roderick

Jeremy Ryan said...

I've worked with a few people who suffer from migraines. I am fortunate in that I don't have headaches but maybe one to two times per year, if that. They are very rare for me.

Some people have told me that sitting in a dark room helps. I hope that the new treatment works for you and that your insurance company doesn't kick up too much of a fuss. Hang in there!

Connor said...

Joe, Have you ever visited a chiropractor for your headaches? Through adjustments and diet, I have seen many patients experience tremendous relief. I was a migraine sufferer as a teen. It was the care and relief that I experienced from chiropractic that inspired me to become a chiropractor myself.