The Awful Anatomy of a Long Migraine

My chronic migraines, while unpredictable day to day, do follow a bit of a pattern. Usually I'll have 1 to 3 days in a row with migraine pain and then have a day or two off before it returns. Every so often, I'll have a long stretch of migraines lasting anywhere from 7 to 15 days. This is a whole different beast from the usual pattern. Here's how it goes.

The first 3 days are hard the way all migraines are hard. They are filled with all the usual symptoms; pain, nausea, sensitivities, fatigue, irritability, sleep trouble and brain fog. It sucks but I'm confident that a better day is just around the corner. This is my "normal", as horrible as that is to say.

Day 4, 5 and 6 are harder. During this time the symptoms are compounding. I can't be sure that the symptoms actually get worse or if they just seem to due to my reduced ability to cope with them. One thing is for sure, without that respite of at least one day with less pain, ALL the migraine symptoms feel worse. During this time I start to suspect that I'm headed into a long migraine and that will begin to inform how I take my rescue medications.

Now on day 7, I will finally acknowledge the fact that I'm in the middle of a long migraine. I don't know how long it will go on but I am confident that it will end. After all they have always eventually come to an end. During this time I'm in full conservation mode with my medications. This will continue through days 8 and 9.

Day 10 is always a big turning point. I mean that in the worst possible way. This is the day that shatters my confidence that the long migraine will end. The day when all the pain and other symptoms overwhelm me. I find myself feeling defeated and full of fear. Fear that it won't end, that I won't be able to cope with it, or that the something has gone terribly wrong and I'm dying. From here on out the migraine is torture. I don't say that lightly. I actually feel like my body is torturing me.

Long migraines are horrible and they seriously complicate the usual protocol for my rescue medications. I'm allowed to treat only 9 migraines a month so deciding which ones to treat is tricky business. Normally I'm left guessing the severity and length of any given migraine. There is no way to tell for sure but after 7 years of practice I've managed to at least get better. Still I'm wrong frequently and, as you all know, if you don't take the meds soon enough you greatly reduce its efficacy. During these long stretches, it is almost impossible to tell if it is just one long migraine or if the migraine has just been retriggered. This makes deciding when to take a rescue med a complete crap shoot. The stakes are so high because you don't want to waste even one of your precious rescue meds. What an awful feeling.

Equally as awful is just hunkering in and suffering through the pain from the moment you wake up until the moment you finally get to sleep (ah, the precious escape that is sleep). Doing that for even one day is hard but having to do it for several days in a row, well, it is simply awful.