I am faking work. It is a Monday afternoon in March of 2015, and I am sitting in my cubicle under a flickering fluorescent light. Checking Twitter. That's part of my job…right? I'm a journalist; I need to be on top of the news. I scan the page, but I'm not absorbing what I read. I have a migraine and I've run out of the drug I use to treat it a week before my insurance company will allow me to refill it. Lately I've been swallowing these big, blue pills almost every single day, even though they make me confused and dizzy, and I'm not supposed to use them more than twice per week.
I have a premonition that things are about to get very bad. For me, a migraine begins with what I call a "twinge" in my left eye, which quickly evolves into a rhythmic throb, and then a nauseating sensation like having a screw tightened into the side of my face. I decide to hail a taxi, as quickly as possible, and ride home to my apartment in Brooklyn, where I'll knock myself out with sleeping pills. I rush out of the office, mumbling an excuse to the colleague who sits next to me. The elevator ride down to the lobby is interminable. As I step out onto 57th Street in midtown Manhattan, I realize I'm not going to make it into a cab. I'm going to puke right now, in my wool pea coat and leather boots. So I do, into a public trash can. Tourists and businesspeople gawk.
I don't really care. I wipe my mouth with the back of my glove and feel, actually, relieved. The worst is over. At least for today.
For a period of several years that ended only six months ago, I had a migraine, of varying degrees of intensity, essentially 100 percent of the time I was awake.
I must have been five or six the day my mother, in a suburban parking lot outside a bowling alley, taught me how to swallow my migraine pill. I placed it as far back on my tongue as I could manage and quickly took a big gulp of water.
In elementary school, I got a migraine about once a month. The first prescription drug I can remember using was a child's dose of Fioricet, a barbiturate. Barbiturates can be addictive, and worse, they often didn't take the pain away. Thankfully, in the mid-1990s, an innovative new medication became available for migraine patients, first as a nasal spray and then in pill form. It was called sumatriptan, and worked by shrinking the blood vessels in the head that swell during a migraine. My doctor was excited for me to try it. Unlike the potentially dangerous barbiturates I'd been using, sumatriptan was not, at that time, considered habit forming.
Right away, I thought sumatriptan was a miracle. If I took a dose soon after the twinge set in, the drug would hit me hard a half-hour later, washing out the pain and nausea on a wave of lightheaded dullness. Like any teenager, being left out of the fun was my greatest fear. With sumatriptan, I could continue whatever I was doing: schoolwork, hanging out with friends, eating normally. Sure, I'd be a little fuzzy. Sumatriptan brought on a mild confusion, a sense that what had been clear and precise just a few moments ago was now obscured. I'd have to remind myself to listen as somebody spoke to me, or the words would pass through my mind without making much of an impression. But this was a small price to pay to avoid the stupefying pain of a full-blown migraine.
You aren't supposed to use sumatriptan more than two or three times per week, and for more than a decade I had little trouble adhering to that recommendation. Fast forward to 2009: I was 25, and had moved to New York City for a job at a Web magazine with long, unpredictable hours. A year later, I went through a difficult break-up with a live-in boyfriend. I felt twinges of pain in my left eye every day. At that point, the FDA had recently approved a drug called Treximet, which combined sumatriptan with a large dose of naproxen, an anti-inflammatory painkiller. It was even more potent than sumatriptan on its own. I loved it.
Without realizing what exactly was changing, my life slowly began to feel like a lurch from one dose of medication to the next. Part of the problem was the essentially contradictory advice given to migraine sufferers. We aren't supposed to overuse our medications, but we are also encouraged by drug manufacturers and some doctors to treat an attack at its earliest onset.
I told myself that if I "nipped a migraine in the bud," it wouldn't blossom into a multi-day ordeal of nausea and missed deadlines. On big days like work conferences, friends' weddings, or a funeral, I would occasionally go rogue and take a Treximet preemptively, figuring that I was bound to get a migraine anyway.
I began to horde pills. I requested an override of my insurance company's quota of nine pills per month. With 18 pills every four weeks, I could take double the recommended dose. Still, I frequently ran out before it was time for a refill. Many times I begged a pharmacist to advance me a few pills, which they sometimes did if I claimed I was about to go out of town. I wonder now if I was able to manipulate these systems so easily because I am white, female, well educated, and professionally dressed.
Over the course of six years, my doctor prescribed alternative medications in an effort to ease my reliance on Treximet: blood pressure drugs, anticonvulsants, antidepressants, and Botox injections, which are supposed to numb some of the nerves involved in migraine pain. In 2013, I even checked into a hospital for five days to receive intravenous doses of ergotamine, another migraine drug, in the hope that it would allow me to end my tortured relationship with Treximet.
But like about half of migraineurs, preventive medications didn't help me. My pain seemed to respond only to Treximet, and I struggled to give holistic treatments, like exercise, a fair shot. It was just too easy to reach for my trusty blue pills, which I knew would offer a few hours of relief. If I had enough Treximet, I reasoned, I would never have to tell a boss that I was coming in late, or turn down an assignment, because of a migraine.
When I finished writing a book in 2014, I took a new job where my role was to report on the criminal justice system. My colleagues and I sometimes wrote about opioid painkiller addiction—stories of desperate people who couldn't hold down a job, lost relationships with friends and family, and ended up incarcerated. That wasn't me. I was newly married by this time, and working essentially two full-time jobs, as a reporter and an author promoting a book.
Still, my pain-drug-pain cycle was dictating my daily routine. I had learned to write through the fog of the drugs, but wondered if the work I was doing was my best. After all, I could hardly even bake a cake. When I hosted a birthday party for my best friend, I was so muddle-headed from days of repeated Treximet consumption that I had to throw away two ruined bowls of batter. I used the wrong amount of flour in one, and then the wrong amount of butter. It was a recipe I'd made many times before.
During episodes like this, I would cry with frustration, and my husband would hug me and tell me something had to change. I had talked about working part time while phasing down my drug use, and he thought it was a good idea. In addition to the mental fog, there were other side effects —severe heartburn, for one. And if I ever decided to get pregnant? Well, I most likely wouldn't be able to. The large dose of naproxen included within the Treximet pill often prevents ovulation when taken too frequently. And like almost all migraine drugs, Treximet is not considered safe during pregnancy.
But I wasn't ready to admit that my health was more important than money, my job, or the book I was traveling frequently to promote. And my tears would usually clear up the moment the next Treximet kicked in, leaving me eager to change the subject and get out of the house. In fact, when the drug was coursing through my system and I felt okay, I'd grab my phone and start texting frantically to make plans with friends. I realized later that my husband got the part of that me was sick and withdrawn, and my friends and colleagues saw me when I was able to focus on something other than the pain.
When I began to worry about how often I felt I needed the drug, I visited a new neurologist to get a second opinion. "Don't worry," he told me, "triptan dependency is a myth. In Europe, triptans are sometimes prescribed for daily use." (Sumatriptan is one , a class of drugs.) The guy gave me a bad feeling. His office was dingy, and he was marketing an over-the-counter migraine drug he had devised himself, which he asked me to review on Amazon. But he was well known, and while I never saw him again, over the following years I would often replay his words in my mind.
My main neurologist, the same one I'd been seeing since childhood, was always honest with me: My condition presented a difficult chicken-and-egg problem. Was I using the drug so often because I was having more migraines? Or was I having more migraines because I was dependent on the drug? I'd know only if I stopped using Treximet.
Three-quarters of migraine sufferers are . Balzac, the 19th-century French novelist, believed the condition was often feigned, a convenient way for bourgeois wives to get out of social obligations they wished to avoid. Freud advanced the idea that migraines, from which he suffered himself, were the result of repressed sexuality. Even the great Oliver Sacks, another migraine patient, wrote in 1970 that those who experience daily migraines have likely "adopted" the condition as "an expression of emotional stress and distress." He added, "[W]e may legitimately use the term 'psychosomatic illness.'"
None of this is true. Migraines are an undisputedly physical affliction that causes the brain to respond to ordinary stresses—tiredness, hunger, or even weather changes—by that cause pain. Migraineurs also overproduce peptides, a brain chemical that causes inflammation of the trigeminal nerve, which wraps from behind the ears toward the eyes, nose, and jaw. If you were with me during an attack, I could place your finger on a pulsating vein on the back of my skull. I have often fantasized about cutting into my scalp, under the bone, to excise this offending blood vessel. When I read , Andrew Levy's beautiful history and memoir of migraine, I learned such a procedure was actually attempted in the ancient world, to little effect.
Yet the old stereotypes haunted me, especially when I thought about giving up Treximet. Without my drug, would I have to cancel plans? Shirk obligations? I feared the boss, coworker, or friend who would wonder if I was faking, grasping for an excuse to be late or absent. And maybe some people would believe I was a little bit crazy. I'd already been told more times than I could count that I brought the migraines on myself, by being "too stressed out." The traits associated with migraine patients neatly match those used to denigrate intelligent, ambitious women: high-strung, uptight, anxious, sexless.
According to Dr. Elizabeth Loder, professor of neurology at Harvard Medical School, about half of the patients she sees at her headache clinic are overusing medications. But most of them are abusing drugs that contain caffeine or even coffee itself, not triptans, which, as Loder points out, "don't produce any sense of euphoria or produce sensations that people like."
I might not have liked the feeling of Treximet, but I liked who it allowed me to be. The very traits I valued in myself—my work ethic, and desire to spend time with friends—fostered my dependency. Treximet could buy me a few extra hours of productivity, allowing me to delay the inevitability of collapsing into bed. Sure, the pain reared back even stronger...at which point I would either take sleeping pills or pop another Treximet.
But there was no doubt that cycle was leaving me existentially out of control. It was clear I needed to unlearn these patterns.
During a desperate late-night Google search for migraine research about a year ago, I discovered a series of papers by two Norwegian neurologists, Espen Saxhaug Kristoffersen and Christofer Lundqvist. They that patients who overuse triptans and other migraine drugs are "highly disabled" and prone to depression and anxiety. While at first jarring—I wasn't disabled! I was young, active, hardworking!—I had to admit that the description resonated. In fact, it brought tears to my eyes. The researchers also that there were "many similarities" between "medication overuse headache"—a condition in which migraine patients develop a dependency on their drugs and need them daily in order to avoid headache and withdrawal pain—and drug addiction.
I clicked over to a offered by the National Council on Alcoholism and Drug Dependence. It indicated I appeared to be "experiencing a substantial level of drug abuse." Among my red flags: I used prescription drugs at higher-than-recommended doses, couldn't go a week or longer without using my drug, felt bad about my drug use, and felt sick when I attempted to stop using my drug. I may not have been addicted—I wasn't chasing a high—but I was certainly dependent.
Last summer I sat down with my boss and told him I wouldn't be able to work until my health improved. I went on disability pay, and over the following months my neurologist helped me implement a drug-withdrawal strategy. He prescribed a two-week course of a steroid, which can lessen pain while coming off other drugs, and suggested I see a younger colleague of his for acupuncture treatments. That doctor helped me, too, less through the acupuncture itself than by reminding me that Benadryl, an antihistamine and mild sedative, could be a replacement for Treximet during the drawdown period, dulling some of the pain and helping me sleep.
The withdrawal symptoms, mostly nausea, fatigue, and head and facial pain, lasted about two months. Overall, giving up Treximet was less of an ordeal than I had thought it would be. Once I changed my routines—dismantling the link I had created in my mind between taking a Treximet and being able to spend the entire workday in my cubicle—the pain and nausea became manageable.
Sadly, few chronic migraine sufferers are able to make the lifestyle changes I did to treat their condition. Kristoffersen and Lundqvist write that Americans are more than twice as likely as Norwegians to overuse migraine medications. They don't speculate as to why, but I suspect our culture, and even our politics, have something to do with it. Norwegians work shorter hours than Americans and are more likely to have flextime. (Migraines cost an estimated in lost workplace productivity.) In the United States, migraines are covered under the Family and Medical Leave Act, but only 60 percent of workers have the right to a 12-week FMLA leave, and that leave is entirely unpaid. I received seven weeks of disability pay equal to about half my regular salary, through insurance provided by my employer, a benefit available to fewer than 40 percent of workers. Plus, I have a spouse whose steady job helped make up for the temporary loss of income.
I now work from home as a freelance journalist. I still have some head pain every day, but I have far fewer severe migraine attacks. If I feel that twinge in my eye, I make sure I've eaten recently, I drink a tall glass of water and I exercise, often something as simple as a brisk walk to get the endorphins flowing. If that doesn't help, I swallow a single Benadryl, and then lie down to rest with a cold pack on my head. I don't take Treximet at all anymore, but I do use a different triptan, Imitrex, a few times a month for the worst pain, which usually accompanies my period. Under no circumstances do I allow myself to take more than two of these pills in a single week; research that for the entire first year after my withdrawal, I will be at risk for a relapse into dependency. My doctor now prescribes me the pills just four at a time.
My life has slowed down considerably, and that has been the hardest change to accept. I never thought I'd be the kind of person who took a two-hour nap on a workday. "It's hard for some women because we live in a society where people like to think there's a way to fix everything," Loder says. I've learned to live with the fact that some pain is unavoidable, no matter what drugs I use. And I know now that I can live with pain and still be a decent (if imperfect) worker, partner, and friend. "It's a chronic illness," Loder reminds me, one that can be managed but not cured.
Dana Goldstein is a journalist and author of The Teacher Wars: A History of America's Most Embattled Profession. More at .
Follow for the latest celeb news, beauty tips, fascinating reads, livestream video, and more.