Vacation & Visit to Doctor (reaction to vacation, Pristiq, and kindling)

I just returned from a vacation to Washington and Oregon. I really needed it. I saved up enough time to be away for 13 days (including weekends). I did this because I suspected that the change would cause an attack (I often get one on Saturday morning). Glad I did that because I did have a bad one for the first two days. Then once I adapted I was okay - just the usual - not exceptionally bad. Except for when I was in a car driving up to the visitor centers at Mt. St. Helens and Mt. Rainier. I had some bad pain and other symptoms then.

When I returned last week several people asked me if I had fewer migraine attacks during vacation. I know they are just trying to be nice. But I think those questions indicate the general assumption that migraine is an inability to cope with stress. While stress may trigger them the root cause of migraine is not simply stress. People just don't understand. And I'm still in the same pattern of attacks.

I saw my new headache specialist for the third time on Friday. She explained that the attacks I experienced while changing elevation were probably due to a change in barometric pressure. Also she explained that the results of the injections she gave me during the two previous visits (numbing agent and steroids) tell her that my problem is not a mechanical problem with the trigeminal nerve (such as entrapment, etc.) but a chemical problem. Therefore I am not a good candidate for surgery, radiation, or botox or other procedures. She has prescribed a new medication Pristiq (desvenlafaxine) - an antidepressant that increases the amounts of serotonin and norepinephrine in the brain.

This actually sort of disappointed me. I've tried so many medications that I was hoping to try something different. But at least she gave me a good rationale for her decision. That is more than I got from my last doctor. I felt like he was just randomly throwing darts and hoping something would stick.

She also described something the brain does called "kindling." When the brain experiences something like pain or a seizure repeatedly it begins to kindle or encourage that same experience and it occurs more often. I wonder if there is some other positive reason the brain would do that. Because in the case of people with pain or seizures - we really don't appreciate that function.

There is so much they do not understand at the moment........ its a shame about the Botox - I was told mine were all chemical - but I was given Botox and it has been a god send.......... xx

I've never heard of the term kindling before, but it is similar to a description by my new clinical psychologist. He told me that sometimes the brain learns incorrectly how to handle some forms of stress and wires itself so that it is rewarded by such stress. Chronic pain can cause this. In my case, it has resulted in extremely low alpha waves even when I'm in a supposedly relaxed state.

It's interesting that you have been prescribed a medication to increase your serotonin levels. The clinical psychologist has recommended I take 5-HTP for similar reasons.

Pīwakawaka, what do alpha waves indicate? Should people generally have high alpha waves in a relaxed state? Does your psychologist measure them?

Tee, Where was/is your pain primarily? Mine is in the front in my face, around my left eye and left cheek.

My doctor also said that she is hesitant to give me more injections because I had 5 really bad days following the last injections and had to reduce the pain with a Medrol dose pack (steroids). She said that in some people an injection can irritate the nerve.

Alpha waves occur when you are in a concious and relaxed state. They are in the range of 8 - 13 Hz. The strength varies depending on the state of relaxation and should go up when you close your eyes. Mine stay the same. The psychologist did the measuring. If you've ever had an EEG, it's a little bit like that, but he used far fewer electrodes. Six regions were measured - Front, top and base of the brain in each hemisphere. Interestingly, my results were "unexpected" as the frontal area was only slightly under the low end of the normal range, whereas the other two regions were about a third of the low end of the normal range. The measurements were done on my last visit. When I see him again tomorrow, I'll learn where he wants to go with this line of investigation.

I misunderstood. I am not a candidate for nerve decompression surgery, but I am a candidate for the Gamma Knife procedure and the Peripheral Nerve Stimulator. My doctor recommends the nerve stimulator. She is going to look for a physician close to my home who can do the surgery and who has experience using it on the face with the trigeminal nerves.

I will continue with the Pristiq to try to control the non-pain symptoms.

I actually feel hopeful for the first time in I can't remember how long. And hope feel good!