Migraines in-flight?
 

I can't think of anywhere else to put this thread.

Does anyone here suffer from migraines? Has anyone ever had to deal with one in-flight? What do you do?

This Thursday, I was returning from AMS to SFO on KLM. I was in business class, and enjoying the very good KLM service when, about half-way through the 11 hour+ flight, I developed a really bad migraine -- a classic, with all of the symptioms: aura, nausea, sensitivity to light, sound and smell and, of course, a splitting half-hemisphere headache. Fortunately, I had Imitrex with me, and shot up in the lav. I also took as many pain killers as I dared. The result of the self-medication was that, after an hour or two, the pain lessened enough to the point that I could sit down -- before that, I stood in a little corridor between the two J compartments with my head against the wall. The rest of the flight was merely miserable, though I did manage to nod off for half-an-hour or so.

Ugh. Not fun! And only the second time I've experienced this while in-flight.

So how do you migraine sufferers cope when this happens to you?

Glad you had some meds with you...! :(

I've had a couple of migraine sufferers as passengers. Such a terrible thing to experience during a flight, close confines, no real control over the environment.

With one woman, we made her as comfy as possible inside one of the lavatories. Fortunately it was non-stinky that day, but she couldn't lock the door without turning on the lights - so we FA's took turns watching it and redirecting passengers. The quiet(er) dark and air from the vent helped her a bit. With another passenger, I found some stray blankets and helped him make a sort of tent over his seat to block out the light as best we could. He had less fresh air though, but he needed to get out of the light more than anything.

I'd love to hear other ideas, though, on how you guys deal with this - I hate feeling so helpless when I have a passenger dealing with it.

My wife gets migraines, and Imitrex has been a big help. Have you read the instructions for Imitrex carefully? Our understanding is that if the first injection does not help enough that you can take a second injection an hour after the first. Then, no more for 24 hours.

There have been a number of cases for her where the first injection helped only a moderate amount and the second pretty much made things quite bearable. Check with your doctor about the possibility of the second injection, if the first one doesn't help as much as necessary.

Also, she has found that a drug originally designed for epilepsy called Topamax can be taken as a preventive, Again, check with your doctor, as taking Topamax on a regular basis has served to significantly lessen the frequency and severity of migraines for many people.

I don't think I could have handled the blankets, but the dark lav would have worked well. I'll keep that in mind, though I hope this doesn't happen to me again. May I ask which airline you work for? FAs as considerate as that would definitely influence my selection of carrier. :)

I've been taking Imitrex so long, I've forgotten the protocol, except that I can't take it more than once every 24 hours. I'll check with my MD and ask about a second shot in an hour. I tend to experience rather unpleasant side-effects from Imitrex -- it feels like every muscle in my neck and back are contracting, and lasts for about 10 minutes. It's a measure of how bad the migraine is that I'm willing to take an Imitrex shot at all.

I've been lucky in that my blood pressure medication is prophylactic for migraine, and simply growing older means I get them less and less. For some reason, though, this has been a bad year.

Most important thing - carry your meds, and take them as soon as you get symptoms. The earlier the better. If you can't remember how to use them, make sure you get a refresher course.

There are a lot of preventive migraine medications. Like everything else, which one is chosen is personalized. Don't take one over another just because it is recommended on a public internet board!

I'm fortunate in that the Imitrex tables work for me; they are easier to travel with. They normally work within about 20 minutes or so.

Me too. Also, at the first sign of any headache I take the Imitrex... since any headache I get can flip over into a migraine at any moment. And changes in barometric pressure are often the culprit.

The biggest problem I have is that I get so many migraines that the monthly 9 pak is not enough. For a long time my doctor ordered 18 for me per month, which was about enough. But then the lovely insurance company refused to pay for the 18.

So, the workaround was for my doctor to prescribe 9 of the 100 mg tablets, which I cut in half.

Isn't it crazy that we have to fight the almighty insurance company to get relief?
Rita

The only time I developed migraines was from a BA flight couple of years back when a 4-year old toddler sitting next to me screamed the lights out of my eardrums.

As for coping with migraines.....this may sound silly but Tylenol works well with me!! :)

As a fellow migraineur, I can sympathize. My worst was leaving IAD with migraine for a 24 hour extravaganza to ORD-NRT-HKG-SIN. My thoughts while getting on the plane were NOT good. Fortunately I had 2 days to recover before I started my presentations.

If not for the post-9/11 situation, I would suggest bringing on a machete and just cut your head off -- I am kidding of course, but as you can probably attest, by only a little. I have times where I've wanted to do that.

More practically --
When travelling, I would be sure to have several different ways to attack the migraine. Of course, discuss with your primary doc or neurologist.

1 If Imitrex has not helped you, then consider switching to another in the same class of medication. Some people have different responses to different ones, even though they are chemically very similar. If you get the migraines often enough, ask for a different one (Relpak, etc) and try before a long trip.

2. If you can take narcotics, I would ask for Tylenol #3 or Vicodin to keep in reserve (whatever works and you can tolerate).

3. I have also found that naproxen (Alleve) sometimes work -- it is not FDA approved for migraines, but it has been prescribed often for migraines. The usual dose is equivalent to 2.5 - 3 tablets of Alleve 2x/day. (If you are sensitive to these pain meds, take with some antacid like Maalox).

3. And also ask for as sleeping med -- sometimes just getting knocked out is the only way to let it resolve.

4. Finally, I have found that sometimes an icepak numbs up my face enough to keep the pain to a minimum until something kicks in. Carry a small icebag with you and the FA's will be happy to keep it filled with ice.

Good luck, "I share your pain"

--- Oh, and don't forget a good pair of eyeshades and earplugs.

A friend gave me a padded eyeshade (almost like a little pillow) that is filled with some aromatherapy beeds that are supposed to help with headaches. At first I said -- NO WAY -- since most odors and scents make the headache worse. But sometimes I do think it helps a bit.

Similarly, rosemary oil rubbed on the temples is reported to help. Same friend gave me a bottle from Bath & Body Works (I think). Once again, I am not really sure it makes a different. But when you are in the throes of a major migraine , you'll try anything.

And don't you hate how the littlest scent will make things worse. Note to all travellers: do NOT wear cologne.

I seem to get a lot of migraines when and after I fly. I've discussed this with a neurologist, and he agreed that the pressure changes due to flying can be a trigger for migraines.

I often rely on nasal spray administered medications when I fly. I don't want the hassle of carrying needles onboard with me, and many times I can't keep anything down with the nausea. The drawback is that I sometimes lose some of the liquid when I open the container to affix the nozzle to the bottle. The pressure change inside the bottle actually causes the medicine to jump out of the container when the top is removed. I literally feel like the same thing happens behind my eye.

I'm wondering if anyone else has noticed a correlation between migraines and flying.

I once had an awful migraine on a flight from GRU to EWR. This was one of my once-a-year, knock-down types that totally sidelined me. It hit around hour 3 of the 10-hour flight. Fortunately, I was in biz class and had room to stretch out; I also had a window seat so I could kind of turn toward the wall. I put on the sleeping mask that CO gives out in the amenities kit. I also travel with a pair of noise-cancelling headphones, which I put on without plugging into the IFE. I tried to lie very still and do some tan jun breathing; all of these things usually get me into a state of near-sleep that helps the migraine tremendously. This time it didn't work, however. I also travel with a prescription for Xanax (alprazolam). I took one of those, and after about an hour of lying there quietly suffering, I more or less fell asleep. I woke up in about 2 hours with the migraine mostly gone. After a Coke and an extra ice cream sundae (thanks, CO flight attendants - you're the best!), the migraine was a memory. Maybe some of those things will help you in the future.

Just have someone else smell-test the lav first! I have a feeling that dank musky thing would be the last thing someone with a migraine needs to catch a whiff of!

I think there are considerate people in every airline...but you're welcome to fly with me anytime (on CO). ;)

I also suffer from migraines. I find that sinus problems will trigger migraines just about as fast as cabin pressure - or maybe they're related.

I usually take Sudafed before and during any flight longer than 3 hours, and I've found that it seems to help tremendously in preventing the migraines.

And I don't do ice packs, I prefer the opposite - moist heat. A ziplock baggie with hot water across my face can relax me in a heartbeat.

Another trick is to put my head completely under a blanket, just as another passenger did. It has been suggested that reducing oxygen intake will force your constricted vessels to open up, thereby helping to relieve your headache. It seems to help with me.

Caffeine can also help, if you can tolerate it. Try drinking a cup of coffee. If you can't keep it down, sipping a Coke might be better.

I was diagnosed with migraines at the tender age of five, long before there were meds that were appropriate for me. So I learned all the little non-medicated tricks at an early age...

This is true, but be very careful with Topomax and know the reported side-effects. My wife took the drug for about a month and had horrible problems with forgetting words mid-sentence (a known side effect) and generally not being very sharp. Although it did manage to lessen the overall intensity of her migraines she found that she started to suffer from near daily lower grade migraines as well as what she described as pressure headaches.

The real problem was that she couldn't just stop taking the drug as that would lead to withdrawls and other problems. It took over a month to taper her off of it and on to something else.

Sinus is my trigger too. The other cause is if I sleep badly and have my neck in an awkward position, which triggers the sinus, and so on.

Thankfully I have only once had a migraine while flying. 4 hour flight, total agony. For me, my usual pain-management routine is anti-histamine, asprin, hot hot shower, hot buckweat pillow, black tea and sleep. Can't do all of those on a plane! Luckily, I don't get migraines bad enough or often enough to use stronger medication. Mine usually last a day but no more than two, which is manageable.

Pre-flight I take a strong asprin (as well as my daily anti-histamine) and use FESS nasal spray and my asthma meds. I read that they've got a special 'flight FESS' out now so I might try that too.

That's a great idea... I'm a heat person too. I have a buckweat pillow that works wonders but I've never travelled with it because I wasn't sure if I would have access to a microwave to heat it up. I'll try the ziploc thing next time.

Usually I find that a prescription strength dose of Motrin (say 600 mg) does it for me. Oddly Motrin seems to work faster than Advil for my migraines.

I'm pretty sure that my migraines are caused by barometric pressure changes (among other things). I also get migraines when I ascend to high altitude. I can often avoid a migraine if I take a couple of Aleve tablets before I get on a plane or go into the mountains, before I experience any symptoms.

At risk of getting off topic, I use Advil liqui-gels if I have afternoon migraines. And have you ever noticed these "migraine" versions of OTC medicines? They have the exact same thing as the regular versions but in different packages. Next time you're in the store, look at Excedrin vs. Excedrin Migraine. They both have 250 mg aspirin, 250 mg acetominophen, and 25 mg (?) caffeine. What's the difference, then? Same thing with Advil Migraine vs. Advil Liqui-Gels. Both have the same concentration of solubilized ibuprofen. One is amber and one is blue. I have used both versions of Excedrin and both versions of Advil, and they've both worked the same for me. I usually just buy whichever is less expensive.

No difference at all. What they did was got FDA approval to market it for migraine use. SO they repackage it under a new name, and charge a buck extra until people catch on.

(The caffeine is a vasoconstrictor...shrinks the blood vessels in your head, essentially. Pretty effective for headaches - except that caffeine is a migraine trigger for some.)

Just to summarize the basic types of medicines in treating migraines --

1. Acute Treatment - used once a migraine has started; examples are Motrin and Alleve (OTC), Tylenol #3, Fiornal, Imitrex (all Rx)

2. Abortive Treatment - used before the migraine has started; most people have a 'premonition' that a headache is on its way; examples include Imitrex and Cafergot (both Rx)

3. Suppressive Treatment - used if someone has frequent migraines or predictable migraine (peri-menstrual, even travel-related); these medicines need to be taken ever day whether or not the person has a migraine; if the migraine is predictable, sometimes the meds can be taken starting a few days to a week before the expected migraine period.

Examples for #3 include most epilepsy medicines, including Topamax, Neurontin, Tegretol. As noted, they -- like all meds, whether OTC or Rx -- can affect people differently.

Remember that the list of side effects are based on relatively large # of people, but it does not mean that a specific person will get a specific side effect or even develop something not listed. And depending on your own medical history and other meds you are taking, your options change.

Conclusion: Discuss with your doctor, and try the med before you take it while travelling -- no use having any surprises while away from home!

(I play a physician in real life, but limit to very general recommendations on-line. As always, discuss with your own physician)

I also get some pretty rough migraines. I've also had a few at work. This is the worst! I can't say whether the cabin pressure has affected them or not because I've been getting them long before I was flying for a living. I personally have found that plain aspirin, taken with coffee, works best for dulling the pain, taken as soon as the vision interference starts. About an hour later, I take two advils. I've learned that avoiding chocolate, for some strange reason, helps also. I remember hearing somewhere that this was a trigger for the headaches, and so far, so good. Also, sufficient sleep is essential. I've noticed that being tired triggers them also. So much for jumpseat medical advice, huh? LOL Take care

Chocolates are, for many people, migraine triggers. Other foods to watch out for:

Dairy products of any kind, but particularly cheese.
Nuts.
Red wine (the tannin is the problem).

Your mileage may vary.

For me lack of sleep can trigger one, as can too much sleep (go figure ;) ). I don't get them from stress, but from a sudden release at stress, a phenomena which has been documented as "Saturday migraines".

Coffee contains caffeine, which is an abortive. This is why some people like analgesics which are compounded with caffeine (I think Excedrin may be one one).

You're lucky that Advil works for your. OTC analgesics don't touch mine. Imitrex, which is an abortive, not a painkiller, works 99% of the time for me, but when it doesn't I take oxycodone, which is the generic for Percodan -- and THAT barely works.

For anyone who hasn't read it, "Migraine" by British neurologist Oliver Sacks (author of "Awakenings" and "The Man Who Mistook his Wife for a Hat") is compulsory reading. It's a little dated now, as it was written before triptans were discovered (Imitrex, etc.), but it's an entertaining explanation of the "aesthetics" of migraines. Though I have had migraines since I was a very young child, I learned a lot I never knew after reading the book, including what aura was and why I sometimes get . . . uh . . . what's the word? . . . oh, yeah, aphasic when I get a migraine.

I, too, was diagnosed with migraines when I was around 12, but I also complained of headaches a lot when I was very young. At the time, the conventional wisdom was that children did not get migraines -- who knew?

If it is any consolation, people tend to 'grow out' of them in middle age. For me, I could count on 4-5 per month until I hit 40, then all of a sudden they stopped -- I think I have had 5 in the past 5 years. (yeah!!!) And for women, migraines very often stop with menopause, which I guess is at least some compenasation for hot flashes, irritability, etc. ;)

I had noticed the same thing -- the older I got, the less the frequency, and also the milder the migraine (if it makes any sense at all to use the words "mild" and "migraine" in the same sentence). However, for some reason, for the last two years or so, the number and intensity has slowly started to increase again (and I'm in my 50s). I'm sure it has something to do with stress which, for me, increased dramatically two years ago and hasn't let up yet.

Alternating hot and cold works for me. In flight I've used a cup of coffee and a bag of ice. I use Vicks under my nose - for some reason the smell doesn't bother me and it blocks other odors.

SOME people. Unfortunately not me. But Imitrex works pretty well for me.
R.

*chortlechortle*

Don't forget about:

Cured/smoked meats
Nutrasweet (lots of people don't realize this might be a trigger and continue to drink diet soda while having migraines)
MSG - still in lots of foods, especially Chinese food.

I need Goldilocks sleep, too. Not too little, not too much. This is why migraines are a problem for me while travelling. Until recently, I was completely unable to sleep on planes. Even in Raffles Class on SQ flying SFO-HKG for 12 hours! I then get off my sleep cycle at my destination and run a sleep deficit for a few days until I catch up. Nothing like 4 straight days of migraines after arriving in China!

Ooops. I'm one of those people who didn't know that, and I drink gallons of the stuff!

Another reason why I am thankful for FT. Thanks!

Another Migraine sufferer. Only once had one while flying - not fun but it was a short flight. I was glad I didn't vomit. Now I carry Imitrex shots with me - works well in the thigh and only takes 7 minutes or so for me to releive my headache. I used to just suffer but now I realize it doesn't have to be that way. For those who take the pills - FYI - it is cheaper for me to get 12 shots in a month than 9 pills - something to consider with insurance. My physician had only prescribed 2 shots per Rx but after talking to the ins company I can get 12 so I only have to pay the co-pay once.

Agree that changes in pressure or weather can be a trigger.

cejkwj

Flying in general usually gives me a slight headache-I believe due to the air press, plane fuel and others cologne/perfum. Of course I do the normal w/ some OTCs before I get on board and for some reason if I sit in the back of the plane I don't get as bad of a headache. Don't ask me why...but it works for me.

If for some reason I can't nip it in the bud and it turns into a migraine and bc no other treatments have seemed to work in the past for me this is my approach:

Tylenol #3 &
3-4 Advil &
cool towel that covers the eyes-trying to make it as dark as possible &
move away from anyone w/ cologne/perfume or scented lotion (if possible) &
turn the air vent on HIGH &
a real coke not diet &
and try to get some sleep

I know the T3 and Advil at the sametime seems like alot ....but like I said nothing else helps me..

btw interesting post.

I have the same problem w/my insurance company. I have my Doctor give me two prescriptions one for Imitrex and one for Maxalt. Of course I don't take them at the same time, but when my prescription for Imitrex runs out I can use the prescription for Maxalt without triggering an international incident with the insurance company. I think its horrible that insurance controls our medical system. Sometimes you have to find a Doctor that will go to bat for you against the insurance company. I have found that Dr's that have migranes themselves are the best RoseMary

Caffeine does seem to help. My migraines is accompanied by unbelievable vomiting. I take CAFERGOT in a suppository as well as Prochlorperazine suppository. OK this is more than some of you wanted to know but it has been a lifesaver for me and probably the flyer next to me too. RoseMary

Oh, the Saturday migraine! I forgot about that. Not only are migraines triggered by release from sudden stress (I, too, found my migraines started just as the stressor was finishing), but there is the caffeine withdrawal headaches, which can turn into migraines.

In the 1080s, I noticed I religiously got migraines on Saturday, lasting through to Sunday, until my doctor quizzed me about my caffeine intake. Sure enough, in the efforrt to lose weight, I drank a lot of regular coffee (8-10 cups/day) at the office, but then only 1 or 2 cups on the weekends. That was when caffeine withdrawal was just starting to become known. I switched to mostly decaf during the week and at least THAT trigger stopped (still had other migraines, though).

I've got one of those migraines right now. Coupled with the Nor'easter going on right now, and even Imitrex isn't working. Went to bed with it last night and it's still here this morning.

I'm hoping that if I get up and move, it will subside a bit. But I know it probably won't.

Has any of you found that the mere "talking" about a headache gives you one? That used to happen to me when I was in my '20s.

Rita

I am a migraine sufferer as well and always take 1/2 gravol and then Imitrex, which helps with the nausea.

Elli

Try orange juice.
 

I get hasseled by these headaches and migraines quite a bit.
Everytime I fly I always bring with me tablets, but once I forgot them and I got one killer headache. The cabin crew gave me lots of orange juice. Not the cheap stuff but real hearty with the pulp and everything. To my astonishment it really worked!! So give it a go in an emergency.

A few things to add. After years of suffering from migraines, my physician referred me to a neurologist who prescribed Imitrex. However, the neurologist advised me to try something before taking the injection: the second I felt a migraine developing, I should take Tylenol and Advil together. (Up until this point, I had relied only on Tylenol to combat the pain, and my migraines frequently developed into the full-scale darken the room, don't make a sound, nobody move, I'm in agony headache.) I was amazed at how effective the combination of the two drugs was in my case, and I never had to resort to taking the Imitrex.

The second point is that like a couple of other posters, my rate of migraines started to fall off in my early fifties. I'm 55 now and can thankfully say that I have had only one migraine in the last 12 months. There are some benefits to aging. :)

And finally, I don't recollect seeing a reference on this thread about whether a tendancy to migraines is hereditary. I know that in my case, my mother, and many in her family, suffered from migraines. My daughter does, although with less frequency than I did when her age.