Persistence and Personalized Care Help Beat Chronic Migraines
Kate Ceballos, RN, started her nursing career working the night shift. She learned to manage an irregular sleep schedule and coped well for five years. Even her migraine headaches, which she’d had off and on since college, were mostly infrequent and responded to medication. Until they didn’t.
“My migraines had become more frequent and severe,” remembers Kate. “I’d get the throbbing pain, sensitivity to light, nausea and vomiting. As a nurse I thought this is just a little discomfort, compared to what my patients are going through. I can stand this.”
Kate’s primary care doctor prescribed a beta blocker, a drug that affects blood pressure, to help prevent the more than 15 migraines Kate now battled every month. But having naturally low blood pressure meant the drug would often leave her lightheaded, a condition that threatened to make Kate the patient. Not being there for her actual patients wasn’t an option.
Kate made an appointment with Virginia Mason’s Neuroscience Institute. With expertise in headache and migraine management, the institute’s care team emphasizes education and creating a close partnership with patients. Kate saw Sarah Hermanson, ARNP, who helped Kate understand migraine treatment as a marathon, not a sprint — finding the right therapy would mean enduring some trial and error. She was started on a new preventive medicine while learning new habits for managing her chronic condition: prioritizing sleep, staying hydrated, eating consistent meals and snacks, managing stress and staying physically active.
“Migraines can present differently and each person needs their own unique treatment plan,” says Sarah. “Medications have an important role, as does addressing lifestyle factors. We help patients understand why they are having migraines and then develop a plan for what to do.”
“When I came in after using the CPAP and I told her it was working, she was overjoyed for me. We celebrated my success together.”
Kate kept a detailed worksheet rating the different therapies tried, noting what did and didn’t work. Sometimes what didn’t work was a medication’s side effects. One made Kate’s emotions erratic, and her hands so tingly she struggled to braid her young daughter’s hair. After failing three classes of migraine medications, Sarah made a suggestion: Botox injections. Botox uses a form of botulinum toxin to temporarily paralyze muscle activity. Better known for its ability to reduce facial wrinkles, Botox’s action also helps prevent migraines in some people.
“I was set against having Botox,” says Kate. “First, it’s a toxin going in my body. And it seemed like such an extreme therapy when I didn’t view myself as that sick. I credit Sarah for respectfully meeting me where I was while keeping the option open.”
It was a nursing colleague’s encouragement — insisting a better life was worth the treatment — that helped Kate agree to Botox. It was Sarah’s careful documentation of Kate’s symptoms and failed drug regimens that got the treatment approved with insurance. Kate took a series of 40 small Botox injections in her neck, jaw and forehead, to be repeated in three months.
While the effect wasn’t immediate, over time Kate noticed her migraines had reduced by close to half. It felt like a win, down to a handful of migraines a month, but Sarah had one more treatment avenue in mind. Because sleep problems are a potential migraine culprit, the neurology care team recommends some migraine patients have a sleep study. Kate’s study results were a turning point: Due to irregular breathing while asleep, she learned she was briefly “waking” up to 27 times per hour. Kate was prescribed a continuous positive airway pressure machine, or CPAP, to regulate her breathing and boost sleep quality.
With Sarah’s guidance and access to the latest evidence-based migraine treatments, Kate’s arsenal of prevention strategies are greatly improving her life and work. Using Botox, the CPAP and a “rescue” medicine when needed all contribute to a new sense of control over a debilitating condition.
“Sarah was completely invested as my partner in the care process,” says Kate. “When I came in after using the CPAP and I told her it was working, she was overjoyed for me. We celebrated my success together.”More Stories