Anatomy of a Bad Day! ER and then Nortriptyline

Like a sink that eventually rebels from too much hair, toothpaste and makeup, sometimes triggers just back-up on you. You can be feeling pretty good for awhile (I have been off all serious medication for 10 months) and so of course you start venturing out from your semi dark and motionless cocoon and innocently begin stimulating those nerves in your sensitive head. I have been on the Migraine Diet, hydrating well and sleeping about 7.5 hours a night. I try to reduce my daily eye motion and protect myself from glare when I can.

But this week I fell off the wagon. Let me begin by saying that summers have historically been bad for me. The only times that I end up in the ER is during the hot summer months ( July '08, July '14 and this time in late September '15 - we are having a record setting long and hot summer in Southern California).

This past week I did some early morning pruning for three days (about 1.5 hours each day), I went to a movie and then out to eat with friends (ate a simple grilled chicken sandwich without the bun). The restaurant was noisy. I was getting ready at home for my son and his girlfriend to visit. So, lots and lots of eye motion and light and noise and increased activity. My eyes were sore and felt strained. I noticed my hot flashes were back. Then I had a thin slice of Trader Joe’s Rosemary (no nitrate) ham and some mozzarella cheese and some chocolate. By Wednesday my vertigo was back and worse when I tried to close my eyes - so I could not rest. Nystagmus was going strong to the left. Objects on a table appeared to be moving to the left. My balance was off and my right ear felt quite full. Taking Advil did not help. I was nauseous - and worse.

Since I could not solve this problem myself, I went to the local PromptCare where they gave me a shot of Zofran which did not help. After 1.5 hours and no improvement I went to the ER at a local hospital, vomiting all the way. They gave me an IV for fluids, more Zofran and 50 mgs of Meclizine. Finally I was given 2.5 mgs of Valium and that did the trick. I went home at 11:00 pm.

Thursday I awoke with a headache, I slept a lot and called my doctor to ask if I should go back on Nortriptyline for a while. Friday I took 2.5 mgs of Valium because I was having symptoms again. I confirmed that Valium gives me a headache. (I am one of the migraineurs who does not get headaches, just severe Vertigo and the other symptoms). I still have not heard from my doctor.

Saturday I skipped the Valium and just took Advil. That night I started 25 mgs of Nortriptyline and so far today, Sunday, I feel much better. I am fairly sure my doctor, when he calls, will recommend I go back on it for at least 10 weeks. It works faster when you are already on the diet and avoiding triggers. Although it is difficult to reduce unavoidable triggers like head and eye movements, I do promise to never again eat TJ Rosemary no nitrate ham or prune in the heat or try to walk 5 days a week (45 minutes each). And it may be that in the heat and glare of summer, triggers are more cumulative and unavoidable. I am convinced that following the diet and trigger reduction does lesson the amount of really bad episodes that I will have and helps me get back on track faster. I am happy that I know Nortriptyline helps me, for now. Perhaps these summer hot flashes are the straw that breaks the camel’s back. They can’t go on forever, can they? And my doctor has to call me back, right? This is a follow-up to “A Success Story ?- Hmmm”