How to treat migraines caused by circadian rhythm disruption?

Question

Hello doctor,

I have been suffering from these debilitating migraines for over a year now. I am 33, working night shifts, and they are becoming more frequent and severe. The pain starts with flashing lights in my peripheral vision, followed by a crushing pressure behind my right eye that makes me nauseous. I have thrown up during shifts twice this month.

Lately, I have noticed that my right arm goes numb, and I slur my words during attacks. My coworkers even thought I was having a stroke last week. Imitrex used to work, but now it barely takes the edge off. My neurologist suggested Botox, but my insurance denied it without requiring me to try three more preventatives first. I have already tried two that gave me terrible side effects.

The worst part is that I can not even predict when they will hit. Could these be something more serious than migraines? Is there anything that actually works?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I am sorry to hear about your struggles.

Working night shifts increases the risk of migraine attacks due to a disrupted circadian rhythm and improper dietary habits. Your role as a night-shift worker is both demanding and exhausting. The first thing you should know is that you should avoid working night shifts continuously for more than two to three months. It is essential to incorporate day shifts as well, keeping your long-term health and well-being in mind. It is crucial to plan our careers in a way that sustains our health. Otherwise, burnout in the profession can come at a heavy cost.

In your case, aside from diagnosing migraines, did your neurologist screen you for the following?

A possible old or new hematoma in the brain or any abnormal growth? Was a CT (computed tomography) or MRI (magnetic resonance imaging) scan performed?
Given that your schedule is not aligned with natural sunlight, were your vitamin D levels checked?
How is your digestion, and do you have regular bowel movements? (This is another crucial aspect of migraines. Addressing digestive health could help alleviate your headaches if no neurological causes are found).

Botox is a viable option, but it is important to first rule out all possible causes. Once cleared, focus on restoring your circadian rhythm and improving gut health.

I hope this helps you.

Thank you.