I am 33, a musician. Why are my migraines getting worse?

Hi,

Welcome to icliniq.com.

I can understand your concern.

I am sorry you are dealing with such a challenging and debilitating condition, especially with the demands of your profession. Migraines, particularly with the symptoms you are describing (visual disturbances, sound sensitivity, and nausea), can be incredibly disruptive, both physically and mentally.

The symptoms you are experiencing are likely tied to a more severe form of migraine called migraine with aura, and the worsening of your condition suggests you may need to reassess your treatment options with a healthcare professional who can approach your case from a fresh perspective.

Here are a few things that may help guide you toward relief:

• Comprehensive Neurological Evaluation: Given the intensity and progression of your symptoms, I would strongly suggest seeing a neurologist who specializes in migraine treatment. Sometimes, medications that were once effective lose their power over time, or other underlying conditions can make migraines worse. It might also be useful to get a brain scan to rule out any other conditions that might be contributing to the symptoms.

• Migraines and Triggers: Lighting and sound sensitivity are common migraine triggers, and in your case, the combination of bright lights and high-pitched instruments may be exacerbating your symptoms. Consider wearing sunglasses with specific lenses for migraines or reducing overhead lighting during rehearsals. It might also be worthwhile to explore biofeedback or neurostimulation devices, which could help with symptom prevention or reduction.

• Non-medication Treatments: Some people with chronic migraines benefit from cognitive behavioral therapy (CBT). It helps manage stress, anxiety, and the psychological aspects of pain. Acupuncture is a treatment that some people find helpful in reducing migraine frequency and intensity. It may help reduce your overall migraine burden, particularly if medication is not effective.

• Medication Adjustments: If your current abortive medications are not working (like Triptans), your doctor might try different options or higher doses to tackle the attacks when they begin.

• Preventive Treatments: If the attacks are frequent, there are newer preventive medications like CGRP (calcitonin gene-related peptide inhibitors, for example, Aimovig (Erenumab) and Emgality (Galcanezumab), that have shown great promise in people who do not respond well to older treatments.

• Botox Injections: In some cases, Botox has been FDA-approved for chronic migraines, especially when they occur frequently (more than 15 days per month). It might be something worth discussing with your doctor.

• Diet and Lifestyle Modifications: Try to track your diet and hydration. Certain foods (like chocolate, caffeine, alcohol, or aged cheeses) can be migraine triggers. Staying hydrated and maintaining a regular sleep schedule can also make a huge difference. Consider stress management techniques like meditation or yoga that could help you stay grounded and calm, especially with the pressure of performing in front of an audience.

• Adjusting Your Conducting Environment: I understand the need for precision when it comes to your performances, but it might help to talk to your team and see if there are ways to modify your conducting environment to lessen triggers (whether it is using dimmer lighting, lowering volume levels in rehearsals, or even incorporating more breaks for your health).

You must seek a second opinion from a specialist, particularly if your current treatment is no longer providing relief. A new perspective may open up new treatment options that better address your symptoms.

While I cannot promise instant solutions, there is hope for better management. A combination of tailored medication, lifestyle changes, and alternative therapies can help you regain control over your migraines. It is definitely worth having an open conversation with your healthcare provider to find a comprehensive treatment plan that works for you, particularly with such an important performance coming up.

I hope you feel better soon.

Feel free to follow up with any further questions or concerns.

Thank you.