Algem Hopkinson woke up on the day of her college graduation with a throbbing headache and wave of nausea.
With her family in attendance (including relatives who flew in from South America), she pushed herself to step across the stage at Auburn University for her graduate degree diploma.
But she couldn’t return to her seat.
“After I got my diploma, I walked right out of the building and my family met me outside,” said Hopkinson. “I couldn’t stay.”
The celebratory dinner was called off. No toasts, no cheers — not even a single photograph.
The crippling migraine forced Hopkinson to retreat into her pitch-black bedroom. Wearing ear plugs, and with an ice pack on her forehead, she sat up in bed and waited 12 hours for the agonizing pain to pass.
Migraines were nothing new for Hopkinson, 28, who had her first at 13. But over the years, they’ve developed from occasional to regular to what is now considered chronic. The migraines now strike at least 15 days a month.
She’s missed college classes, dinners with friends — even vacations.
But missing her August 2009 graduation for her graduate degree in counseling was hands down the worst.
“This degree meant so much to me not only because I worked hard but because I was sick [with migraines] the whole time,” said Hopkinson. “To finally finish was a relief and a triumph. And to not be able to celebrate it the way I wanted to celebrate — it was very sad for me.”
Resistant to treatment
Science long ago found a cure for the common headache. But migraines have remained stubbornly resistant to treatment, and even a detailed explanation of how and why they occur.
For years, doctors believed that blood flow changes caused them. But scientists have learned that the neurological and vascular changes associated with migraines are more complicated.
Outside stimuli cause nerve endings in the brain to become hypersensitive, leading to pain signals that fire in an endless loop deep inside the brain.
They are often accompanied by nausea, extreme sensitivity to light and odors. Visual disturbances called “auras” may precede the headache.
About one in eight Americans suffer from migraines. Women are three times more likely to get them than men.
Prescription drugs can help reduce the pain and lower the frequency of migraines. Some get relief from Botox injections. But science has not developed a cure.
An emerging shift in treatment places a greater emphasis on prevention. Newly updated guidelines, recently released by the American Academy of Neurology and the American Headache Society, suggest preventative medicines could lead to fewer, less severe migraines.
Not everyone needs preventative medicine. But nearly 40 percent of migraine sufferers have headaches that are so frequent (at least once a week) that they could be good candidates for preventative measures, according to Dr. Stephen Silberstein, a neurologist and author of the guidelines.
Unlike acute treatments, used to relieve the pain of an attack, preventive treatments are usually taken every day to stave off attacks from developing as often, and to lessen their severity and duration.
The guidelines list a handful of prescription medicines including an anti-seizure drug, divalproex sodium, and a beta-blocker medication, metoprolol, along with the herbal remedy butterbur. The list also includes over-the-counter medications such as ibuprofen, naproxen and vitamin supplements.
Getting people to take medication to prevent migraines, however, is a challenge. Doctors say it’s hard to persuade people to take drugs on days they feel fine. Other migraine sufferers have not been properly diagnosed or they can’t stomach the side effects, which can include nausea, weight gain and difficulty concentrating.
And while Silberstein said he wouldn’t recommend many of the preventative medications be taken on a daily basis, it might make sense for a woman to take ibuprofen while she’s menstruating.
He’d likely recommend herbal remedies such as Vitamin B2 every day. (It’s important, he noted, to discuss any new drug regimen with your doctor.)
“Don’t give up,” said Silberstein. “There are drugs you can try and if one doesn’t work, there are others you can try. You don’t have to suffer.”
Finding treatment and ways to head off migraines is critical because doctors say the more migraines you have, the more vulnerable you are to more. A person who has occasional migraines faces a greater risk of developing “episodic” migraines (six to nine per month), which can develop into chronic migraines — 15 or more a month.
“Migraines beget migraines,” said Dr. Robert Gilbert, a neurologist at Peachtree Neurological Clinic on the campus of Piedmont Hospital.
Gilbert instructs patients with migraines to keep a diary to identify triggers such as hormonal changes, stress, poor sleep and certain drinks and foods like red wine and artificial sweeteners.
Behavioral changes, such as practiced relaxation, exercise and sleep, can help avert headaches, he said. Regular meals and avoiding bright lights and sounds can also help stymie migraines, he said.
Waiting for relief
For Hopkinson, it starts with a pull near the right eye, and a pulsating pain. She gets an “aura” or flash of light before the migraine is full-blown.
“When it’s like that, I need to put my ear plugs in and call it a day,” said Hopkinson.
Sometimes, she feels better in four hours. Other times, it takes 12 hours — or even up to three days to feel better.
Waiting for relief is a grueling exercise in patience. It’s not easy to simply rest — and not do anything else — when your body is not tired. But to fret about resting would only make matters worse.
Hopkinson turns to prayer and reassuring thoughts. She takes deep breaths and meditates.
She has modified her home in Fairburn to eliminate things that can set off migraines. Lamps with four bulbs are lit by just one bulb; she opens windows when cooking to avoid feeling queasy.
Hopkinson has taken a break from medication, and she believes vitamin supplements, yoga and meditation are helping more.
“It doesn’t make the pain go away but it helps me better deal with it and function,” she said.
Hopkinson, who works as a therapist, said she can some times push through the pain.
She said she sets her own hours and schedules her therapy sessions after lunch when she feels the best.
She believes her work as a therapist has helped her grapple with living with debilitating pain.
“Maybe because I work in a field of people with a lot of issues, I am used to encouraging people to try and focus on the positives instead of the negatives. I have to work therapy on myself,” she said.
She added: “This is something I don’t have a lot of control over. I don’t know when it’s going to strike or how long it’s going to last. But I can control how I am going to respond. ...
“I wasn’t always like this. I used to have months of sadness because I couldn’t do things like be a bridesmaid because I wasn’t sure how I would feel on that day. I would be so afraid that I might have to cancel and feel so guilty, I wouldn’t commit to things. But I don’t have as much anxiety about what’s going to happen next. I go ahead and commit and hope for things to work out.”
Second chance
Two and a half years after her graduation from Auburn, she got to redo a day she thought was gone forever.
At the Peachtree Club, with a skyline view and surrounded by Auburn orange calla lilies, Hopkinson recently got a second chance to celebrate her college achievement.
Wearing a graduation cap and surrounded by family and friends, Hopkinson smiled for the camera.
Hopkinson won an essay contest called “Rewrite your Day,” sponsored by the National Headache Foundation, Allergan drug company and HealthyWomen, a leading, nonprofit information site for women.
The evening included framed menus in Auburn’s orange and blue, along with individual place cards shaped like graduation caps. The private room was filled with laughter. And lots of picture-taking.
“For people who suffer migraines, there’s always those days you wish you could redo. This was mine,” said Hopkinson. “It’s the graduation party I always dreamed of. This is something I’ll still be talking about 20 years from now.”
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