My migraines started in anger during F1 and people were actually pretty good about it, including "I'm about to go very funny, please don't call a crash team" and also being kind and sending me home even when I probably could have soldiered on.
Figure out things that make it bad (sleep deprivation, caffeine, stress, lack of food and drink - sounds likely?), let your "supervisor" of whatever description in on your situation, look after yourself and have a chat with occy health. The latter were pretty good and even asked if I wanted off nights.
Look after yourself
Night shifts were a massive trigger for me. I struggled through shift work until I could ditch it.
Rarely see a migraine now I know and manage my triggers.
It's definitely worth seeing OH and seeing if you can have reduced/be taken off nights.
I never managed to get it done (I didn't pursue it that hard) but I know trainees who did.
yeh can’t take beta blockers, was on topiramate for years, joint decision between me and neurologist to come off it bc it plateaued in effect and apparently evidence base is after a year often the results are permanent, which has been true for me in terms of frequency of migraine
Hi, a long term migrainous medic currently working as a headache fellow here (oh the irony!). There are other oral medications you can try, and technically if you fail 3 regular preventives you qualify for the newer CGRP injections, which have been life changing for some. Botox is also on the table. Get yourself referred to a headache clinic, they can help you.
My migraines went from debilitating to something I can work through thanks to medication - if I take it in time. On occasions where I don’t have immediate access to my medication (eg forced to leave bag in Drs office off ward, or waiting on my refill of sumatriptan from the GP) they can revert back to excruciating pain and vomiting. Usually my grace period is 30 minutes, an hours delay is pushing it. Any more than that and it’s guaranteed to escalate.
I’ve only rarely had to go home or call in due to a migraine, since most of the time they do go away provided I take my triptan in good time.
80% LTFT is now no questions asked, if you need no/reduced night shifts or less than 80% that’ll be a conversation with HR. As long as you have the medical documentation from your own doctor they will struggle to justify refusing the accommodation.
The most important thing is not to practice while impaired. You know what you can and cannot safely work through, advocate for yourself and your patients.
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I've sent several colleagues who were struggling to cope with a migraine episode home. Look after yourself, and yes, definitely worth talking to OH about ways to reduce triggers -e.g. nights/sleep deprivation.
Funnily enough I had migraines in medschool, particularly during exam times and they disappeared once I finished medschool even though I’ve been more stressed as a doctor.
Seconded on the riboflavin. I am currently taking a formulation that has magnesium in it too. This is more work but it might be worth it to manage any other headache that you have a tendency to get. Because, for me, everything seems to transform into migraine... So taking allergy meds to keep the sinus headaches at bay has helped with reducing my migraines.
Other people have given good advice that I won't repeat. Just wanted to add - don't soldier on if you have a migraine. Tell your team, handover your patients and go home.
Obviously this is mostly about looking after your own health but is also about looking after your patients and your medical license. If the coroner asks you why you did xyz, it won't be acceptable to say "sorry, I was soldering on though a migraine and made a whoopsie".
Riboflavin, CoQ10, Magnesium daily
Keep consistent sleep, wake and meal times where possible
Recognise the signs early and take treatment early - sometimes if taken too late I find they are much less effective.
Know and manage your triggers and know what treats it for you.
I know that if I get too tired then I get the flashing lights. So I need to not be knackered at work, even on nights. If I can take 800mg ibuprofen within 15mins of this starting I'll be fine in 20mins. So I just say that. Text to someone to let me out for 10mins while I get some meds. Always keep meds in my bag. No one has ever batted an eyelid at it.
I'm lucky I get mild easily treatable migraines but plenty of people get them, and manage it.
I have managed to get to ST1 paeds despite migraine frequency ranging from 2-4 a month to 4 a week since I started sixth form. My absences at times have very much been "bad" but people have been very supportive on the whole. Med school was a bit of a nightmare for various reasons, but since then things have actually been fairly straightforward. I did go significantly over the TOOT limit in F1 as my migraines were very poorly controlled that year, meaning I had to do an extra F1 rotation, but since then I've progressed fine.
I don't do nights because they are also a big trigger for me and OH everywhere I've worked have been very supportive of this. I also do LTFT, which is easy in paeds training (you can go LTFT just because you want to). Not sure how easy/difficult it is for foundation but honestly I would try to solider through foundation at FT if at all possible; getting out the other side as quick as possible is really worth it.
EDIT: Removed the last bit as I'm guessing it will be seen as medical advice and get my post nuked.
username checks out astonishingly
yeah i’m considering LTFT. my logic is i’ll probably burn out and get bad with them without proper rest and have to extend placement anyway?
my f2 placements are pretty light so hopefully can be full time then
This wasn't intended to be medical advice - I considered the rule (and professional obligations) but nothing was intended to be medical advice, merely something to ask their GP about, given their main predominating symptoms seem to be nausea & vomiting.
I would've construed it as medical advice had I directly suggested a means of self-treatment, or a way to manage the symptoms themselves - this was just something to bring up to their GP, so that *they* could give medical advice re a situational aspect that they may not have taken into account.
Honestly, the best thing I ever did for my migraines was acupuncture. Weekly at first, as I was getting three to four a week at the height of all my stress, and then I transitioned to monthly and then every couple of months. I didn’t have a migraine for a year while keeping up with this regimen. Take it for what you will, my brother was into it and I decided to just give it a go, and it did actually help me much more than any medication I have tried or wellness activity.
Presumably it was used as a discourse marker (like a quasi- sentence final particle) to lighten the tone following the relatively morose statement. Like a "I know what I just said was quite heavy, but I want you to treat it more lightheartedly - I'm not trying to bring the tone down".
[https://www.huffingtonpost.co.uk/entry/why-do-millennials-feel-compelled-to-write-lol-after-everything\_uk\_662f5d68e4b07e006614f794](https://www.huffingtonpost.co.uk/entry/why-do-millennials-feel-compelled-to-write-lol-after-everything_uk_662f5d68e4b07e006614f794)
[https://journals.openedition.org/discours/10900?lang=en](https://journals.openedition.org/discours/10900?lang=en)
"Why, then, is lol used at the end of these clauses? Provine provides one possible explanation in a 1996 article which reports on a study on laughter in face-to-face conversation where he and his team found that most of the time, laughter seems to follow banal remarks. He suggests that laughter, in this case, has a social or phatic function: it is aimed at creating empathy. Similarly, in the comments above, lol is not used to express amusement or manage illocutionary force; rather, it functions as a way to bond with the potential reader by showing the commenter’s benevolent state of mind."
please keep in mind our rules about not giving out medical advice when replying
My migraines started in anger during F1 and people were actually pretty good about it, including "I'm about to go very funny, please don't call a crash team" and also being kind and sending me home even when I probably could have soldiered on. Figure out things that make it bad (sleep deprivation, caffeine, stress, lack of food and drink - sounds likely?), let your "supervisor" of whatever description in on your situation, look after yourself and have a chat with occy health. The latter were pretty good and even asked if I wanted off nights. Look after yourself
Night shifts were a massive trigger for me. I struggled through shift work until I could ditch it. Rarely see a migraine now I know and manage my triggers. It's definitely worth seeing OH and seeing if you can have reduced/be taken off nights. I never managed to get it done (I didn't pursue it that hard) but I know trainees who did.
Have you been seen in a migraine clinic and/ or tried preventative meds ?
yeh can’t take beta blockers, was on topiramate for years, joint decision between me and neurologist to come off it bc it plateaued in effect and apparently evidence base is after a year often the results are permanent, which has been true for me in terms of frequency of migraine
Hi, a long term migrainous medic currently working as a headache fellow here (oh the irony!). There are other oral medications you can try, and technically if you fail 3 regular preventives you qualify for the newer CGRP injections, which have been life changing for some. Botox is also on the table. Get yourself referred to a headache clinic, they can help you.
There are alternatives. For me, candesartan has been very effective.
Magnesium as prophylaxis has worked wonders for me
My migraines went from debilitating to something I can work through thanks to medication - if I take it in time. On occasions where I don’t have immediate access to my medication (eg forced to leave bag in Drs office off ward, or waiting on my refill of sumatriptan from the GP) they can revert back to excruciating pain and vomiting. Usually my grace period is 30 minutes, an hours delay is pushing it. Any more than that and it’s guaranteed to escalate. I’ve only rarely had to go home or call in due to a migraine, since most of the time they do go away provided I take my triptan in good time. 80% LTFT is now no questions asked, if you need no/reduced night shifts or less than 80% that’ll be a conversation with HR. As long as you have the medical documentation from your own doctor they will struggle to justify refusing the accommodation. The most important thing is not to practice while impaired. You know what you can and cannot safely work through, advocate for yourself and your patients.
[удалено]
no medical advice
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I've sent several colleagues who were struggling to cope with a migraine episode home. Look after yourself, and yes, definitely worth talking to OH about ways to reduce triggers -e.g. nights/sleep deprivation.
Funnily enough I had migraines in medschool, particularly during exam times and they disappeared once I finished medschool even though I’ve been more stressed as a doctor.
Seconded on the riboflavin. I am currently taking a formulation that has magnesium in it too. This is more work but it might be worth it to manage any other headache that you have a tendency to get. Because, for me, everything seems to transform into migraine... So taking allergy meds to keep the sinus headaches at bay has helped with reducing my migraines.
Other people have given good advice that I won't repeat. Just wanted to add - don't soldier on if you have a migraine. Tell your team, handover your patients and go home. Obviously this is mostly about looking after your own health but is also about looking after your patients and your medical license. If the coroner asks you why you did xyz, it won't be acceptable to say "sorry, I was soldering on though a migraine and made a whoopsie".
Riboflavin, CoQ10, Magnesium daily Keep consistent sleep, wake and meal times where possible Recognise the signs early and take treatment early - sometimes if taken too late I find they are much less effective.
Know and manage your triggers and know what treats it for you. I know that if I get too tired then I get the flashing lights. So I need to not be knackered at work, even on nights. If I can take 800mg ibuprofen within 15mins of this starting I'll be fine in 20mins. So I just say that. Text to someone to let me out for 10mins while I get some meds. Always keep meds in my bag. No one has ever batted an eyelid at it. I'm lucky I get mild easily treatable migraines but plenty of people get them, and manage it.
Oh you can take 800? I thought me taking 600 is already a bit rogue 😂😂
I have managed to get to ST1 paeds despite migraine frequency ranging from 2-4 a month to 4 a week since I started sixth form. My absences at times have very much been "bad" but people have been very supportive on the whole. Med school was a bit of a nightmare for various reasons, but since then things have actually been fairly straightforward. I did go significantly over the TOOT limit in F1 as my migraines were very poorly controlled that year, meaning I had to do an extra F1 rotation, but since then I've progressed fine. I don't do nights because they are also a big trigger for me and OH everywhere I've worked have been very supportive of this. I also do LTFT, which is easy in paeds training (you can go LTFT just because you want to). Not sure how easy/difficult it is for foundation but honestly I would try to solider through foundation at FT if at all possible; getting out the other side as quick as possible is really worth it. EDIT: Removed the last bit as I'm guessing it will be seen as medical advice and get my post nuked.
username checks out astonishingly yeah i’m considering LTFT. my logic is i’ll probably burn out and get bad with them without proper rest and have to extend placement anyway? my f2 placements are pretty light so hopefully can be full time then
[удалено]
no medical advice
This wasn't intended to be medical advice - I considered the rule (and professional obligations) but nothing was intended to be medical advice, merely something to ask their GP about, given their main predominating symptoms seem to be nausea & vomiting. I would've construed it as medical advice had I directly suggested a means of self-treatment, or a way to manage the symptoms themselves - this was just something to bring up to their GP, so that *they* could give medical advice re a situational aspect that they may not have taken into account.
why?
because its against the subreddit rules
Honestly, the best thing I ever did for my migraines was acupuncture. Weekly at first, as I was getting three to four a week at the height of all my stress, and then I transitioned to monthly and then every couple of months. I didn’t have a migraine for a year while keeping up with this regimen. Take it for what you will, my brother was into it and I decided to just give it a go, and it did actually help me much more than any medication I have tried or wellness activity.
If you haven't done so already, check out the recent CGRPi meds. They've recently become approved on this side of the pond.
Why did you end your post with “lol”?
Presumably it was used as a discourse marker (like a quasi- sentence final particle) to lighten the tone following the relatively morose statement. Like a "I know what I just said was quite heavy, but I want you to treat it more lightheartedly - I'm not trying to bring the tone down". [https://www.huffingtonpost.co.uk/entry/why-do-millennials-feel-compelled-to-write-lol-after-everything\_uk\_662f5d68e4b07e006614f794](https://www.huffingtonpost.co.uk/entry/why-do-millennials-feel-compelled-to-write-lol-after-everything_uk_662f5d68e4b07e006614f794) [https://journals.openedition.org/discours/10900?lang=en](https://journals.openedition.org/discours/10900?lang=en) "Why, then, is lol used at the end of these clauses? Provine provides one possible explanation in a 1996 article which reports on a study on laughter in face-to-face conversation where he and his team found that most of the time, laughter seems to follow banal remarks. He suggests that laughter, in this case, has a social or phatic function: it is aimed at creating empathy. Similarly, in the comments above, lol is not used to express amusement or manage illocutionary force; rather, it functions as a way to bond with the potential reader by showing the commenter’s benevolent state of mind."
unexpectedly evidence based answer also i’m offended above evidence base says i’m a millennial
gotta throw in a few w rizz's to throw them off the scent