I'd like advice from LW regarding migraines

Upvoted to encourage more people to ask LW for help in this way, which I think is good trend. But I would suggest a title that describes more specifically what the post is about (i.e. "LW, help me with my migraines" or something).

I have no advice on the migraines themselves but I wish you luck.

If you want conventional advice, I guess the best thing is just to follow what your doctor says.

If you want experimental advice, I went to a talk on rational drug policy, at which it was mentioned that 5-HT2A agonists, aka psychedelic drugs, stop migraines. The theoretical neuroscience behind it checks out too (modulating vasoconstriction).

See this:

http://www.nature.com/news/2006/060911/full/news060911-05.html https://www.erowid.org/plants/mushrooms/mushrooms_article8.pdf

Where cluster headaches are discussed, but cluster headaches and migranes are very similar in terms of treatment.

This might work prophylactically, and might work at dosages below concious perception of mind altering effects, depending from person to person.

Unfortunately I don't see this becoming prescription medicine any time soon, due to the problem that someone could claim to have migraines, and there are not objective symptoms. I don't know your opinions on legality, or what the law is like where you live, but there are also so-called 'legal highs'.

Otherwise, apparently diet works very well, but you have to be extreme about it. Something along the lines of cut out everything except one meat, one vegetable and one fruit, and then if that works add foods back in one at a time.

Transcranial magnetic stimulation is also being tested at some places with promising results, if you want to be on the cutting edge.

I've also tried taking magnesium supplements, but they had a negative effect on me i.e. strange dreams and lack of sleep.

There are far worse side-effects than strange dreams.

I have migraines too, so this is something I am knowledgeable about and interested in discussing. I can stop them using beta blockers, but I'd rather not have to take drugs everyday.

A few years ago I suffered from an extremely severe case of repetitive strain injury/tendinitis. (As far as I can tell, attempts by medical professionals to come up with careful definitions for those terms have mostly failed, so I use them interchangeably.) My case was more severe than almost any I have ever heard about—I was stuck controlling my computer using a voice recognition system for over a year and spent all of my time being unemployed, depressed, and living with my parents. What finally solved my problem was information about trigger points found in this book and this ebook. I actually purchased the first book relatively early on in my condition, because I wanted to try everything, but I was convinced it was pseudoscience and put it down after only a couple minutes of reading. It was only the skeptical tone and citations in the second ebook that convinced me trigger points were a thing. Since my experience, I’ve talked to other people with chronic RSI, mostly within the Less Wrong community, and my current guess is that trigger points are responsible for most chronic RSIs, as well as a wide variety of chronic pain problems that science currently isn’t very good at treating (the same trigger point therapy that was useful for my tendinitis was also very useful for my chronic knee pain, stomach pain, and back pain).

I mention this because the first book I linked to cites trigger points as a possible cause of migraines. I recommend searching for migraine info using the index. There’s also this web page by the author of the second ebook.

If trigger points are a significant factor in your migraines, I expect that you will find the right massage therapy or acupuncture treatments helpful, and in the best case they will clear your condition up entirely with clever and diligent application, although they will aggravate your condition a bit initially (for maybe a couple days after treatment; this is discussed more in the resources I pointed you to). (This great textbook explains how acupuncture works.)

(Unfortunately my latest chronic pain condition is eyestrain, which is not capitulating as easy as the previous ones; the muscles in my eyes are not accessible for massage the way most of the muscles in my body are. I’ve been doing self-acupuncture (after reading lots of safety information) to try to relax the smooth muscle tissue innervated by both my eyes and areas accessible to a needle (it’d be really spiffy if I could talk to someone who has expertise in neuroanatomy) and it seems helpful but it hasn’t been a slam dunk. Wrote this post mostly using a screen reader so I wouldn’t have to look at my screen very much.)

If you searching general things to try, curetogether is good website. It provides a list of 237 Migraine interventions and self reported effects of those interventions.

The strongest recommendation seems to be for "Dark Room and No Noise" and "Sleep".

I would seek a 100% dark room when you sleep. Seek to get a regular schedule with 8 hours of sleep where you go to bed every day at the same time.

Floating tanks are worth trying.

I would use good noise cancellation headphones plus guided relaxation/hypnosis recordings to fight cases of headaches in real time when I can't do anything else anyway.

I expect hypnosis to be helpful based as a prior and quick googling finds a peer-reviewed review that suggests it's helpful.

I suffered from severe migraines for most of my life, but they were much more frequent when I was younger -- about two or three times a week. During high school they decreased in frequency a lot, to maybe once a month or once every two months, and now that I am in my late '20s, I only get migraines once or twice a year. Unfortunately I can't give you much rationalist advice; although I discussed migraines with my doctor and we worked together to find a solution, to my understanding it's still not a scientifically well-understood problem. So all I can tell you is what I've found worked for me.

My symptoms were usually a severe throbbing pain around my head somewhere between my eyes and ears, light and sound sensitivity, nausea, and a strange kind of dizziness. Reorienting my head would affect the pain a lot, and so during a migraine I usually end up with my head tilted to one side.

I couldn't find any good way to rid myself of a migraine once it had started, but Advil worked well for dulling the pain, after about 15 minutes. I'd just lie in a dark room until it passed, which sometimess took up to an hour.

Preventative measures worked the best.. I did learn some warning signs (well, feelings that are a bit hard to put into words) that a migraine might be impending, and after I noticed them I would try to remove myself to a quiet, low-stimulation environment, and make sure that I was well-hydrated and calm. That would often help avoid the migraine becoming severe. I found that migraines were always much, much worse when I was dehydrated, which as it happens is an easy condition not to notice.

I don't know exactly what has caused the large reduction in frequency of attacks for me, although I'm thankful for it. It could just be that my body grew and changed and now I don't get them as much. It also could be dietary changes -- I used to eat very different foods when I was a kid than I do now, including a lot of instant ramen noodles and other salty foods, and candy, whereas now I keep a much healthier diet. I cut out the ramen noodles at my doctor's suggestion that MSG might be a trigger, and that was definitely correlated with a major decrease in occurrence frequency, but it wasn't a controlled experiment and I changed a lot of other things too. I wouldn't be surprised if the dietary changes helped, but it's hard to be certain.

Good luck. Migraines are bad, bad, bad and I hope you can get rid of them.

*Edit: By the way, have you been to an optometrist lately? It might be that you are suffering from low-level eye strain and are in need of glasses.

Here's what's helped for me. I had strong headaches that would persist for weeks, with some auras, which my doctor called migraines. (They don't seem to be as bad as what people usually mean by the word.) A flaxseed oil supplement keeps them away. When I don't take enough, they come back; it needs to be at least 15g/day or so (many times more than the 2-3 gelcaps/day that supplement bottles direct you to take). I've taken fish oil occasionally instead.

I found this by (non-blinded) experimenting with different allegedly anti-inflammatory supplements. I'm not a doctor, etc.

I spent about a month a couple years ago having migraines, which I had never had before and inexplicably stopped having afterwards. I was prescribed a generic version of Fiorecet; you don't mention it or its unusual ingredient (butalbital; it also contains caffeine and acetaminophen). This worked almost completely if I managed to take the pill during my prodomal symptoms (weird visual aura, in my case; I don't know if you get this warning). However, even unmedicated my headaches did not last as long as it sounds like yours do. Apparently Fiorecet isn't customary for migraines, so you may not have tried it.

I also pestered my significant others for neck massages. I do this anyway but it was especially important when I had just had a migraine.

It seems to me that you've exhausted the traditional approaches to diagnosing and treating your issue, and that you're unlikely to stumble upon a solution yourself. My guess is that your best bet is to figure out who the real specialists are and see one.

I also suspect that there are a lot of tests that could be done that your doctors haven't ordered due to costs, and that would be useful. Depending on your financial situation and how much this means to you, perhaps you could make it clear to them that you would like more extensive testing and are willing to pay for it. Similarly, it might be worth paying them to tighten the feedback loop.

Normal doctors can often be incompetent. Example: I've been having problems with my achilles for over 6 months now. I've since consulted with a foot specialist, two general practitioners, and two physical therapists, none of whom offered me good advice. In doing some research online, I've come across a treatment that has been shown to be very effective and has a ton of studies supporting it. I had prodded all the doctors to tell me all of the treatment options available to me, and none of the mentioned this. Moral of the story is that sometimes there exist good options that your doctors don't know about. I had similar experiences with DSPS too.

Brainstorming

Normal Options:

1. Figure it out yourself.
2. Normal doctors.
3. Specialists.

Other options:

1. As Shminux mentions, "MetaMed used to offer custom medical research and advice, but they appear defunct." Too bad. Maybe similar services exist.
2. Come up with a better way to incentivize your doctors. Maybe you could figure out how to motivate them to actually brainstorm, do research, explore alternatives, quicken the feedback loop etc.
3. Look into what the available clinical trials are. Maybe reach out to Neurology departments at universities.
4. Use Amazon Mechanical Turk to pay people to research what your options are for you.
5. Perhaps there are some sort of organizations for people with migranes that you could reach out to.
6. Take the time to really educate yourself. There are different extremes to which you could take this ranging from "just read a handful of lit reviews" to "studying neurology more formally".

@Alicorn, have you managed to fix this problem yet?

I read that a while back and I've been thinking about it for a while. After reading the discussion post in this thread, I thought I'd post this suggestion since the community doesn't appear to have a consensus approach to the problem.

Alicorn, have you considered adding more dimensions than diet to your self-tracking? And @Algon, have you considered self-tracking. If I had migraines constantly, it would be well worth my time to figure out the problem. I've been brainstorming dimensions to assess over the last few days and came up with a spreadsheet. I've come up with the broadest possible set of dimensions. Realistically, it might be hard to enter in values into the sheet at regular intervals, but depending on how important this is to you I'd narrow the scope from all to some.

Right now the variables I have in it are:

Anxiety level Emotional state Energy level Thoughts People Temperature Mood Comfort Memories Sensations Awareness Attention Beliefs Time Visualisation Identity Sequence of introspection attribution style confidence self esteem empathy risk perception diet cognitive distortions exercise attachment style expectations subjective wellbeing rating personality arousal

If you have any mental disorder symptoms, I'd recommend adding a variable for that too. For instance: psychosis, or obsessive thoughts.

Now, the next step up would be to go from subjective ratings of these categories, to more 'objective' ratings. I don't know what literature exists on the execution of psychometric tests, so I'm going to assume its irrelevant and the formalisation of the occupation of psychometrics is more a protectionist measure than something inherently dire.

The way psychometricians make assessment of variables formal is to ask specific questions.

Does anyone know, re there question banks for psychometricians? Psychometrics is about assessing particular psychological variables through structures tests and interviews. With such a tool, psychometricians designing new scales, inventories and constructs can simply use that search engine to find relevant questions. I suppose the traditional way to do things is just to trawl through the literature for related domains and just to individually extract items. Say, a question that assesses mood in a depression inventory might be taken from a paper constructing the depression inventory then brought into a novel inventory along with other dimensions of interest from different inventories. However, I'm not a psychometrician and haven't read the seminal works in the field nor the textbooks, only Wikipedia, a couple of guides to parts of the field on university websites, and individual papers of interest. Can someone enlighten me?

Edit: Beware, rationalists. Quantified self seems like a good option only after exhausting population wide studies - which are the source of other people's recommendations here and in Alicorn's thread. Take quote Gwern:

Confirmation bias is an issue in self-experimentation/Quantified Self because one is already at a disadvantage in evaluating the results - humans don’t weigh them very well; satt points out that (via the Bienaymé formula) “An RCT with a sample size of e.g. 400 would still be 10 times better than 4 self-experiments by this metric.” If one encountered 4 immaculately run self-experiments, I suspect they would feel like more evidence than 1/10th that RCT. When you toss in any selection effects (due to confirmation bias), the value of those 4 trials plunges even further.

Fortunately, just as there is a somewhat easy way to test for status quo bias, there’s also a somewhat easy way to test for confirmation bias: simply present a high-quality result - with the reverse of the true outcome. Or present the initial data about the setup and whatnot, but hide the results. (The savvy will recognize this as similar to Robin Hanson’s proposal for result-blind peer review.) Or better yet, present the same study with both egosyntonic and egodystonic. If the subject rates them differently, well, the only varying factor was the outcome… (One of the tests on YourMorals.org does just this by rewording a ‘study’ on gun control.) This is a strategy similar but not identical to a Sokal affair, since the subjects in the Sokal affair could plausibly claim that they didn’t understand the pseudo-physics and were trusting the word of a physics & mathematics professor in good standing - in a confirmation bias test, the subject must understand the material and reject it because it conflicts with his prior beliefs.

things you could try altering: Sleep Sleep position/environment Light (exposure of your eyes to light) Food vitamins exercise Posture allergies (non-food, may include fibres, washing powder, local plants , anything that touches your skin i.e. Jewellery, skin-cream, toothpaste, dust, fungi, mould and bacteria)

Other misc: metal toxicity, check for lead in your environment/blood (kits can be purchased online) radiation inner-ear problems (causing potential dizzyness and leading to migranes)

Other other: Someone I knew had a 6 week long reccuring migrane, a doctor recommended taking the maximum safe doses of 3 different panadol (paracetamol), neurophen, aspirin, drugs at once (the ones that work with different mechanisms, I think it was those 3). She woke up in the morning and has been fine since (several years ago).

other other other: any epilepsy run in the family? some people grow out of them as they grow through their teenage years. Have you finished your growing?

Are you female? Then you could try going off the pill and use another form of contraception, or switch to another pill. Migraines can be hormone-related; I used to get them at ovulation and at the onset of menstruation, back when I still had those.

There is a particular weather pattern called the Chinook Wind that is sometimes a cause of migraines. nih.gov / Wikipedia. Strangest thing but peer reviewed and tentatively confirmed. Moving to a location without Chinook Winds might help. Or knowing they are coming might help one prepare.

Have you checked for allergies and food sensitivities? I used to know someone who would get migraines a few days after eating seafood.

Does alcohol have any effect? My girlfriend suffers from TMJ which causes her headaches and alcohol helps her jaw muscles relax.

MetaMed used to offer custom medical research and advice, but they appear defunct.