Lyrica

Went back to my neurologist again.  Had to schedule the appointment to get the Gabapentin refill, but it’s been a while since I’ve seen her and I’m 5 month post-op so it seems 15-20 headache days a month is going to be the standard. 
For someone who used to 30-31 headache days a month 20 feels like an improvement. 18 feels great and 15 feels like a new life! But it’s still too many. It’s still not normal. It’s still not ideal. 
I met with Dr Williams and she still has lots of ideas. How refreshing to be seeing a doctor for over 3 years and she’s still got plenty in her arsenal.
We were discussing what I have and haven’t tried and she asked, almost rhetorically, “And you’ve tried Lyrica?”  I said, “I haven’t.” She seemed a bit surprised. So I’m swapping out Gabapentin to try Lyrica. 
The effects? My sleep is better.  It's not nearly as difficult to come out of sleep on Lyrica then it was on Gabapentin.  But the headache frequency is the same.
We've known for a little while now that some of the headaches, or at least their severity, are effected by my menstrual cycle. Now that I'm closer to a 15 or so day headache month it's even more obvious that they are effected by my menstrual cycle so there has been some talk of stopping that.  Maybe that will be next on the list. 

4 Month Post Surgery

Month 4 had fewer debilitating migraines, but not fewer overall headaches.  One issue though was that I ran out of Gabapentin in the third week of January and so my quality and quantity of sleep really began to suffer.  And when I don’t get enough sleep or quality sleep, that’s a trigger.  Last weekend of the month I got back on it and started sleeping better immediately.  In a few days the headaches had calmed again. 

3 Month Post Surgery Update

Dr. Rose said that it would take between 1 and 3 months for me to notice a difference in the number of headaches.  Month 1 was bad, but I was trying to stay positive.  Month 2 I went from my usual 22+ days a month of headaches to only 15 days! But month 3 was back to 23 days with a headache.  Determined to still remain hopeful I decided to look at not just the frequency of headaches, but also the intensity.  While month 2 was again like most months pre-surgery, month 2 was an excellent month again and so was month 4.  I guess ultimately, the jury is still out.

Splints

One week post-op I go back to see Dr. Rose and I'm so excited to get the splints out of my nose!  I can't breathe with them in there and they are so uncomfortable.  Imagine the worst congestion ever and nothing relieves it and you can't blow your nose at all!

Dr. Rose informs me that the bone spur had torn some of the tissue inside my sinuses and he had to use some of the cartilage he removed during the septoplasty to repair the tear.  Because of this, the splints have to stay in an extra week.  I nearly cried.

I go back in two weeks post-op and finally get the suckers removed.  Dr. Rose said it would feel like he was pulling my brains out through my nose when he pulled the splints out and he wasn't kidding!

And look at the size of those things!  I don't think I realized there was that much room inside my nose.

But oh my goodness I can breathe!

Septoplasty

September 9, 2016 I had my septum corrected and the bone spur removed.  I read that the first 24 hours are the worst and I can attest to how true that is.  I was also told that I'd probably feel fine enough to go back to work after 3 or 4 days, but that most people don't because of the bruising.  Since my time of was going to be unpaid I planned to swallow my pride and return to work as soon as I felt well enough - bruises be damned.
I googled what the bruising would look like and when I could expect to return.  And then I waited for the bruises to come on.

Ok, so I'm sort of drugged Day 1, as you can clearly see.  Day 2 I'm still fairly drugged.  Day 3 is good.  But where are the bruises?

I don't know if I'm an anomaly or if  it's because I went to a plastic surgeon instead of an ENT, but I never got a single bruise.

And I didn't feel better after 3 or 4 days.  While the first 24 hours were certainly the worst, I had a migraine every day for 6 days.  

The doctor said I won't experience any headache or migraine relief for 1-3 months because of the inflammation.   

Botox with the Plastic Surgeon

So in July 2016 I go visit the plastic surgeon who does migraine surgery  (Dr. Kevin Rose of the Rose Clinic in Provo, UT).  Armed with the information that I have a deviated septum and that the only nerve block that has had any measure of success at all is the SPG block (sphenopalatine ganglion) I feel we can narrow down the possible culprits much easier than before.  I get his Botox injections, deeper and concentrated in very specific areas.  We inject above both eyebrows and in both temples.  And then we wait.

In the meantime, I am to get a CT scan of my nasal septum and sinuses.

The botox injections haven't reduced my headache days, but this time they have allowed me to hone in on the headaches and their origin a little better.  They most often originate behind my left eye.  But if my septum is deviated towards the right side then why are my headaches starting behind my left eye?

I follow-up with Dr. Rose and see the images from the CT scan.  I have a bone spur on the left side of my septum deep inside in my nose.

Deviated Septum

The neurologist treating me for sleep apnea made the observation that I have a deviated septum (interesting that no one else has ever said anything about this).  I also have hypertrophy of the tonsils (EVERYONE mentions this to me).  She suggested I see an otolaryngologist (ear nose and throat or ENT) about it.  Which I do.  He suggests surgery, though not very strongly.  Because I can't take the 2 or more weeks of work necessary to have my tonsils removed and the 1 week for the septoplasty I decide not to pursue it at this time.  Besides, is getting my tonsils out going to cure my headaches?  If the CPAP isn't helping the headaches then how will getting my tonsils out help?

But the deviated septum, that gets me thinking .... remember the plastic surgeon? The one who does migraine surgery? One of the nerves that can cause migraines is deep in the nose.