A couple of weeks ago I had my appointment at the City of London Migraine Clinic. It was a first appointment, and I went armed with migraine diary from the previous 18 months, and spent a good while being examined and questioned in detail by one of their migraine specialists. In some ways I felt I didn't have enough detail for her, but overall it was a very useful experience. She's followed up with a letter to my GP, copied to me.
She made a thorough physical/neuro exam, testing all sorts of movements, and having a good poke and prod over my neck, shoulders, back and abdomen. She took my blood pressure (normal as ever at 112/80). Her notes say the exam was generally unremarkable, apart from being "tender over temporalis muscles and both sternocleidomasteoid muscles". Must find my anatomy book. She was quite concerned about the tension in my shoulders and back, although I pointed out that I'd had a particularly stressful week leading up to the appointment, and has recommended my GP to refer me to a physiotherapist. In the mean time, I should use either heat or a cold pack to ease the tension. (Along the same lines, I decided to get back into daily yoga practice, as it is excellent for easing stress.)
I explained I wanted to come off beta-blockers and she said I should have come off them after six months. Of course, I can't just stop them, I have to "step down" over about two weeks, and I need my GP to prescribe me smaller doses in order to do so. So, another trip to the docs is due before I can get off the energy-sapping things. She recommended that I take 20mg of motilium together with 600-900mg of soluble aspirin dissolved in something fizzy at the first sign of migraine. The motilium is to reverse the usual "gastric stasis" of migraine, and presumably to allow further medication to be absorbed. Can still take my triptan half an hour later if needed.
Finally, she told me that my pre-migraine chocolate cravings were almost certainly an indication of low blood sugar, and I should at the very least have a mid-afternoon snack to reduce the likelihood of low blood sugar in the afternoon (almost all my weekday migraines have been in the afternoon). I mentioned my tentative ideas about the GI diet, and she said that was an excellent idea and I should try to incorporate the principles into my diet as it would help avoid the periods of low blood sugar likely to be triggering my migraines. I have yesterday got around to ordering a bunch of books which I hope will give me a bit more detail than Living the GI Diet
- that book doesn't distinguish between foods banned for being calorific and foods banned for being high-GI. It's almost impossible to overeat if you stick strictly to its "green list" of allowed foods, but that's very hard to do. I'm far more concerned about always being able to eat low-GI than I am about losing weight now. So I have coming The New Glucose Revolution
(an update to the original "The GI Factor" which has been around for years before the idea became fashionable), The Complete Guide to GI Values
, Top 100 GI Foods
(actually the 100 foods with the lowest
GI factors, which I reckon will be handy) and The Glucose Revolution: Diabetes
. Between them all I hope to have enough information to eat for my head.
She made no comment on the quantity of diet coke I consume, except to say it was a good thing to drink the aspirin and motilium in. Yuck, but good for me I'm sure.