Migraines + Margin

March 29, 2022


I still have them. It’s very unfortunate. I do have a prescription rescue medication that works fairly well but it definitely makes me feel groggy, so I often don’t take it right away. Sadly, every time I go to bed with a mild headache (thinking “surely this isn’t a real migraine, I just need to rest”), I wake up with a worse headache. This happened last night at 1:30 am and just . . .ugh.

Part of me wonders if my migraines are linked to the birth control I take to control PMDD, but when I consider stopping, I just think about the 14+ days of each month that I was completely miserable, and that doesn’t seem like a viable plan either.

I’m not sure there are obvious solutions out there, but I have spent my life as a healthy person and it feels odd to have any sort of medical problem at all really (I know I am incredibly lucky to be able to say that). I also know it could be so much worse. But I would really like to stop having migraines.

(I already had an MRI which was normal, but have not seen a neurologist or headache specialist which may be the next step.)


I am back in the Hobonichi Cousin. I have a good handle on my tasks + responsibilities, and I am getting the essential #*&$(# done. But I really wish there was more margin. I feel like I am always rushing to squeeze one more task/appointment/event into my day, and I know that this is absolutely my own doing.

I wish I had more margin in the clinical world; we are booked so far out that even moving vacation dates in August is going to be problematic.

I wish I had more margin to spend more time on my creative pursuits instead of always bumping up against a deadline (for podcast upload, script drafts, etc).

I wish I had more margin in my ENERGY to enjoy the evenings more with the kids. (Lately, headaches have been a barrier to that which is really sucky). I have read so little this year compared to my usual. I have watched almost no TV and I honestly haven’t even been scrolling much online. WHAT HAVE I BEEN DOING? I’m not even sure.

I wish I didn’t eat so many of my meals in 5 minutes often while standing up.

Cousin page in all of its show-through glory


  • Reply Gillian March 29, 2022 at 6:51 am

    You should definitely see a headache specialist! There are a number of medications to try that can significantly reduce the number of migraines you have. My family are all migraine sufferers and many of them have nearly eliminated their migraines with prophylaxis and avoiding triggers.

  • Reply Elisabeth March 29, 2022 at 7:31 am

    I had a 2-3 year struggle with migraines and they are so debilitating. I’d echo Gillian on seeing a headache specialist. My first bout with migraines was brought on by intense work stress when I was in my graduate program; I wonder if your lack of margin/white space is a big trigger for the migraines? Your life is SO busy. I’m sure there could be many other things at work (I used to get migraines on vacation, too, so it wasn’t limited to stress, but it was the initial trigger when I had them). It always feels wrong to give advice over an internet forum because everybody responds to different treatments, but chiropractic adjustments were what ultimately made the difference for me, not medication.

    I have a post all about margin coming up on Thursday. Since I only work part-time, it should be a lot easier for me to find more margin in my life, but…I feel like I have to fight for/pursue it. Between work and kids and marriage and exercise…it’s so easy for all the white space to get filled up. But without it, life just starts to feel like a slog. The last few weeks I can tell I’ve filled my schedule too full and it eventually catches up with me and I essentially crash. Lack of margin really drove us to having my husband take a big step back from his work (for 6 months) and I’ve got to be more intentional about maintaining sufficient margin. Also, different people need different amounts of margin. I’m an introvert with long-term health issues that cause low energy…so my margin would, ideally, be larger than some of my extroverted, energetic friends.

    I’d love to avoid the crashing bit.

    I really hope you find a way to carve out some extra margin; I suspect it might take some pretty big changes given the intensity of your career to see a significant expansion of that margin…but even little tweaks might provide some extra breathing room? Hugs from afar.

  • Reply Gwinne March 29, 2022 at 7:34 am

    I’m prone to migraines. I how many triggers but they often operate in concert. Weather is definitely one of them. I remember a horrible migraine attack the last time I was in Florida actually. Not that you can avoid your state. LOL. but I do wonder if humidity/heat has something to do with it? I would look at the food triggers first? Dehydration is an obvious one

  • Reply Alyce March 29, 2022 at 7:53 am

    You know, your birth control may also be contributing to your depression of late. I know hormonal birth control impacts me in that way. I only used birth control when I was actively in relationships and having sex regularly, so I started and stopped hormonal birth control in my 20s. It took me years to figure out that it was my birth control that cause my depression. The depression wasn’t immediate, but it started low level and built slowly over time to something that really interfered with my life. Didn’t matter what kind of hormonal birth control I used, it eventually ended in the same place. I haven’t had issues with depression since moving to a non-hormonal IUD. But maybe if the hormonal birth control is triggering depression in addition to migraines, it’s worth reconsidering.

    • Reply Sarah Hart-Unger March 29, 2022 at 8:21 am

      My pill has actually been very helpful for PMDD (bad depressive and irritable symptoms for 14 or more days each month).

  • Reply Kat March 29, 2022 at 8:08 am

    Thirding there migraine specialist. There are better preventative medications on the market now, with a success rate of (very roughly) 25-50% reduction in frequency and/or 25-50% decrease in intensity.

    Also, it might help to try different rescue medications with different half lives etc.

    Also, things like chocolate, red wine, etc can be triggers. For me, most triggers my Neuro described as “deltas”. Change in stress (“the Sunday migraine”), hormone levels (I’m on a 90 day birth control), caffeine (I have only one cup of coffee, and every day), sleep (yeah I don’t stick to schedule whoops).

    The first step before seeing a Neuro is to spend a month or two tracking migraine days and intensity.

    • Reply Irene March 29, 2022 at 9:41 am

      Tracking is helpful but I’d start calling neurologists now. You very likely will have over a month wait for a new patient appointment. I think I had 6 months wait to get in with my headache specialist. There is so much out there for prevention, please look into it.

      Agree with all the other recommendations for things you can do in the meantime but also wanted to add magnesium basically every Dr has been a fan of magnesium for migraines.

      I can’t take hormonal birth control because of the migraines I get. You may be able to manage with some additional migraine tools.

      • Reply Sarah Hart-Unger March 29, 2022 at 9:51 am

        Well this message motivated me – I got one for august …

  • Reply Cindy March 29, 2022 at 8:09 am

    So sorry about your Migraines. They are a huge distraction and painful. My mid 20’s I experienced my first and these are hard to explain to an employer as well co-workers. As I navigated through trying to “ buck-up” and persevere whilst at work this didn’t always work well either. The tincture of time worked for me in retrospect. We had 3 children…. Now in their 30’s. My Migraines slowed in my late 30’s and then went away…. 40’s. Thinking back I was soooo stressed in my early years ( me)… my husband was finishing a Cardiology Fellowship and with little resources and no family in vicinity being primary caretaker for all was a lot. ( just my story here in no way trying to make it better thru my lenses)….. just sharing. I hope for you these get better and manageable. You have a beautiful family.

  • Reply Jjiraffe March 29, 2022 at 8:15 am

    I battled migraines for a while. After trying a number of prescription meds, tons of over the counter pain relievers, acupuncture, Chinese medicine, etc etc my doctor finally recommended Botox and it was a game changer. I haven’t had a migraine in about 5 years.

  • Reply AM March 29, 2022 at 8:26 am

    fellow migraine sufferer here- since I was 13. I tried literally all the things suggested- acupuncture, avoid triggers, no alcohol, get enough sleep, take preventative and relief meds (many different varieties). Three years ago I started monthly injections of Amivog, which completely changed my life!! I have not been in bed with a migraine since.

  • Reply KDR March 29, 2022 at 8:32 am

    I’ll add to the migraine stories. I just started getting them regularly last fall and I think they were caused by the coincidence of my triggers: tight neck/shoulder muscles AND a change in weather or hormones. So i’ve been focusing on what I can control, which is the tight muscles, by getting massages, doing PT etc. and it’s helping (along with my prescribed meds). Some food for thought!

    Reading your post I was also reminded by this idea of the three P’s: we tend to think our problems are personal, pervasive, and permanent and often reframing them as universal (at least among other women in your career stage), specific (are there areas where you do have margin?), and temporary (only a few more years until the kids are more independent) can help. Of course you are very busy and having no margin sucks no matter what. And sometimes reciting the P’s helps me reframe and be slightly less miserable.

    • Reply KGC March 29, 2022 at 9:32 am

      I love this concept of the three Ps. Thanks for sharing!

      • Reply Irene March 29, 2022 at 9:42 am

        I love this too. I’m going to write it in my planner!

    • Reply Mrs. Candid March 29, 2022 at 10:20 am

      Wow to the 3 Ps perspective, thanks for sharing.

    • Reply Amy March 29, 2022 at 10:25 am

      Wow! Super helpful. Thanks!

  • Reply Amanda March 29, 2022 at 8:50 am

    Peds Neuro here – definitely would see a neurologist for the migraines! Sounds like things could be much better. In the meantime it can really make a difference to hyper-hydrate (I recommend 100 ounces per day) and you can even try the “headache vitamins” before trying some Rxes – I like riboflavin 400 mg daily. No side effects. I also wish you success in figuring out the margin question – I’m also an introvert (as one of the above posters) and while I enjoy a full life, I really need the margin as well. I can handle short spurts of no margin but then I really need to recover.

  • Reply Mrs. Candid March 29, 2022 at 10:25 am

    Sometimes after eliminating a time consuming habit, and yet feeling fully occupied, I also get the feeling of What have i been doing … 🤔 I should start tracking time more diligently and for a longer time frame.

  • Reply anereson March 29, 2022 at 10:54 am

    one billion percent see a neurologist. my hormonal migraines weren’t responding to anything, and I also appreciate but also despise the rescue meds because of brain fog. but now there’s a new class on injectables for migraines, I take one of them (Ajovy) and it has been an absolute gamechanger. I hope you find relief!

  • Reply Lisa of Lisa's Yarns March 29, 2022 at 10:57 am

    I hope you can get your migraines under control. I think seeing a specialist would be key but probably takes awhile to get an appointment. :/ I luckily do not suffer from migraines. I get headaches frequently and some will linger but motrin typically does the trick and if it doesn’t, they are debilitating. But I definitely have a laundry list of other health issues. The daughter of my husband’s cousin is a nursing student and interviewed us for a school project which included us sharing our medical history. My husbands was so short – basically nothing! Mine felt sooo freaking long!

    I hope you can find a way to get more margin in your schedule. That’s something I’d had to learn to do since becoming a parent. Even though I’m a hard core introvert, I am also pretty outgoing and like to keep in touch with friends but I had to majorly majorly cut down on what I said yes to. And then the pandemic really gave us a lot of margin! I’m starting to make more plans and trying to figure out the “right” amount of plans for us. Because a completely open weekend is actually harder than a weekend with plans, especially in the cold months when we can’t be outdoors as much. But I don’t want to over commit and feel like we are running from one thing to another.

  • Reply Julie March 29, 2022 at 11:32 am

    Started with migraines after the birth of my daughter (3 years ago); definitely seemed hormonally related. I have a rescue medication that works, but 400 mg riboflavin and 400 mg Magnesium daily has decreased my headache days from ~ 8 per month to 1-2 month!

  • Reply Sara March 29, 2022 at 11:38 am

    This post and all the comments are very timely! I’ve suffered with migraines for more than a decade and saw a neuron for this first time *yesterday*.

    He didn’t change too much of what I was already doing — upped a medication dosage, shifted me to a different triptan (will be the third I’ve tried) and said to take B2 x 400mg daily (and continue taking magnesium).

    But I feel better just knowing that I now have a specialist following my case. I will go back in 3 months and if those things don’t help, we’ll try something else. I am going to make sure to keep a very specific migraine journal in the next three months. I record my headaches in the Clue app but no specifics. If you Google “migraine tracker” there are a lot of templates posted online by different medical groups.

    I can’t believe I waited so long to see a specialist. :-/ I’m glad you made an appointment!

    • Reply Sara March 29, 2022 at 12:28 pm

      Uhhh that should say *neurologist*, not neuron.

  • Reply B March 29, 2022 at 1:10 pm

    Another plug for seeing a headache specialist. I am married to a neurologist who treats a lot of headache (some neurologists hate doing this, and some love it– so probably worth finding someone who lists it as an interest/specialty), and there are really good drugs (and supplements like magnesium) plus lifestyle things that can make a huge difference. I don’t know how frequently you are getting them these days but his threshold for preventative (rather than just abortive) is typically more than 1/week on average. The new generation drugs are game changers for some people, as is botox. It’s really one of those things where you have to work with a specialist to figure out your regime, but once you do, it can really make a huge difference.

  • Reply Amy March 29, 2022 at 1:26 pm

    No migraine advice, only good wishes that you feel better quickly.

    At some point over the last year I started to give myself permission to stop pushing so hard / frequently. Maybe it’s pandemic related, maybe it’s age related (47). Your words about wanting / needing more margin resonate with me.

  • Reply Sophie March 29, 2022 at 3:10 pm

    My migraines were being caused by my birth control pill for years- I thought I was just someone who got migraines (would take triptans for them monthly). Finally stopped the pill and my migraines just stopped- forever. Last year I got bad anxiety from covid related stress and went on Lexapro and gee for me it’s a miracle drug! No side effects (after first two days) and I just feel normal. It even got rid of any PMS symptoms for me. So perhaps you could try an antidepressant instead of the pill and see if that eliminated your migraines and also helped your PMDD? Could be worth a shot because migraines are no fun.

    • Reply KB March 29, 2022 at 10:41 pm

      This happened to me too. I used to get a few migraines a year, and when I went off hormonal birth control they stopped completely. I have not had one in eight years. Wish I had linked the two.

  • Reply Kimberly Cohn March 29, 2022 at 5:43 pm

    Re: migraines I recently saw this and was intrigued! I don’t have them myself but I keep meaning to start drinking a spinach + blueberry smoothie daily and see if it helps me to feel generally better.

    • Reply Sharon March 30, 2022 at 10:43 am

      @Kimberly, thank you for sharing! This is so interesting.

  • Reply Chantal March 29, 2022 at 7:29 pm

    In regards to margin and white space, I wonder if you stopped/cut down listening to podcasts/music while driving and running/walking that you might feel you have more bandwidth?? I went through a period where I was listening to audio books and podcasts non stop and soon realised I couldn’t even think properly because too much information was going into my mind.

    Maybe you could try it for a week??!!?

    • Reply Amy March 30, 2022 at 7:16 am

      This is an interesting suggestion. I sometimes feel the same way, like there’s too much “noise” and I can’t hear myself think. You’re one step ahead by being off social media but maybe there’s too much of other people’s voices in your life?

    • Reply Canuck March 30, 2022 at 7:45 am

      Yes! I have definitely found this as well. Some blank space really helps me process through the day

    • Reply Ashley March 30, 2022 at 11:46 am

      I have noticed this in myself, too! Specifically with podcasts, not so much music. It’s hard because I love podcasts and find them so useful, but it can contribute to mental clutter.

  • Reply lawandcreative March 30, 2022 at 5:41 am

    Sending hugs for the migraines – I get them too and have done all the tests etc, nothing is helping. It’s so debilitating especially when it comes to work life, because my migraines are mainly visual pain/disturbance so I just can’t sit and concentrate on a screen like I used to. It’s rough. Hope something helps for you soon!

    (Also, is it just me or are more and more people really suffering with migraines? I’m sure there’s a stress link and I wonder if the pandemic has caused an increase in the number of people now having migraines. I never used to!)

  • Reply Jenn N March 30, 2022 at 5:30 pm

    I can’t seem to read this year either! 2 years ago on mat leave I read 100 books; last year I read 72 and this year my goal is 50 and Goodreads informs me I’m 2 books behind. I know part of it is I’m rereading the Diana Gabaldon books and they are tomes, but I also think there has to be some sort of burnout phenomenon that is happening because of covid. My brain just feels sort of…overwhelmed these days. I have no solutions, just commiseration. 🤗

    • Reply Sarah Hart-Unger March 31, 2022 at 6:07 am

      thank you – it does help to feel less alone!

  • Reply Kathleen March 30, 2022 at 6:23 pm

    I appreciate you, your blog and your readers. I want to share something you already know but I feel like it might help. Moving is stressful and a lot of work!!! Even a nearby move is still a move. In fact, you might end up trying to do more by making trips and moving things in your car. Good luck. I hope you feel better.

    • Reply Sarah Hart-Unger March 31, 2022 at 6:07 am

      thank you kathleen!

  • Reply Amy March 31, 2022 at 8:26 am

    Hey Sarah- just adding a note to consider talking to your OB about a LARC like IUD or implant. Much less likely to cause issues with migraines but still offer benefits for PMDD. Sounds like you already booked an appt with a headache specialist as well. Sometimes as HCW we are the worst patients because we just “suffer through it.” But I try to remind myself that I wouldn’t want one of my patients to suffer without sharing their symptoms with me.

    I’m similarly going through a season with little margin: home remodel, first trimester fatigue/sickness, and my new job ramping up. I’ve had to really cut back on basically everything else in order to get the sleep & downtime I need to be a functional human. And I keep reminding myself that it’s a season that will eventually pass.

  • Reply Jen April 2, 2022 at 9:30 am

    So here for all of this. Thank you ❤️

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