Practicing and performing when faced with a migraine

Practicing and performing music has many challenges. With migraines, they are magnified. As with any job, when coming face to face with yet another one, I am also faced with the question, "How am I going to get done what I need to get done?"

I know I am not alone. Every day I find musicians on Twitter that are asking this same question so I thought I would spend a few minutes sharing my experience in the hope that it will help others in the same boat feel a little less alone and a little more understood.

For me there is a difference between how I deal with practicing and performing when I'm dealing with a migraine. With performing I feel there aren't really many options since it's very difficult to cancel a performance, especially when it involves other musicians. But there some things I keep in mind.

• I lower my expectations. My goal is simply to get through the performance as gracefully as possible. More often than not I lose the ability to sing along with the music and to immerse myself in musical intention so I've come to accept in situations like this that I may have to perform in a way that isn't as musically satisfying to me. Very often it feels like it's truly an act of survival and I have to trust that my years and years of being musical and my musical training show through in spite of what's going on (or not going on) in my head.
• I count on adrenaline helping me out. While I'm playing music, my migraine usually fades into the background slightly so I try to stay positive and look forward to a little relief while I'm playing.
• If I'm performing by myself I very intentionally take the edge off all the tempos that I can. When I'm experiencing a migraine my brain has a very difficult time working as quickly as it usually does. There is also less coordination between my brain and my body so having a little extra time to let my brain reset or catch up with itself can be beneficial. 
• I actively remind myself to breathe whenever I can - before I start playing, in between phrases, during rests, and right before difficult sections. It can be so tempting when I'm in pain to hold my breath, as if that will get me through the situation faster. Unfortunately that's not very helpful and tends to make matters worse. 
• I'm intentional about keeping my eyes relaxed and I try not to focus on reading the notes on the page quite as much. Staring and not blinking can make my migraine worse. 
• Along with the previous point, I rely more on my memory of how it physically feels to play the music. This keeps my brain from getting too busy and stressed which definitely doesn't help the pounding in my head.

When it comes to practicing, there's a lot more flexibility. A lot of my friends on Twitter mentioned that they rarely practice when impaired. That's understandable and perfectly acceptable since most of us end up having to spend much of our time hiding under a blanket in a dark room without any sound, doing nothing except waiting for the migraine to decide to take a hike. If I'm fortunate enough to have a low to mid-grade episode, however, I do try to practice a little bit, especially if I'm getting ready for a performance. I use the same tips listed and very intentionally choose modes of practicing where speed and perfection are not the focus. I also do a lot of practicing with my eyes closed since that helps with the sensitivity to light, and I keep the volume either at piano or pianissimo. Doing both of these things are good for practice sessions when I'm feeling good but I find them especially helpful during these times. And more often than not these exercises end up deepening my interpretation of the music and improving my ease of movement. I guess that's a positive aspect of having migraines. I may as well make lemonade from lemons, right?

To all my fellow sufferers out there, I'm so sorry you're dealing with them too! Go easy on yourself. And if you manage to get through a performance or to eke out a somewhat decent practice session, no matter how short, know that you are a superhero in my books. Pat yourself on the back gently and then hide back under your covers and rest knowing that you are amazing.

Feel free to leave your own thoughts and suggestions based on your experiences in the comments. And if someone has a foolproof cure for migraines, do let us know. 

If you want to read more about my personal experiences with migraines and searching out solutions for myself, here are two more that I've written:

Mired in Migraines

Thankful for my migraine?!

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Thankful for my migraine?!

© Sergey Galushko - Fotolia.com

That's correct, believe it or not.  This week of Thanksgiving I am truly thankful for the migraine I have right now.  But rest assured, I have a good reason.

I am thankful because this migraine was my choice this time.

In August my dad sent me yet another link to an article about migraines.  This one was about common food and beverage triggers.  Quite honestly I was not so sweet in my response at first.  Ah, yes, here is is...

"Thanks, Dad. Most of those I had heard about.  It's so discouraging to me.  Basically I should only eat vegetables and water since a lot of people I know also cut out anything with gluten.  I just don't know if I'm willing to completely change my diet.  Tough. But it's good to be reminded of all this so thank you."

Hmmm, that actually doesn't sound so bad but I assure you that what was going on in my heart was not quite so tame.  I believe my exact feelings were, "You've got to be kidding!  I'm miserable as it is - I am not going to start thinking about every little thing I put into my mouth.  No way!"

My strong reaction lasted until the next time I was struck with an intense migraine.  It was then that I decided that perhaps it was time to give the migraine trigger diet an honest go.

I am thankful that I decided to take the plunge and that my family was so supportive.

Using lists such as this one, which is actually based around knowing the levels in tyramine in foods, I stripped my diet of everything that could be a trigger.  (If you want to learn more about tyramine in connection with migraines, here is one article.)  It didn't take long for my migraines to disappear almost entirely.  I still had some thanks to hormones, but it was an incredible relief to be virtually migraine free and to realize that food could indeed have been a factor this entire time.  And yes, at this point my eye-rolling at my dad stopped.  Feeling 100% more energetic, excited, and motivated I now use one day out of the weekend to add one potential trigger back into my diet to test it.  If I end up with a migraine within about 24 hours (triggers can take up to 48 hours to cause a migraine), I cross that particular item off my list of safe foods.  Some of my discoveries have been pretty sad - any sort of aged cheese, anything with MSG, wine, bananas (it's those stringy things in between the peel and the fruit - incredibly high in tyramine!), and the most devastating of all - PEANUT BUTTER!  This process of discovery is slow since I am only willing to have a migraine once a week so I can only test one item a week, but wow, it's mind-blowing to me.  It's no wonder that I was constantly battling migraines!

Yes, my diet right now is very limited.  And yes, it's not very exciting.  Eating out at restaurants?  Hah!  Not really possible right now.  But isn't that such a first-world problem that isn't worth crying about?

To think of all the trips to migraine clinics hours away, the repeated dilemma of whether or not I needed an MRI, the many attempts to find a doctor that would listen and medicine that would work, the battles against debilitating side effects of medication, the dollars we shelled out to pay for prescriptions when I had reached our insurance company's approved amount, the days and nights wasted with me buried under the covers, the opportunities to build even more wonderful memories with my family while I was being tormented by my head, the performances I spent trying to break through migraine fog and pain...and not one of my doctors insisted that I try a diet like this to identify triggers!  I understand that it's difficult for them to think of everything especially when they only see me every so often but oh my heavens!  If only someone had demanded I do that if I wanted to continue getting their help.

But better late than never and ultimately it is my own responsibility.  My journey is not done but my life is definitely changing.  I am remembering who I am again and discovering all that I am capable of doing with a clear mind.  When I do get a migraine now it is much easier to get rid of it, sometimes not even requiring drugs.  If just one migraine sufferer reads this post and decides to try this approach I will be so glad.  And if it works for him or her, oh my, that would be the best.

In closing, why am I thankful for today's migraine?  Because I chose to take this one on last night when I was eating at a friend's house.  I sat down to the meal knowing that I had a free day today and that I haven't had to take my medication for a week - there would be no risk of having a rebound migraine because of taking too much medicine in a short period of time.  I wanted to enjoy last night without being careful about everything I put into my mouth.  So I did and it was an enjoyable evening.  As I consequence, yes, I got a migraine this morning but this time I greeted it with a nod of acceptance, a dose of medicine, and a "good-bye."  It completely disappeared in the two hours it took to write this post.

Today I shall eat carefully and thoughtfully because I choose not to get a migraine tomorrow.
Who knows what I'll do on Thanksgiving.  What I do know is that it will be my choice.

Choice.  What a change of pace - a welcome change of pace for which I am thankful.

HAPPY THANKSGIVING!!


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Mired in Migraines

© mast3r - Fotolia.com

This is the first time I've bothered to mention this on my blog but since I've had a day that was made null and void by a severe migraine, I decided I want to end it with something productive.  So here's my attempt, written with all the lights turned off, drugs taken, brightness turned down on my computer screen, fan blowing on me gently, and the room quiet and waiting for something.

Migraines are mysterious. 

Migraines are merciless.

But often times they are seen as just as "big headaches." Take some aspirin, get some rest, you'll be fine.  

Unfortunately it doesn't work that way.

Migraines don't usually go away overnight.  I have gone through two weeks at a time with a constant migraine, of varying intensity, but there nonetheless.  And I know of folks that have had migraines last for even longer than that.  So just taking some aspirin and getting some rest doesn't really work - at least not for some of us.   Because they aren't "just headaches."

Migraines can be debilitating.  Sometimes I can continue to function with one but on a bad day, like today, I am forced to do nothing.  And I mean nothing.  Reading hurts, looking at the computer screen hurts, listening to music hurts, practicing piano definitely hurts...yup, see how bad it gets?  If something keeps me from my piano that says something.  I can perform if need be, albeit in a bit of a drugged-up state, thanks to all the endorphins that come with walking on stage but afterwards?  Oh boy.  You don't want to see me after a performance under the influence.  Not pretty.  

Migraines make me want to cry...or worse.  But because they are so painful and debilitating any thoughts of doing either are quickly realized as impossibilities.  Imagine that.  

Migraines make me feel pathetic.  Here I am, a wife and a mother, and I am made worthless to my family.  I remember several times when my daughter was much younger and not yet in school when she had to nurse me through the day.  It might have been somewhat fun for her - a chance to truly play nurse, but it wasn't so fun for me nor did I feel it was really right.  I am thankful that I have a family that is so understanding and helpful but I wish it didn't have to be this way so much of the time.

Migraines are difficult to figure out.  I've tried so many different medications, many of which have had way too many side-effects to be bearable; I've driven long distances to go to special clinics;  I've kept charts trying to make some sense of all the possible factors; I've had many different doctors that have completely different philosophies; I've tried to figure out the triggers; I've tried different things in regard to my diet; I've checked the barometric pressure on a regular basis...it's been a lot of work but yielded very few consistent theories.  Out of it all I have learned just a few things which I'll share now, for what it's worth.

• It's challenging to find a good doctor who can really help with migraines.  I finally ended up with a neurologist that has migraines herself and this has meant the world to me.  With her I feel comfortable because I know she gets it.  She listens to me, has figured out that my body is not very good with medicine, and has taken more of a "let's just get you through this approach."  We tried some of the preventative options but they were not well-received by my extremely sensitive system.  Instead, she has put me on a daily regimen of supplements and has found for me several different options that I can use once a migraine sets in.  There are good doctors out there and they take some work to find but it's worth it.  

• It seems like MRIs are not necessary unless a neurologist does a basic set of tests (that doesn't require machines, radiation, or big bills) and he or she sees a need to proceed with the big guns.  I had two neurologists, after seeing me once, order MRIs after only speaking to me for about 10 minutes each.  It was such a knee-jerk solution for them.  Migraine = MRI but seriously?  Do you know how much those tests are?  Plus talk about migraine inducing!

• Rebound migraines can be more debilitating than your average migraines but they can happen so incredibly easily.  I had no idea that the medicine that works best for me, Maxalt, is only supposed to be taken every couple of days.   For whatever reason, none of my doctors or pharmacists ever told me this little detail.  So for little old me, that was having migraines for days on end, for weeks on end, taking Maxalt every day was causing massive rebound migraines!  Of course I was also running out medicine on a regular basis, being forced a few times to pay $75 per pill when I was desperate and had run out of what our insurance would pay for.   Somehow I stumbled upon information about rebound migraines online so I asked my neurologist about it and she confirmed what I had figured out.  I immediately started keeping track of when I took Maxalt, allowing for 2 to 3 days in between doses, and instantly reduced my attacks and their severity.  For a long time I also didn't know that I could take advil at the same time I take Maxalt.  And on top of that I can also take an anti-nausea medication I take.  It pays to ask the pharmacist or your doctor!  Perhaps I'm the only person that didn't know these things but I want to go on the record for passing on these important bits of info.  

• I have discovered a website, migraine.com, that has a wealth of information daily.  They also have a twitter account at @migrainedotcom.  

I wish I had more helpful information to offer but like I said at the beginning of this post - migraines are mysterious.  I certainly hope that more research will be done in the years to come so that this those of us who deal with them on a regular basis will find more relief.   Until then, if you're someone suffering from migraines, go easy on yourself - it's not easy to live with these things.  And for those of you that know someone with migraines, thank you for supporting them and believing them.  It means the world to us and makes living with them so much more tolerable. 

Now my head is really hurting so it's time to sign off.  Here's to a new and better day tomorrow.  Stay healthy, everyone! 

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