Migraine robbed 20 years of this young mom’s life but she’s finally tamed the monster in her head with novel therapy

Most patients suffering from chronic migraine make the mistake of wasting too much time consulting neurologists when they should be seeking pain management sessions. There are graded protocols with radiofrequency ablation therapy being used in intractable cases for long time relief, says Dr Vivek Loomba, pain management specialist, Indian Spinal Injuries Centre, Vasant Kunj

Prabhjot became a compendium on pain medication and patches, having visited many doctors

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Till today, 46-year-old Prabhjot Nirula cannot put a finger on what caused her migraine in her adult years. But she suffered from it for 20 long years. Was it the stress of an early marriage, divorce and the balancing act of being both mother and father to her daughter? Was it the death of her father, her support in those years, low self-esteem or was it plain idiopathic? That’s the thing about migraine, you never know what the trigger can be. But it pushed Prabhjot into the deep end of her personal trauma, as the thunderclap in her head tied her to her bed for much of her early life. “The attacks progressively became longer, lasting up to 20 days at a time. The painkillers wouldn’t work. Effectively, I wasn’t able to step out of the house for three straight days together,” she says of the days when she was lost in the labyrinthine darkness of her room and morbid thoughts. Now, three years after radiofrequency ablation therapy, which uses radio waves to numb nerves and stop them from sending pain messages to the brain, Prabhjot has begun to love her life the way it was meant to be. She is now the PR head of a corporate firm and is looking forward to a vacation in Malaysia with her daughter, just the two of them.

“I have lost so much time. I couldn’t take care of her,” she recalls. As a young mother, Prabhjot had a hard time dealing with her divorce and says she needed five years to find her feet and get a marketing job. With her father’s encouragement, she even became director of her division. But then she lost her father and her dependence on him meant that she felt rudderless. That’s when the migraine attacks began. “Once diagnosed, I took medication as prescribed but since my condition would not improve, I would go to the next specialist. I consulted many doctors, hoping one of them could identify my trigger and offer long-term cure but all I got was symptomatic relief as the attacks became severe over time. I consulted neurologists and psychiatrists, did CT scans and MRIs, where nothing unusual was detected. Yet, my head felt like it would explode at any moment. There were moments when I felt like dying rather than suffer the piercing pain that literally threatens your sense of rationality. I remember blocking off my family, screaming, ‘No, no, not right now.’ This impacted my daughter, who would cry, ‘Don’t die on me.’ I couldn’t blame her because for a long time I was convinced that I had an undetected life-threatening condition. How could migraine immobilise and paralyse somebody’s life, I thought. I needed intravenous pain killers that affected my digestive system to such an extent that the sight and smell of food disgusted me. My vomitting wouldn’t stop, my eyes felt like they would pop out any moment as they throbbed relentlessly, I would tie my head with a cloth and lie in a dark room. I was debilitated to such an extent that I gave up my job,” says she.

Over the years, Prabhjot became a compendium on pain medication and patches, having visited many doctors. “I even maintained a diary of what I did each day, from the food I ate, the perfume and soap I used to my activities, trying to isolate my triggers. They could be anything from stress and hormones to bad lifestyle habits. Desperate, I even tried alternative medicine, homeopathy, naturopathy, acupressure and all sorts of ghee and oil massages,” she says. Till she met Dr Vivek Loomba, pain management specialist, Indian Spinal Injuries Centre, Vasant Kunj, in 2018. “What she had was chronic migraine and needed painkillers almost on a daily basis. The classic mistake she made was consulting neurologists when she needed pain management. Most migraine patients do that, with their condition remaining misdiagnosed and untreated. Feeling hopeless, they self-medicate with whatever they think works on them and are prone to self-harm. Just last week, a young man in Kolkata killed himself with a saw after a disorienting migraine attack. Taking too many painkillers often can trigger serious headaches as a side-effect,” he says.

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According to Mayo Clinic, “The risk seems to be highest with aspirin, acetaminophen and caffeine combinations. Overuse headaches may also occur if you take aspirin or ibuprofen (Advil, Motrin IB, others) for more than 14 days a month or triptans, sumatriptan (Imitrex, Tosymra) or rizatriptan (Maxalt, Maxalt-MLT) for more than nine days a month.”

Dr Loomba first tried a nerve-blocking method where he injected a mix of local anaesthesia and a steroid around specific nerves in the face and head to stop them from sending signals to the brain. This offered relief for a few months. When her migraine recurred in 2019, Dr Loomba went for radiofrequency ablation. As Prabhjot lay awake with an intravenous anaesthetic stilling her face and neck region, she indicated her pain points. Dr Loomba pushed a thin probe needle, guided by X-ray imaging, starting from jaw to temple and skull. “The needle uses a radiofrequency current to burn nerve cells that cause you pain. As these cells die, the immune system removes them. This works on chronic migraine patients rather well with no relapse reported up to a year. In some, the effects last longer, in some lesser. But rather than popping painkillers, this is a safe alternative. Also this therapy is recommended only in extreme cases. There are graded pain management therapies that can work wonders in the early stages of migraine if detected at the right time,” he says.

The therapy worked well on Prabhjot, who hasn’t had a repeat attack in three years. “Once the anaesthesia wore off after the procedure, the pain lasted a while that had to be taken care of with paracetamol. That was nothing compared to the pain I had all those years. Finally, I am free. Today, I am not on any medication, exercise regularly, keep to a diet and sleep routine. I have settled into my new work profile. Years of using painkillers tires me out easily but I am rebuilding myself,” she says. At one time, she would see blinding flashes of light during a migraine attack. Now she has a clear vision of where she wants her life to go.