What 48 Hours with a Migraine Attack Look Like

The physical pain has a start and a beginning. Changing someone’s negative opinion based on a disease I can’t control, however, is all-consuming.

Trigger warning: This post references suicide in the context of chronic pain patients.

My head is incredibly foggy right now. It hurts a little, too. 

My most recent migraine attack has just loosened its grip on me, about 60 hours since it began. While I’m relieved the pain has lessened, I’m headed toward the emotional portion, where hopelessness takes over. 

I tried sitting down to write social media posts once the worst cleared. Instead, I stared at a screen, coming up with less-than-stellar copy in my head. A foggy white noise cascading across my brain makes thinking too challenging. I give up.

After four years of finding a balance via trial and error, I have a supportive client roster and a workload that’s just right. I can make a comfortable living without getting overwhelmed with work if a migraine interrupts. I often must remind myself ‘You’re not going to get in trouble’ when I choose rest over work. This time, I choose rest.

Depending on the season, I take these migraine waltzes at least once a month. Some months are more brutal than others, with intense weather swings and distance between Botox appointments being the biggest contributors. 

I will have many more attacks in my life, that is guaranteed. Currently, there is no cure for migraine, the disease I have. I’ve shed many tears over this—knowing torture is always ahead and I just have to sit and endure it—but the attacks are, thankfully, fewer now. 

For us unfortunate ones, pain is just one hurdle. We also must navigate ignorance. A lot of it.

“Can’t you just rest?”

“Why didn’t you answer my messages?”

“You are using your migraine attacks to manipulate a situation.”

Those are all direct quotes from former colleagues, people who either have never experienced a migraine attack or get mild attacks.

I often say the psychological pain is sometimes worse than the physical pain. The physical pain has a start and a beginning. I know there is relief and a string of good days on the other side. Changing someone’s negative opinion based on a disease I can’t control, on the other hand, is all-consuming. It’s like Donkey Kong sneaking into my brain’s self-esteem chamber and splintering all progress. 

It’s surprising, though, how many people don’t consider how encompassing it is to live with migraine. So, using my profession, my knowledge and my lived experience, I want to share what it’s like to go through one of my* bad migraine attacks.

The first five hours 

My attacks usually develop overnight, so it is difficult to pinpoint their true beginning. All I know is I need to take my meds at the beginning or I’m screwed. People with migraine understand this dance. Taken late, a medication’s efficacy is often too weak to abort the attack.

Another careful dance we go through is rationing our meds. I’ve gone through many attacks without medication because I’m saving them for a just-in-case moment during travel or an important responsibility. Currently, I pay $32 for nine pills. (By the way, did you know I use this publication to help cover my migraine costs? Become a paid subscriber here!)

In addition to counting my meds out and timing them just right, I also need to take them before the nausea hits. Most attacks wake me with nausea, followed by a “Fuuuuuuuuuuuuuuuuuuuuuuuuuuck, not this again.” When I begin vomiting, I’m usually locked in for 12 to 48 hours. The duration and severity vary. Sometimes, I have to hurl every 30 minutes to an hour, other times a few hours pass between puke sessions. 

To fight this symptom, I’ve developed a chronic illness version of the Dream Team: Zofran, weed and a cold compress directly on my chest. (My OB-GYN taught me this trick and it changed my life.)

Then, I buckle in and start to ride it out.

The next five hours 

At this point, I’m at my worst. In addition to my head pain, I also experience intense muscle pain, which means my whole body is inflamed. Unfortunately, this symptom’s intensity has increased in recent years. 

I wanted to understand why pain washes over my body in this way, so I turned to some research. 

A 2019 study discovered migraine patients are more likely to experience other painful physical symptoms (PPS). In reading through this study, I enjoyed a little (depressing as it be) discovery about myself. 

“Mood disorders and migraine are closely related.”

Hold up. We need some context real quick.

For anyone not in the know, I am diagnosed with Bipolar II, which is the ‘depressed bitch’ of the two variations. 

OK, back to business.

“Migraine is a common comorbidity among patients with [major depressive disorder (MDD)]. Shared underlying genetically determined disease mechanisms of migraine and depression have been reported. … Among patients with MDD, migraine was also found to be associated with increased other somatic and pain symptoms. Moreover, migraine was also associated with an increased suicidal risk.”

If you are someone who loves me, you probably felt the same pit-in-your-stomach sensation I did reading that last sentence. Those are words so plain and harsh. 

The good news is you don’t have to worry about me. Yes, thoughts get dark and I will continue to have dark thoughts. It’s just how my brain wants me to live.

What that bad part of my brain doesn’t know is the good part of my brain loves too hard. I’ve found my people and the backyard animals are just now starting to get comfortable in my presence. No way, dude. I’m holding onto that shit tight.

Hitting 12 hours

The aforementioned body aches make finding a comfortable sleeping position difficult. And when I do sleep? Woooweee, here come the nightmares.

I’ve never been a monsters and ghosts nightmare-haver. My fears have always been steeped in reality. At nine, I read too much about earthquakes and scared myself silly. (I also took no solace in Michigan’s low earthquake record.)

So, it makes sense that my nightmares involve real-life scenarios. The majority involve me trying to escape. Sometimes I’m in a house without access to a car, other times I’m on a boat. The boat ones are the scariest because I love boats. In these dreams, a switch flips and I realize how terrifying a boat can be in the right context. And I don’t like that!!

I also have silly nightmares about not being able to pack everything in my return carry-on or being years overdue on a library book and, every once in a while, a stranger’s dead body shows up and I’m roped into hiding it. Oh, I’m also on rollerblades for roughly 30 percent of these dreams. Sounds gnarly, however, YOU try rollerblading while hiding a dead body. 

And, because I’m a Curious Cathy, I searched to see if this is common. 

I turned to Reddit’s r/migraine subreddit, which is a great platform to figure out if something is a ‘just me’ thing or not. My nightmares are not a ‘just me’ thing. 

Having my anecdotal evidence, I turned to published studies to explore migraine nightmares further. A 2021 study addresses this correlation. 

“Sleep disorders have been registered in about 90% of patients with chronic pain, and half of patients with insomnia complain of pain.”

Thatsa me!

“The comorbidity between headaches and sleep disorders has been explained by shared neuroanatomical structures within the nervous system and neurobiological and psychological factors involved in both headaches and sleep disorders.”

Y’all, I am learning so much about myself right now, it is bananas. 

“From an anatomical point of view, there are structures where pathways of sleep and headache cross, including the thalamus, hypothalamus, locus coeruleus, and periaqueductal gray.”

It’s definitely not just me.

The first 24 hours 

I’ve likely finished my seventh shower by now.

I recently turned to hot and cold therapy to loosen my body. I’ve begrudgingly forced myself to be one of those cold-shower people in a desperate attempt to reduce pain a fraction. 

Rapidly changing the water’s temperature from hot to ice-cold surprises my body. The shock, combined with the cold constricting my blood vessels, temporarily takes the edge off my muscle aches. As a psychological bonus, I feel like I’m turning the tables and playing a trick on my body—paybacks for all the tricks it plays on me.

While I haven’t found strong research on cold’s effect on migraine attacks, I did discover Beth Francis’ story. A marine biologist, Francis did a 100-day cold therapy challenge and believes regular swimming in the sea helped reduce her attacks from 24 to 15 per month. 

Francis’ story is an example of how discomfort often leads to relief. I know because I’ve desperately resorted to Botox, an unbelievably painful procedure. Every three months I have small needles shoved into some of my body’s most sensitive areas, just to reduce head pain. 

The first session was a shock. Botox is a household name and, from my perception, common for those who can afford it. I left thinking ‘Oh my god, how do people willingly do this!?’ It wasn’t a judgmental thought, however. I actually have respect for anyone who can raw dog a Botox session. I cannot. My doctor’s location is within walking distance and before every appointment, I pop a gummy to numb the impending pain. I know that’s dramatic!!!

But guess what? I now average 10 migraine days every three months.

The next 12 hours 

I may be done, I may not. 

I never know when my attack plans to let up but, in my opinion, it is never soon enough. 

I’m typically useless on day two, however, I can feel the grip loosening. By now, my nausea is either gone or on its way out. I can begin consuming light fluids and food, which is always a relief. On day two, I subsist on a diet of saltines, jam, seltzer and Vernors ginger ale (all other ginger ales are gross). 

Like the first day, I spend the second day in bed. I’m antsy from sleeping all day but know I am still not completely rested. Luckily, I can move around the house better. I relish the small moments I’m out of bed, whether they are taking another shower, sipping water or snacking on a saltine. 

In the evening, I eat a very plain meal. My go-to is macaroni and cheese, however, I did have a religious experience with some roasted red pepper soup earlier this year. It’s necessary I have all my favorite snacks available by this point. On average, I lose five pounds over two days and I need to gain it back via cookies and ice cream before my next attack. Don’t you dare say ‘I wish I had that problem.’  

With a clearer brain, I think about everything I missed. It’s amazing how much happens in two days. I’m overwhelmed with missed communication and cultural moments every single time.

The first pain-free day

An average attack lasts two days, with one hangover day. If I’m lucky, it’s done in 24 hours. In February, I had one that was over in half a day. It was also close to my latest Botox appointment, so three cheers for my medically frozen head. (Not like that.)

The pain dissipates around the end of the second day or early in the third day. But I’m not in the clear yet. My brain just went through a battle, and it’s tired.

Being in a creative field, my work suffers as a result. My mind feels so fuzzy and blank. I struggle to write captions, blogs, emails—basically, everything I need to get paid. 

I’m also very depressed and overwhelmed by this point. There are notifications. So many notifications. Texts, emails, DMs, social media and news alerts pile on. It takes a half hour or more just to get those cleaned up. Then, it’s onto all the projects that just sat for dozens of hours. 

Luckily, I have strong professional support. I don’t know how many times I’ve apologized and received an “It’s OK, your health is most important.” I’ve been waiting for the other shoe to drop—just as it has in other professional settings—but after four years, I’ve seen consistent, positive responses toward my health troubles.

Reentering life 

When living with migraine gets particularly tough, I remind myself that I always get up. Getting up takes time, though. From beginning to end, it can take up to a week to get my normalcy back. 

After an attack, I mostly fight brain fog and drowsiness and am fortunate to work from home so I can control my comfort. Sometimes, I’ll need a midday nap and tear up with gratitude that I’m out of office life. 

I have a new perspective because of this. Reentering my life after a migraine attack has taught me to slow down and not feel guilty about it. 

I’ve learned to let go of my creative and leisurely goals. Nobody will get hurt if I choose my couch over painting, I will still find joy even if I can’t get back into running the way I used to. I no longer race to devour every book. Instead, I enjoy the ride. 

Earlier this year, I read The Body Broken by Lynne Greenberg and felt seen. I don’t know Greenberg, but her story is familiar. Chronic pain, including head pain, ravaged Greenberg’s body to the point where she could barely leave her bed. 

Throughout the book, Greenberg is open and raw with chronic pain’s realities. She wrote about her guilt, feeling like a burden on her family and even how she flirted with ending it all. I understood everything. 

Unfortunately, some readers didn’t, and that’s frustrating. Many low reviews sneered at her privileged situation—Greenberg’s Brooklyn apartment is in a hotly desired location and she had the financial stability to stop working to focus on her health. 

These readers missed that Greenberg’s story shows very clearly that the American health system is structurally flawed. If a woman with the money, time and resources for the best doctors can’t get an answer, what hope do the rest of us have? Any takeaway should be how hard it is to have pain and illness in this country. 

I felt, and still feel, for Greenberg. While her socioeconomic status makes for a more convenient life than my own, I know pain doesn’t discriminate. It creates a very small world, one where there is a singular focus: Get it to stop. 

Thanks for reading this one. I know it’s not an easy topic and it is not my intention to get sympathy. It is my intention, though, to use my platform to create more empathy toward people living with migraine. We go through a lot. 

*It is incredibly important to note: people living with migraine experience their attacks differently. My attacks may not represent what someone else goes through. Similarly, my attacks may be lighter than another person’s attacks.

I live with chronic migraine, which affects how much work I can take on. On average, I lose one workweek a month to migraine attacks. Not a Fit for Our Publication is my way to raise funds to manage my disease while offering something in return. You can help me out by subscribing to Not a Fit for Our Publication, sharing the website, sharing a free blog post and gifting a subscription.