In addition to having chronic, intractable migraines, I have occipital neuralgia now.

This was, as the kids like to say, “sussed out” by the location in which my migraines almost always start. Apparently it’s not a common diagnosis or even a common thing, although I am not surprised to have been diagnosed with… wait for it, something that isn’t common. This would explain why triptans do not really work on me, or they only work a little bit. The pain from occipital neuralgia can not be ameliorated by triptans because that pain is not actually migraine pain, even though I have both diagnoses at present. However, it can be lessened with targeted Botox shots as well as steroid shots along the location in which the nerve travels. I am open to both of these things if they can in any way meaningfully help. My pain management clinic is actually trying to get Botox injections approved for me, so I will see how that goes. It has taken awhile, but apparently these things predictably do. I will just bide my time here and wait, heh.

For the most part, I’ve transferred my neurological care from the neurologist that I was seeing one town over to the local pain management clinic here in my city. My primary care doctor was, and has been, in full support of this and thinks that it was (is? how do I phrase this?) the right thing to do. We discussed Botox when I was seen for the first time, which I am amenable to attempting… we just need to get insurance approval for it, or know that insurance denied the clinic’s attempt to seek approval for it from me so that we can appeal the denial. So far, no one relevant has heard anything back about whether it was denied or approved… so I guess that’s a waiting game, and we’ll see when we see. In the interim, and to have it on hand in the event that I need it, I’ve been prescribed Fioricet again, and we are currently working on getting me the highest dose and frequency of that medication which works, but not go beyond that unless we have to so that I don’t inure to it the same way triptans do in that they no longer work on me at all. “Fioricet is love, Fioricet is life” has become one of my biggest inside jokes, because to be honest, it works decently…

For me, for someone who very often doesn’t get a lot of pain relief other than by waiting it out, this is huge.

I also found out that I am on nearly the largest dose of Gabapentin. That is 3,000mg, and I am currently on 2,700mg. I’m also not sure if I’ve mentioned it here, but I’ve begun to develop peripheral neuropathy on my left side due to it… but as long as it helps migraines, which it does, I am reluctant to give that up unless I am made to give that up. The only major downside to this is that I am left-side dominant. My left ring finger, left pinkie finger, and the area going downward from that to my elbow is numb now. I also can’t bear weight on or with my left hand. But like I’ve said, if it makes a sizable dent in the pain, I am willing to live with all that.

The back of my left foot is also numb, which means that I have to be careful walking, but… see above, heh.