When is Enough Enough When it Comes to Migraines?

[k8l8]

Hello all,

Two timer of the TBI club - loss of consciousness on the second one. 10 year Army enlisted woman currently assigned to NCR and working a desk/computer reliant MOS.

Post-second TBI, a laundry list of issues arose - but for this purpose, the migraines have been increasingly severe to the point of nausea and fatigue requiring laying down in the dark for hours; progressively worse TMJ (bruxism), neck/head pain accompanying, and high vision stress (one eye is working harder than the other).

I am prescribed an SNRI, a migraine abortive, and topical gels/creams to manage; along with therapy for vision and upper back.

The migraines, vision issues, and neck/head pain haven't gotten better (but haven't gotten worse) during the course of treatment. However, SNRI was actually causing anovulation, so I had to drop it from use along with the migraine abortive to bring my reproductive system back to a normal baseline. Following getting off of the SNRI, all symptoms have begun steadily increasing in severity - very much aggravated by lengthy daily commuting and 8-hours in front of a computer screen.

To get to my point/question, when or where is the point of MEB referral for migraines?

I do not wish to return to a long list of medications and I am unsure about the other treatments, such as botox.
I'm working with the NICOE clinic at Walter Reed, which is a fantastic institution that has worked incredibly hard to help, but these symptoms are quickly burning me out. I'm spending an average of 2 days a week commuting to WR for appointments on top of managing symptoms.

I don't see the writing on the wall of when migraines become not fit for service?

 

[DaveK]

As a fellow multi-TBI sufferer, I feel your pain. That said, your PCM would have to recommend a MEB.

If I were in your shoes, I would build a clear picture of your timeline, diagnosis, and treatments. The key will then be to show how much these issues interfere with your specific military job. Profile restrictions, missed time from work, LODs, and anything similar will help your case.

In my amateur opinion it sounds like you would qualify for a MEB pending how much this has directly and measurably impacted your work.

 

[Provis]

Hello all,

Two timer of the TBI club - loss of consciousness on the second one. 10 year Army enlisted woman currently assigned to NCR and working a desk/computer reliant MOS.

Post-second TBI, a laundry list of issues arose - but for this purpose, the migraines have been increasingly severe to the point of nausea and fatigue requiring laying down in the dark for hours; progressively worse TMJ (bruxism), neck/head pain accompanying, and high vision stress (one eye is working harder than the other).

I am prescribed an SNRI, a migraine abortive, and topical gels/creams to manage; along with therapy for vision and upper back.

The migraines, vision issues, and neck/head pain haven't gotten better (but haven't gotten worse) during the course of treatment. However, SNRI was actually causing anovulation, so I had to drop it from use along with the migraine abortive to bring my reproductive system back to a normal baseline. Following getting off of the SNRI, all symptoms have begun steadily increasing in severity - very much aggravated by lengthy daily commuting and 8-hours in front of a computer screen.

To get to my point/question, when or where is the point of MEB referral for migraines?

I do not wish to return to a long list of medications and I am unsure about the other treatments, such as botox.
I'm working with the NICOE clinic at Walter Reed, which is a fantastic institution that has worked incredibly hard to help, but these symptoms are quickly burning me out. I'm spending an average of 2 days a week commuting to WR for appointments on top of managing symptoms.

I don't see the writing on the wall of when migraines become not fit for service?

My wife was sent to MEB due to migraines. When her provider put in a profile for them to include her botox injections that put her down the road towards being medically retired. She still suffers from them frequently years later after being retired. Keep seeking treatment and ensure you have a profile to include limitations when having a migraine and limitations for the treatments. My wife wasn't able to deploy to austere locations and that necessitated a P3 profile for migraines that lead to MEB.

 

[koxin222]

From what I’ve seen on here and heard from others, migraines can lead to an MEB referral if they’re severe, frequent, and clearly impacting your ability to perform your MOS or maintain readiness - which honestly, sounds like what you're going through. Especially if treatment options are limited or not well-tolerated, that’s often when they start looking at unfitness.

 

[k8l8]

My wife was sent to MEB due to migraines. When her provider put in a profile for them to include her botox injections that put her down the road towards being medically retired. She still suffers from them frequently years later after being retired. Keep seeking treatment and ensure you have a profile to include limitations when having a migraine and limitations for the treatments. My wife wasn't able to deploy to austere locations and that necessitated a P3 profile for migraines that lead to MEB.

This is incredibly helpful.

In a bit of an awful way, I wasn't even aware I could be on profile for the migraines!

 

[k8l8]

As a fellow multi-TBI sufferer, I feel your pain. That said, your PCM would have to recommend a MEB.

If I were in your shoes, I would build a clear picture of your timeline, diagnosis, and treatments. The key will then be to show how much these issues interfere with your specific military job. Profile restrictions, missed time from work, LODs, and anything similar will help your case.

In my amateur opinion it sounds like you would qualify for a MEB pending how much this has directly and measurably impacted your work.

Any opinion on bringing up the MEB first? Working with the NICOE makes me wonder if they'll continuously hesitate to consider it since they are a clinic specifically focused on treating TBI's and MEB recommendations may negatively impact them in some administrative way.

I recently built out the clear picture, following your suggestion, in a migraine tracking app to include the injury events, diagnosis, treatments/Rx's, and the HA/migraine events. Pushing the roll-up of all that info to my NICOE PCM. I did catch that I've only been labeled with "Heachaches, unspecified" so far.

I just feel like this is such a grey area and I am so skeptical of the terminology used and the clinical notes by some specialists; trying to get an idea of how this has looked for others, so I can best communicate with the specialists.

 

[DaveK]

Yes, you could discuss the possibility of a MEB with your PCM. Some are more willing to listen than others. Maybe consider presenting it from a standpoint of how much it interferes with daily life and your specific job. And the system is designed to give service members every chance at rehabilitation before the possibility of separation or retirement.

As far as I can tell you have 3 main challenges..getting a diagnosis of TBI if it only reads "Headaches, unspecified", getting the TBI diagnosis "service connected", and ensuring that the level of injury meets the standard for DoD purposes. It will have to show a 30% or more level for DoD retirement vs separation. If your paperwork does not clearly show these points, you could risk a non-service connected separation without MEB. Headaches/migraines by themselves could also possibly lead to a MEB process.

Added-- Look up the "8 year rule" for medical conditions. This could prove as a protection should they try to state your headaches are not service connected as you have 10 yrs active. The system tried to separate me without MEB at 19+ years traditional till my unit intervened.