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.

 

[k8l8]

Follow-up months later --

I completed my course of care with vision therapy - my migraines can be spurred by a lot of visual stimulation and sometimes auras to tip-me off that one is coming. Vision Therapy's clinical notes seem strong in capturing the correlation of my TBIs to ocular motor difficulties and the increasing frequency of my headaches. I had a key follow-up appointment with neuro-optometry and captured the continuation of ocular issues. Took this all to my PCM and pressed the increased frequency and debilitating nature of my migraines. Made a clear point that lifestyle changes do result in impactful management. I am averse to boxtox and medication due to pregnancy planning - with a scheduled timeline for assisted reproductive technology.

The big move now is that my PCM was willing to provide the referrals to the clinics necessary for a MEB. I got crazy lucky and snagged an appt with neurology for this same week.

Any recommendations or direction of how to go into this neurology appointment to best set myself up for the MEB process?

 

[Provis]

Follow-up months later --

I completed my course of care with vision therapy - my migraines can be spurred by a lot of visual stimulation and sometimes auras to tip-me off that one is coming. Vision Therapy's clinical notes seem strong in capturing the correlation of my TBIs to ocular motor difficulties and the increasing frequency of my headaches. I had a key follow-up appointment with neuro-optometry and captured the continuation of ocular issues. Took this all to my PCM and pressed the increased frequency and debilitating nature of my migraines. Made a clear point that lifestyle changes do result in impactful management. I am averse to boxtox and medication due to pregnancy planning - with a scheduled timeline for assisted reproductive technology.

The big move now is that my PCM was willing to provide the referrals to the clinics necessary for a MEB. I got crazy lucky and snagged an appt with neurology for this same week.

Any recommendations or direction of how to go into this neurology appointment to best set myself up for the MEB process?

I wouldn't focus on MEB so much. Focus on treatment and going over your options. The best way to getting a MEB is showing that you are trying and that trying isn't getting you the results needed to continue on in your military career.

 

[DaveK]

Follow-up months later --

I completed my course of care with vision therapy - my migraines can be spurred by a lot of visual stimulation and sometimes auras to tip-me off that one is coming. Vision Therapy's clinical notes seem strong in capturing the correlation of my TBIs to ocular motor difficulties and the increasing frequency of my headaches. I had a key follow-up appointment with neuro-optometry and captured the continuation of ocular issues. Took this all to my PCM and pressed the increased frequency and debilitating nature of my migraines. Made a clear point that lifestyle changes do result in impactful management. I am averse to boxtox and medication due to pregnancy planning - with a scheduled timeline for assisted reproductive technology.

The big move now is that my PCM was willing to provide the referrals to the clinics necessary for a MEB. I got crazy lucky and snagged an appt with neurology for this same week.

Any recommendations or direction of how to go into this neurology appointment to best set myself up for the MEB process?

I definitely would follow the advice of Provis on focusing on treatment and care over pushing for a MEB.

And I thought sharing a little bit of my own path might help. I too suffer heavily from TBI with various forms of ocular issues predominantly from serving as a bomb tech along with other separate head injuries.

That said, I found some relief through some special ocular doctors that took their time with me and ran me through lots of testing. We were able to determine that certain lenses helped me. And luckily one of those lenses is not even prescription. My eyes reject polarization based on the testing but I also knew that as it makes me dizzy and hurts pretty bad in a short period of time. However, specifically Oakley branded lenses due to their assembly layering process in the non-polarized prism form really seem to help reduce my symptoms. Prism being the key element. Specifically a rose or purplish tent seem to be the best. I remember wearing these in the beginning and it was a little challenging at first. But now my eyes have adjusted to them and it calms my symptoms significantly, reduces headache frequency and also helps with computer screens.

The second element that has been tremendous in helping me manage has been neuro-based physical therapy. In fact, I actually had to go back in for the last 5 months just to get more of that. Basically it's eye movement and retraining how one connects eye movement, orientation on Earth, and their physical body movements. It's called neuro-optometric rehabilitation.

I don't know that this will help you, but maybe it's worth a shot.

 

[k8l8]

I definitely would follow the advice of Provis on focusing on treatment and care over pushing for a MEB.

And I thought sharing a little bit of my own path might help. I too suffer heavily from TBI with various forms of ocular issues predominantly from serving as a bomb tech along with other separate head injuries.

That said, I found some relief through some special ocular doctors that took their time with me and ran me through lots of testing. We were able to determine that certain lenses helped me. And luckily one of those lenses is not even prescription. My eyes reject polarization based on the testing but I also knew that as it makes me dizzy and hurts pretty bad in a short period of time. However, specifically Oakley branded lenses due to their assembly layering process in the non-polarized prism form really seem to help reduce my symptoms. Prism being the key element. Specifically a rose or purplish tent seem to be the best. I remember wearing these in the beginning and it was a little challenging at first. But now my eyes have adjusted to them and it calms my symptoms significantly, reduces headache frequency and also helps with computer screens.

The second element that has been tremendous in helping me manage has been neuro-based physical therapy. In fact, I actually had to go back in for the last 5 months just to get more of that. Basically it's eye movement and retraining how one connects eye movement, orientation on Earth, and their physical body movements. It's called neuro-optometric rehabilitation.

I don't know that this will help you, but maybe it's worth a shot.

Thank you greatly for the follow-up and the insight to your route! It’s actually a bit similar to mine —

I have followed through with care from neuro-optometry that did result in some prism prescription and reader glasses. I had been regularly using them for management up until I discontinued use of the SNRI. After dropping the medication, the prism started contributing to my migraines, unfortunately.

Within this same span of a year, I’ve completed a course of care with WRNMC’s vision therapy, which sounds similar to your neuro-optometric rehabilitation. It was a love-hate relationship. Some days I could work well through the therapy; other days I was walking in not feeling 100% and began a migraine with auras shortly after beginning the therapy session.

To wrap it all up, after finishing my course of vision therapy, I returned to neuro-optometry to find that my eyes took a 180 and do the opposite of what they were doing when intervention began.

So, I guess I feel at a lost because the intervention from neuro-optometry, vision therapy, and others feels like the conservative end of the measuring stick. The doctors current giving me long-term medications or botox as my only options feels like conservative treatments have been exhausted…

 

[k8l8]

I wouldn't focus on MEB so much. Focus on treatment and going over your options. The best way to getting a MEB is showing that you are trying and that trying isn't getting you the results needed to continue on in your military career.

Through the last couple of appointments, I’m certainly to the marker of botox being regularly recommended for treatment ( or long-term medications ). I have gotten on board for adding vitamin B12 to my routine and a doubled up dose of my rescue medication, to have on hand.

Apologies for sounding like such a tart with “how do I best set myself up for a MEB”. It’s more so that I feel like botox or long-term medication are past my limit of conservative treatment.

If I’m not willing to opt into botox or long-term medication, where do I go from here? Is there a route for refusing medication like refusing surgeries? Is there any military regulations to support individuals who what to be minimal with medications/injections, that isn’t for religious reasons?

 

[DaveK]

Thank you greatly for the follow-up and the insight to your route! It’s actually a bit similar to mine —

I have followed through with care from neuro-optometry that did result in some prism prescription and reader glasses. I had been regularly using them for management up until I discontinued use of the SNRI. After dropping the medication, the prism started contributing to my migraines, unfortunately.

Within this same span of a year, I’ve completed a course of care with WRNMC’s vision therapy, which sounds similar to your neuro-optometric rehabilitation. It was a love-hate relationship. Some days I could work well through the therapy; other days I was walking in not feeling 100% and began a migraine with auras shortly after beginning the therapy session.

To wrap it all up, after finishing my course of vision therapy, I returned to neuro-optometry to find that my eyes took a 180 and do the opposite of what they were doing when intervention began.

So, I guess I feel at a lost because the intervention from neuro-optometry, vision therapy, and others feels like the conservative end of the measuring stick. The doctors current giving me long-term medications or botox as my only options feels like conservative treatments have been exhausted…

Sorry to hear it's been so challenging for you. While it's taken me years, the body finds ways to adapt. I hope that happens soon for you finding some measurable improvements. Don't give up.

 

[Vaz28]

I am currently in the IDES Process for Migraines.

I have suffered TBIs throughout my career with significant docs notes about the incident. NTC combat training but never had it documented due to being in the box. But I have been suffering with migraines around 9 years or so with TBI conditions (Dizziniess, Vestibular, Light sensitivity, ADHD worsening, memory loss, Nausea, neck and shoulder pain that radiates to lower back) I have seen the TBI Clinic and currently still see them for care along with multiple neurologists in my career (military and civilian referrals)

You can but it’s depending how the PCM wants to initiate it or wants you to continue care for it until someone supports the med board in my case the Neurologists Fully supported my Medboard.

Make sure you get EVERYTHING documented. I didn’t realize those little off time visits to ALL Docs mattered until I reviewed my medical records.