How to tramp with migraines

What I’ve learnt so far about tramping with migraines.

I often used to go tramping on my own, and had the occasional migraine alone in the wilderness. But that was before the migraines became very frequent – now I have migraines for around 10-12 days a month, that means for any longer tramp I go on (a week or more), the chances are, I’ll have a migraine on at least one day of tramping. Flicking through the notes I’ve taken on recent trips, I spot a recurrent theme. ‘Headachy on waking, turned into a full-blown migraine so took some pills. They worked after an hour or so but felt dopey and clumsy until lunchtime.’

‘Woke with neck pain and thought it was due to a bad sleeping position, but it soon became a migraine. Took a pill but it increased in severity. Felt yuck all day but pain only moderate so carried on with the walk for the day.’

So nowadays, I make sure I have company when I go tramping – and picking the right companion(s) is the first important step. They need to know about the migraines, be understanding, willing and able to help out if necessary. If I’m flaked out at the end of the day, my partner is happy to put up the tent, get dinner ready, inflate my sleeping mat and take on all navigation responsibilities (oh, hang on, he does that anyway).

Flexibility is the other crucial element. We always have a plan A, for what we’d like to do, a plan B for if I get sick, and probably a plan C as well. For longer trips, we’ll usually budget at least one spare day that I can lay up if I have to. We’ll pick tramps that can be lengthened or shortened depending on my state of mind. This is why I’ve never done a trip with a tramping club. I’ve heard too many stories of people who were left behind on club trips because they couldn’t keep up, and it was up to them to find their own way out. That sort of environment and those sort of people are not safe for me to tramp with. Most tramping clubs are not able to accommodate people with a disability on their trips, and migraine can be a disability that is invisible, making it even more likely to be misunderstood.

An example of a trip where flexibility was the mainstay of the experience was a visit to the Wilkin Valley and Gillespie Pass over New Year in 2016.

Day 1: We flew into Jumboland Flats on a brilliant clear, still day and walked to Top Forks Hut, which was actually two huts, perfectly located beside the Wilkin River and with views out to a snow-capped Mt Castor, which even at the end of December cracked off an avalanche or two while we were there. On the walk in, a migraine started forming behind one eye and temple, increasing in intensity despite downing every type of drug in my possession.

Day 2: Day-walk to Rabbit Pass. We’d planned this – spending three nights at Top Forks to explore. Because of my pounding head, I viewed the pass at a respectful distance, before stumbling back down the rocky track to lie down in one of the huts.

Day 3: Day-walk to Lake Diana and Lake Lucidus. I forced myself to walk up to these beautiful hanging alpine lakes, but lost the will to reach the third one (Lake Castalia). The track upwards looked like hell. Once again, I retreated to the hut for some quiet. It was New Year’s Eve but only one other couple was at Top Forks, so we took a hut each. At least my partner Tony had someone to talk to.

Day 4: Despite lots of time with the bunks, the migraine persisted. If you have never had a migraine, imagine your worst hangover. It feels like a knife is slicing through your head, you want to throw up, you can’t think, you just want to crawl under a blanket and close your eyes for a very long time. Now imagine you are in the middle of a tramp, it’s hours until you can reach a hut and days before you can finish. I trekked down to Kerin Forks Hut in a blinding haze of pain. One foot in front of another. But the skies were blue, the Wilkin River was exuberantly gushing and the trees breathed serenity.

Day 5: We had planned to reach Siberia Hut and dash up to Lake Crucible, a 7km side trip. I didn’t get further than Siberia. Tony did the Lake Crucible dash and comforted me with photos. I tried to sleep.

Day 6: Finally, I woke up with a clear head. We had several options. We could press on, as planned, over Gillespie Pass to Young Hut, and walk out the next day to Makarora, where we had our last night’s accommodation booked. This took us into the shadow of Mt Awful. I didn’t think I was up for that. The weather was fine and we knew the next day there would be hordes of day trippers flying into Siberia Hut for a turn about the wilderness. We could hitch a flight back to Makarora (i.e. pay half price for the return trip). So we did a leisurely walk up to Lake Crucible, Tony for the second time. He didn’t complain. It was spectacular.

Day 7: We wandered down to the airstrip in the morning, lounged in the sun until the plane could take us out, and spent the rest of the day wandering around Makarora. I missed out on Gillespie Pass, but saw so much beauty my mind was full.  

More about migraines

What is a migraine? Really, who knows. It’s a serious kind of brain fart. Something sets off the brain, maybe a change in neurotransmitters (the chemicals that nerves communicate with), or blood flow, or hormone levels, or nutrients, or… so many options. The end result is a pulsating, throbbing, stabbing pain in one side of the head, often befriended by nausea, fatigue, intolerance to light and sound, visual disturbances and lots of other symptoms to demonstrate that the brain is having a meltdown.

For example, my brain under the influence of migraine finds it difficult to process words. Sometimes I can think of a sentence but can’t seem to articulate it. Sometimes I have a concept of a sentence, but can’t think how to form it. This has helped to develop a saintly patience in my beloved partner Tony. The fatigue is extreme, often preceding the pain and lingering long after it. Every movement and every thought is weighted with lead. You lie down but can’t sleep. You get up and want to lie down. If you’re out tramping, you lean on your walking poles, crawl over obstacles that you would otherwise joyously jump past, and fail to navigate rivers with dryness.

Migraine affects around one in ten people, but more women than men. According to the Migraine Research Foundation, migraine is the 3rd most prevalent and 6th most disabling disease in the world. A little startling to know, then, that the first medication specifically designed to prevent migraine, was only approved in 2018 (CGRP pathway monoclonal antibodies). Before that, migraine preventive treatments had been second-hand drugs – anti-hypertensives, anti-depressants, anti-epileptics, anti-wrinkles (Botox). I haven’t tried the new CGRP wonder drug – I’m waiting, but not with bated breath because I might pass out. New Zealand is always the last to fund new treatments. I’ve tried pretty much everything else that is available, prescription and otherwise (if you want a list, it includes amitriptyline, nortriptyline, timolol, propanolol, atenolol, sodium valproate, topiramate, lisinopril, candesartan, pizotifen, verapamil, melatonin, venlafaxine, fluoxetine, ibuprofen, butterbur, riboflavin, magnesium, coenzyme Q10, feverfew, acupuncture, chiropractory, osteopathy, ayurvedic medicine, massage therapy, even cannabis, just quietly). None of it helped appreciably, and/or had unpleasant side effects. My episodic migraines persist.

Preventive treatments are supposed to reduce the frequency and severity of migraine attacks – but acute treatments are used to stop an attack in its tracks. I’ve had more success with these. Sometimes, aspirin or ibuprofen, maybe with the assistance of a stiff coffee, beats the migraine back. More often, I use a triptan (rizatriptan is my substance of choice). Mostly that works. Sometimes it doesn’t, and the pain can drag on for days. For me, this was commonly around my period – known as menstrual migraine. The relationship between female hormones and migraines is complicated – but for me, hormone replacement therapy has been a godsend. I do still occasionally get the prolonged, unresponsive migraines, but not every month. For those, I use a TENS machine to ease the pain – the cefaly. Tony tried it once to see how it felt – you can probably tell from his face. We call it the Wonder Woman device, but it doesn’t convey any superpowers, only a replacing of the migraine pain with a nerve-stimulating drill-like buzzing. You take what you can get.

A wee historical note – the triptans, which were the first drugs developed specifically to treat migraine, came to market in the 1990s, the same decade that saw the launch of Viagra, the blockbuster drug for erectile dysfunction. Hmm. Migraine is the 6th most disabling disease in the world; erectile dysfunction doesn’t even rate as a disability (unless you are a veteran in the US, where you may be eligible for a monthly payment for loss of a creative organ); but no one has to take time off work because they can’t get a hard-on (ok, unless they are a porn actor). Why was there not more research and drug development for a condition like migraine, that causes so much pain and suffering; and why was there so much research and drug development for a condition like erectile dysfunction? Hypothetical question: we know the answers.

If you want to know more about migraines, check out some of these links:

Gear list

What are we taking and how much does it weigh?

Very good questions. Not entirely sure, yet, but here is the latest estimate.

What we’ll wear while walking: T shirt (Icebreaker), shorts, socks (Icebreaker) and boots (Lowa), sunhat, underwear, walking poles (Leki), gaiters, sunglasses/glasses.

Gear carried in Osprey Ariel 55 l pack. This has no relation to the little mermaid, although the pack is kind of the same colour as Ariel’s tail.

Spare clothes: T shirt for sleeping in (Icebreaker), long johns (Icebreaker), underwear, shorts, down jacket (Rab), rain jacket (Outdoor Research), long sleeved top (Icebreaker), socks, neck gaiter (buff), beanie, sandals (Teva)

Camping items: Tent (Hilleberg), inflatable mattress (Thermorest), sleeping bag (Enlightened equipment), silk liner, inflatable pillow (Sea to Summit), cooker and gas, matches, mug, spork, pot, knife, sitting mat

Personal care items: trowel, towel, face cloth, toilet paper, hand sanitiser, toothbrush, toothy tabs (Lush), dental floss, soap (Ethique), sunscreen, lip balm, medications.

Food stuff: rubbish bag, dishwash liquid, dish cloth, tea towel, food bag and food, water bottles/bladder, water filter, shopping bag.

Other: Headlamp (Led lenser) and batteries, GPS, PLB, camera, phone, chargers, battery pack, first aid kit, nail clippers, earplugs/headphones, wallet, Backcountry hut pass, pack cover, notebook and pen, little book of NZ trees for botanising.

The goal is for my pack to weigh less than 15kg, fully loaded with food and water. The more we eat, the less it will weigh!