Mirtazapine on A long dance with Rona

Migraines and the headaches 💊

Tue, 12 May 2026 00:00:00 +0000

The migraines and mental health issues

Migraines have been a constant companion throughout this journey. They were always there in the background, but over the past several months, they’ve moved to the forefront. Between the vestibular issues, the autonomic dysfunction, and whatever else my nervous system decides to throw at me on any given day, the migraines have become one of the most debilitating symptoms I deal with regularly.

Worst. Crash. Ever.

With the latest crash, it has led to severe panic attacks, and unresponsive benzo treatment to say the least. Additionally, the depression and anxiety have skyrocketed. I have gotten to the point of nearly giving up, almost like I did early on. I feel incredibly hopeless, and am working on this with medications, family, friends, support networks, and outpatient mental health services as best I can.

I say this because if you need help yourself, get it. If you need to be admitted, do it. We may feel very alone in this fight, but we’re not, and we need everyone we can get to work on getting through this together.

Emgality

I started Emgality last week, which was a trade from the Scripps drug trial injections (with everything getting worse, it was on less medication to manage - no idea if it was working). The latest injection is a CGRP inhibitor — basically, it targets a protein involved in migraine signaling. The hope was that it would reduce the frequency and intensity. So far, results have been interesting. Some days are better than others, and it seems to be trending better.

Pramipexole

I’ve been slowly titrating up on this (currently at .75 mg), with the hope of reducing RLS (which came back again a few months ago). Sometimes the RLS is controlled, other times not. It is hard to know what is helping here, but I think this also helps with mood and the headaches.

Xolair

I’m still taking monthly Xolair injections as well; which seemingly addressed the headaches pretty quickly in the early days last year (but not the neck pain). My IgE numbers doubled after a stopped this for a few months, but no more. I will be doing these shots at home monthly.

Mirtazipine

The course of this was paused during outpatient mental health stays. I am on 15 mg again, and sleep seems to be returning to near baseline. I still cannot nap (that’s crazy town for the part; mixed thoughts, not awake or asleep).

A few other med changes, but everything is up to date under my [[treatments/index|Treatments]] page. Of which I’ve had some medical journals to show potential efficacy (not medical advice).

In conclusion

The PLF surgery did go well (what’s a 4 hour vestibular collapse to a former runner anyway?). I worked on a draft of this, but I’m not ready to post it yett; some unknown variables yet that I need answers to.

I hope everyone is doing okay, this is not a pleasant experience to navigate. I’m losing my own identity at this point, as well as family and friends (of which I do not fault).

End of year update 📋

Sat, 10 Jan 2026 00:00:00 +0000

Where have I been?

Whew, 2025 is over, and I have been neglecting things here. My apologies! I am still working full time, and the holidays have been crazy. I managed to get through Thanksgiving masking, Christmas Eve and Day but ended up in the ER on December 25th (more on that later).

Drug Trial Update

I started either a placebo or tirzepatide on January 6th, 2026. There are a combination of emotions: scared, excited, worried about side effects, or, if I get the placebo. No matter what happens, unless the side effects are intense, I will take the weekly injections for the purpose of being a participant.

I will not be updating much about this for the remainder of the trial unless something drastic changes; after all, it is a double-blind trial. I’m really the perfect candidate for this. Adderall never works the same day to day (sometimes it suppresses appetite more often), and mirtazapine makes me binge eat occasionally (and now Hayley Williams singing Mirtazapine is stuck in my head 😄). No idea if it is tirzepatide, placebo, or the meds I’ve been on!

December ER visit

I did not mention this here yet; I have been back to ENT for ongoing tinnitus in my left ear and mild hearing loss. It is a swooshing sound and is triggered both when I look right and also at random. Additionally, my last audiology visit back in the early days of long covid picked up pretty minor unilateral hearing loss.

I had a weird episode where the tinnitus was so relentless, and I got pretty dizzy, and overall symptoms were changing (has never happened before). I was leaning toward waiting it out, and of course, in hindsight, that would have been fine—but not something to mess around with (thanks, wife). Furthermore, I made it 8 months without a visit to the ER, which kind of bums me out going back—but it’s worthwhile, even though we all know where this is going.

The ER doctor was interested in post-COVID issues and did a few out-of-band tests (after asking) for them to really understand my symptoms. While I appreciated that they were understanding and offered to help in any way they could, they were like the 8th doctor I’ve seen who, after doing some vision tests, said, “Man, that’s wild. You have divergence, double vision, and are cross-eyed—it’s like your brain just won’t let your eyes track well at all.” That’s cool that you all see and confirm these problems, but I actually want them fixed; it’s been over a year 🥹

I had a head CT with and without contrast and labs before (to make sure my body can properly expel the radiation from it). I have never had a CT in my life before this; it was impressive how quick it was. The warm peed your pants feeling wasn’t too bad with the contrast and faded pretty quickly.

In conclusion

The radiologist compiled the report and sent it to the ER doctor. Nothing notable other than normal wear and tear, arthritis of the neck (I’m 43; this is not normal), and mild congenital deformities that shouldn’t cause major pain or issues like I’m experiencing. Onward we go.

What a crash feels like these days

I have been having crashes every few weeks all through last year. Lately they haven’t been too brutal. But when I forget to take medications, they hit hard. For example, I didn’t take my mirtazapine (or Remeron, or as I call it, Car Ramrod), guanfacine, or glycine last night. I didn’t really sleep at all—severe rebound insomnia. I felt like crap and like I was nearing zero most of the following day. Pulled it mostly together with a short nap. It’s crazy and depressing to think that my body gets so messed up without medications. I wish it didn’t have to be like this.

The moral of the story is to make crashes less severe. Take your meds. Nighttime meds are harder for me; my stimulant has worn off, and I always have a million things to do before I go to bed. It’s been hell to live life normally before this, and now it’s all around worse.

I hope to get better at updating this more frequently. Instead of scrolling social media over and over again (thanks, Adderall!). Here seems to be a much better place for my mind to be.

Talk of circadian rhythm 👨‍🎤

Thu, 04 Dec 2025 00:00:00 +0000

Talk of circadian rhythm 👨‍🎤

Sleep has been something that eluded me, it was like falling down a cliff in December 2024. It started with waking up at a 6 am (instead of a minute before the 7 am alarm – almost always my norm). Then 5 am, 4 am, and landing on about 2 am. When that was done, it turned into falling asleep becoming a problem. When I thought that was the worst of it, the panic attacks started. Profuse sweating, heart palpitations, impending doom, namely death. My body was on high alert, but it didn’t know what to fight.

An invisible enemy, that Rona

I’ve always been a fighter of danger. Sick? Rest and exercise carefully, paying attention to my body. Spinning out on black ice in the car, calmly brake and make slow corrections. Someone with a weapon? Grab and clear the weapon, and fight. My brain didn’t even think, it just did these things before. But there was no black ice, person with a knife, or a normal viral infection to fight. Rona is an invisible enemy, I had to find a way to fight it for me.

Benzodiazepine the life preserver I hardly knew 🛟

What pulled me through this back then was a spouse who knew I needed it: Xanax. Nothing that worked before for addressing rare sleeplessness. This includes, and am certain not limited to, melatonin, Benadryl, CBD, CBN, THC, and trazodone (knocked me out while completely clogging my sinuses, so I’m forced awake). Gabapentin and Lyrica helped early on, but gave me uncontrollable tremors even on low doses, and their efficacy seemed to wear off within a week (I did not want to keep going up).

Back to Xanax: with two screw caps of 5 and 10 pills, it lasted me six months (with some to spare). It shut my mind down so I could sleep. At first, it was 3 – 4 hours, but inched back up to 7 (my normal) after adding a more long term sleep option.

Going to battle 🥷

In January and February, I hit the sleep thing as hard as I could. Sleep phycologist (and everything that comes with that) ✔️, inpatient sleep study (nothing found, other than poor sleep) ✔️, and a psychiatrist to prescribe heavy hitting sleep drugs ✔️

What I found for me was, it’s a very complex problem. Anxiety wasn’t and still isn’t helping, and it fed off insomnia and made it worse. Xanax is not a long term solution, so I moved on to Lunesta (or as some call it, baby Ambien).

After being on Lunesta for about 7 months, I switched to Mirtazapine 7.5 mg, and it is where I still am.

What worked for me, kinda

It is an ongoing deal with insomnia. What works for one, doesn’t work for all by any means.

In order to put myself in the best possible path to success with sleep, I hit every area I could. And, I typically fall asleep fast 90% of the time. I still have occasionally wake ups. No one thing solves this for me. If I don’t take Mirtazapine, I wake up around 2 - 4 am, and have trouble getting back to sleep (those buggers are small!).

Blackout shades
Foam ear plugs
White noise
Comfortable eye mask
Logging sleep with a tracker (if it doesn’t cause anxiety!), or written - helps with false insomnia, and to try to gauge what helps or hinders it
Night guard to address TMJ while sleeping
Keeping the temp cool (67 degrees Fahrenheit)
Getting up and reading or moving to another place if awakened too long
Mirtazapine 7.5 mg
Occasional CBD with low melatonin gummy (bumps up falling asleep faster, and increases REM slightly)

The bottom line

Insomnia is unique to the individual. It requires a ton of trial and error for each case. It is trying one thing at a time for a couple of weeks, which requires a bit of upfront work and planning.

I have met folks who say even Xanax doesn’t help. For me, early on, almost nothing worked. Time and having the brain heal are important too - that alone is a hard thing to accept, I still struggle with that.

If you’re struggling with sleep, I encourage you to reach out to specialists and address it. It was a huge weight pulling me down early on, and having it mostly controlled gives me time to address other symptoms.