What a doozy of a topic to start my blog on, right?

I have chronic migraine. For those who have stumbled onto this post and don't know this experience intimately – chronic migraine is not just headaches. It's a debilitating, incurable, lifelong neurological disease. Migraines can involve stroke-like symptoms, light and sound sensitivity, nausea and vomiting, hallucinations, vertigo, brain fog, fatigue, joint and skin pain, sinus congestion, temporary blindness, and more. People with episodic or chronic migraine suffer from many migraines per month, sometimes even daily. We take a lot of prescription medications to improve our condition bit by bit. Even when your migraines seem well managed, a rogue atmospheric pressure shift, a strong smell, or stressful event can bring you right back into an episode.

Personally, I'm not willing to give up on my passion for gaming because of my disease. It's a lot harder for us migraineurs to enjoy this hobby, but I think it's still worth it to try if we are at a place where we're able. Whether you're an old migraine sufferer, a new migraine sufferer, or a friend of one looking to understand their experience better – I hope my advice can help you keep on gaming. And truth be told, I wrote this post to help myself keep on gaming, too.

I have included links to resources, none of which are affiliate links.

Step One - Know Your Migraine

I assume in the rest of this post that you know your triggers, what works for you, and what doesn't. But if you're new to having migraines, you might not know those things! "Welcome to Migraine" is a whole different post, but in the meantime...

1. Go to a doctor. Preferably a neurologist, preferably one that specializes in headache medicine. Migraine is a real disease, and there are medical treatments that help. If you're tight on money, some of the most common migraine medicines are really cheap, and community health doctors can prescribe them. There's no need to suffer without help.
2. Find your triggers. Keeping a headache diary helps this a lot.
3. Put your health first. Do not make your health worse in pursuit of this hobby. (Or at least, don't aggravate it so much that it outweighs the happiness you get from tabletop games. Sometimes in order to live with migraine you have to trigger migraines, and that's okay.)

Session Zero

Get Your Migraine Spiel Ready

If you're playing with old friends, you may not need to explain all the needs associated with your disability. But if you're playing with new friends, you'll have to explain it all to them – preferably during Session 0 if there is one, but if not, over whatever channel is being used to organize your first game.

Start the conversation by telling people you deal with migraine, and what that is – maybe ask if anyone else in the group has them or knows someone who does. Explain your triggers (and anything people can do to help you avoid them), plus your symptoms and any strange behaviors you might do to treat them, so people know what's going on when you pull a headache hat out of the GM's freezer. This is a good time to talk about absences as well. More on that later.

Accessibility Is Important!

This is a good opportunity to start a conversation about accessibility with the rest of the table, too. You never know when others might have needs they need to talk about, but didn't have the confidence to say first.

This is all contingent on one thing: play with cool people. If the people you're playing with are jerks about your disability, they don't deserve your time.

Migraine Logistics

Schedule Mindfully

This may seem paradoxical, but it helps to join games that play more frequently. That way, you have more chances to feel good on a game day, and it's not as big of a deal if you need to skip. If your group only meets once a month, it'll feel real bad when you have to miss three months in a row.

Additionally, if you tend to get migraines at a certain time of day or day of the week, try to join games that are during your better times or days. If you have a choice, play in games that are shorter (2 to 3 hours). This will require less stamina.

If you have limited rescue migraine medication, you will need to plan ahead. Count how many events you schedule in a month that may require the medications, and how close the events are together. If you schedule too many events, you may run out of medication or take them too frequently. This could affect the frequency of how often you can play.

Plan To Be an Absentee Player

Let your GM and all the other players know you may have to unexpectedly dip out of some sessions due to migraines before you start playing with them. Design a character who has a feasible in-universe reason to disappear from the narrative occasionally – and character plot hooks that are easier for the GM to throw in without much prior planning. Or, look to join in really deadly OSR games like Mork Borg, where characters are disposable.

Play a support class or a duplicate class with another player that will still help out the group when you're there, but not leave them hamstrung in combat if you are not present. Or, assign one of the other players to play your character in combat-forward sessions when you're absent.

You can also let your GM know ahead of time when you're reasonably certain you'll get a migraine. That may seem impossible – and true, it is impossible to predict when you will not have a migraine. But it is possible to occasionally predict when you almost certainly will. Maybe next session is scheduled for the day after you get back from a trip, during a week when work will be a nightmare, during a huge thunderstorm warning, or the day before your period (if you menstruate). Or maybe you're just doing particularly bad as of late. Give your GM a heads-up so they can make contingency plans, but let them know this isn't a guarantee you wont be there.

Can you keep playing with a migraine?

One may assume it's impossible. It's not always so cut and dry. We often exist in a state of almost-migraine – prodrome, postdrome, interictal, and that hazy state where the meds kinda worked and kinda didn't. Even with chronic or daily migraine, there are many times when you feel like crap but you can still partially function. And maybe, that means you can still play a game with your friends. You can sometimes hold these two opposite things in your body at once – physical suffering, and fun. Up to a certain breaking point, anyway.

You wont always have the same level of function even at the same level of migraine, and that's okay. Some days you just don't have the juice and you can't have fun and you need to rest. Some days it is impossible. But not all days.

Decide Ahead When You'll Tap Out

One of the hardest parts of chronic migraine is the uncertainty. "Am I getting a migraine or am I just [tired, hungry, etc]? How bad will it get? Will the meds work? Will I be able to get home? Is it worth it to stay with my friends? Should I stop playing or keep going?" And then even worse, your brain is foggy all the while.

If you make these decisions ahead of time, you can relax more.

Try out using the Traffic Light System even when it's not game night. This can help you evaluate when to take action to prevent the migraine from getting worse. You may decide to always take your meds and keep playing if you're in the Green – but if you're approaching the Yellow or Red (depending on your comfort level) you will get ready to go home or log off. You can set reminders to do hourly traffic light check ins so the migraine doesn't sneak up on you.

For more granularity, you can make yourself a little card with "if-then" statements. This will be highly dependent on your symptoms and the character of your migraines. Here is an example of my own if-then statements:

• Before I start playing, I will use my shades and earplugs.
• If I'm yawning a lot or shading my eyes, I will take my meds and continue playing.
• If I'm getting dizzy, I'll lie down for a bit, and continue playing.
• If my head is beginning to hurt, I'll take my meds, use a headache hat, and continue playing.
• If I'm slurring my speech, my head is throbbing, or I'm no longer having fun, I will log off or go home.
• If I'm feeling nauseous, I'll try ginger and crackers. If it continues, I'll take zofran. If it continues, I'll call it quits.
• If I suddenly need to go home and the drive is longer than 10 minutes, I will ask for a ride and worry about my car later.

Now, even if you get a migraine, you can trust that past you has it under control.

Your Environment

In Person or Online?

Though unintuitive, I think most migraine sufferers will find online games the most workable. It takes overall less energy and stimulation, as long as you don't find the presence of a dim screen to be too irritating. However, online games may not be as fulfilling as playing in person, especially if your group doesn't use good online play practices (hey, there's another future blog post!)

Prefer In-Person Games If:

• You find screens triggering.
• The venue is not noisy or overstimulating. Game stores might not be the best idea unless you're very sure you can handle them – but a library might work!
• The venue has the resources you need (freezer, place to lie down, etc).
• You feel comfortable and safe potentially feeling vulnerable around the people you're playing with.
• There is someone who can drive you if you are unable to drive yourself.
• Your migraines come on with enough warning you can get home if it's bad.
• You really don't love playing in online games!

Prefer Online Games If:

• You do better when you can control the ambient lighting or use green light therapy. (I recommend Hooga and Aloe for affordable green lights.)
• You don't find screens triggering, or are able to use them in dark mode or with a green tint.
• You need more control over sound and temperature.
• You need a place to lie down and an in-person venue cannot provide one.
• You are unable to tolerate a car ride or there is not someone who can drive you.
• Your migraines come on too quickly to get home from an in-person event.
• You don't feel comfortable potentially feeling ill around other people.

You Deserve To Be Comfortable

It can be scary to assert your needs, but you deserve to be comfortable and have fun too! If you are meeting in person and struggle with triggers such as scents, ask the other players to avoid wearing perfumes and explain that it can cause you a migraine, leaving you unable to play. Ask the host if they can keep the lights and music low. Speak up if the room is really stuffy or really cold. If it's not too big of a lift, you may want to offer to host the game yourself so you can control these factors more easily.

Be Prepared

Bring Your Migraine Kit

Pack your game night bag not just with rulebooks and character sheets, but all your migraine paraphernalia. Bring all your tools any in person game. It is better to always be overprepared rather than ever be underprepared.

• Rescue Medications. Bring all you got.
• Sunglasses. Or Avulux glasses if you have them.
• Bucket hat. I find this helps with fluorescents and ceiling lights.
• Earplugs. Earplugs meant for concerts are best because they maintain the fidelity of others' voices – I recommend the Curvd Live and Alpine MusicSafe Pro earplugs. I find they have better fidelity than the more popular Loops.
• Comfortable Clothing. It's game night, not a ball – wear whatever lets you have the most fun. It's much easier to have fun with friends while you're nursing prodrome when your clothes aren't itchy or tight.
• Jackets, Blankets, or Handheld Fans. Especially if being too hot or too cold is a trigger.
• Ice Packs. Or even better, headache hats. You can toss them in hosts' freezer or bring a cooler.
• Water Bottle. And/or ginger ale.
• Safe Snacks. Bring snacks that don't contain triggers, and some that are potentially bland if you find yourself nauseated. Salty pretzels, rice cake minis, fresh berries, or ginger snaps.
• Ginger Candy, Mint Gum, Etc.
• Alcohol Swabs. Rip one open and take a big wiff to ward off sudden bouts of nausea so you have time to make a....more graceful exit.
• Squishmallow. Okay, hear me out. These suckers are literally the best pillow when you have a migraine. There is nothing on earth that is more cloud-like to lay your head on. If you're able to keep playing curled up on the couch – it's worth it!

Stay Calm

Stress is a huge trigger for almost every single person with migraine. This is a silly little game you play with your friends. Avoid adding stressors before a game (think twice before you promise to bring Hors d'oeuvres!) Give yourself plenty of time to get ready without rushing around. Take deep breaths, before and during the game.

Make The Game Easier

We get brain fog and memory issues from both the migraines and the medications for the migraines. It's difficult to understand and remember rules, difficult to focus on reading, difficult to comprehend a character sheet, and difficult to make decisions based on them during the game. Not to mention, it's difficult to remember what happened last session, or 10 sessions ago.

This is an accessibility issue, and there are adaptations you can make to help!

Easier to Understand

When you pick up a new game, look for free Quickstart Rules. These are usually abbreviated and easier to comb through.

If possible, play games that are simpler for you. If you are very familiar with D&D 5e, play that. If you struggle with grasping the mechanics of D&D 5e, suggest to your group that you try a game that is easier, such as Shadowdark or Nimble.

You don't have to stick only to games you've played before, but consider your ability before commiting to a game. Don't sign up for games like Pathfinder or Lancer if you struggle to keep all those rules in your head. If you like narrative games but struggle to wrap your head around Blades in the Dark – just don't play Blades in the Dark. Don't torture yourself unnecessarily, even if the games you're skipping are "good".

Easier to Read

If you struggle with reading on screens, borrow or purchase physical books. If you need to use PDFs and you have the cash, get a large eReader like the reMarkable which can fit a whole PDF page.

It takes some fiddling, but screenreaders can be used to read game PDFs aloud to you. PDFs can be tough for screenreaders to parse – I find that NaturalReader is basically the only one that can do it right. However, if you have a game with rules available online or in an ePub or text file, apps like Audify and Speech Central handle them very well.

Use paper character sheets if that's easier for you – even if you're playing online. If you struggle with visual acuity during migraines, some communities have created special character sheets for people with dyslexia or visual impairment that could help you out, such as this one for D&D 5e. Some games have half-sheet character sheets that are easy to print larger on landscape paper. If reading dice is difficult, you can get jumbo dice sets from various retailers.

Easier to Play

Play a premade character when you play for the first time. Start with a class or archetype that has relatively simplistic gameplay. If the floor for engagement during a game is listening to other people's and then saying "I hit them with my sword" when it's your turn, that's way easier to do when you're feeling foggy than deciding which spell to use.

Find yourself some reference sheets. Type "[game here] Quick Reference Sheet" into Google or ask your GM if the game came with one. You can ask another player to buddy up with you and plan to help you out when your brain has left the building.

Easier to Remember

It's probably best for you to not be the designated note taker in your group. However, taking little notes for yourself can help with your memory. Don't try to recount every session. When you learn something important, meet someone new, or get a new item, write it down as briefly as possible, preferably in a notebook you always bring to game night with you. For example:

• Titivillus – serves Dispater (2nd layer), little pointy horns
• Bullette scales – from tower dungeon, for crafting?
• Package – cursed if not delivered 30 days

Easier to Run

Being a game master with migraine could be an entire post in and of itself – and in fact, it will be! Stay tuned for part 2.

Grief.

You may be disappointed you can't engage as fully or as often in your hobby as you once did or wish you could. Or maybe you read all that and thought, "Damn that’s a lot of work, I don't know if I can do that. I guess I’ll take up crochet instead." That's a totally valid decision, and one only you can make.

I don't want empathy for my fellow chronic sufferers to go unspoken. Some of us are so sick that none of this is possible right now (and nearly all of us have been, or will be, at some point.) Maybe the best you can do right now is listen to critical role, or read a new OSR zine and dream. That's okay. That's still doing the hobby.

I don't want to give the impression that if you just Do All These Things, you can be a Normal D&D Player and your migraines wont screw it all up. My migraines take pieces of my life and passion and joy every day. I don't get to have a normal relationship to my hobby – or anything for that matter – and I don't expect you will, either.

Sometimes I have to let myself grieve. Not chastise myself, or look for something I screwed up – as I often do – but I just have to be sad for myself and what I've lost. Then it's somehow easier to figure out how to keep going.