(updated 12/10/1999, or later)
It irks me, although it probably shouldn't, when someone gives one of these mildly melodramatic waves of their hand toward their head and says "Oh, I've got such a migraine headache." and then continues moodily along with their business. This is not a migraine headache. A full blown migraine headache, as I know and hate them, feels like someone has tossed a hand grenade in your ear (first reinforcing your skull so that the explosion simply reverberates around and around in your brain, not finding an exit). It is debilitating. You do not go on about your business. You collapse on the floor; if you attempt to get up you fall down, head first. You vomit. You suffer -- and you wait.
The intense part of the pain lasts for 12 or 16 hours; if you're lucky you get some intermittent sleep with your head buried under a tightly clutched pillow. Your awakenings are characterized by trips on hands and knees to pray for relief at the altar of the porcelain god. Surprisingly, for me at least, he grants it, temporarily. Throwing up offers me some brief reduction in pain and the room quits spinning for a while, hopefully long enough to become unconscious again -- but I pay for it in the next stage.
Eventually the main headache subsides and is replaced by localized throbbing, disorientation, weak limbs, motion sickness and lethargy. The depth and length of this stage seems to be proportional to how much you give in to stage two. Each bout of relief gained through realizing your nausea adds a couple hours. Each hour of sleep stolen in stage two is paid for, 2 for 1, in stage three. Since you've forced yourself to sleep during most of stage two now you can't sleep soundly through stage 3. You're restless and uncomfortable for the next 24 to 48 hours. It's a discombobulated, frustrating waste of time but at least it's not Hell.
You may have noticed that I seemed to have forgotten Stage One above. Actually I just deferred it. In some ways stage one is the most insidious portion. In a classic migraine the sufferer-to-be gets a warning, typically 20-30 minutes before the real pain starts. Once you've learned to recognize the signs of "The Aura" the anticipation of the imminent ache can be maddening, like something out of an Edgar Allan Poe short story (see "The Tell-Tale Heart" or "The Black Cat"). It begins with bright lights at the edge of your vision and an increased sensitivity to man-made lighting. These hot spots will be off the center of your vision, out of focus, often lost in the complex tapestry of the real world. However, should you look at an empty wall or a blank white sheet of paper these hot spots will become more evident blazing up like balls of lightning burning inside your head, a prelude to the booming thunder on your personal horizon. But this vicious threat, this "Aura" is also a migraine's undoing -- if it is taken as a harbinger, as a warning.
I'm not chronic. I understand some people get these things frequently, some more than once a week. It must make life difficult, although there are a number of new and very promising drugs (see the link below). I'll also apologize now for my irksome nature above, if anyone is still reading who gets what is known as "common migraines" they are typically more frequent and much less severe than the "classic migraines" I've described above, and so you could well go on about your business.
For myself, however, it's the classic variety that is at issue. Looking back I think my first, somewhat mild, migraine occurred during the days when my mother dropped me off at college; the first time I was really on my own. I didn't recognize it then. The next one I remember was about five years later. It scared me. I really figured I had a brain tumor exploding inside my skull, and I was alone. I got home to mine and Madelyn's apartment and got my sister Cathi on the phone. Maybe my mother, too. I don't remember. I do remember that someone recognized the symptoms and told me the bad news: "It will pass." So I rode that one out, and several more over the next few years.
I got one a few days before I proposed to Madelyn. I got one on my first airplane trip job interview (this one I had to fight through actually during the interview; it turned out to be not as severe as some, this was a clue that I missed at the time; I didn't get the job). It became obvious that they were stress related, although I couldn't always identify the stressful agents. (Migraines have all kinds of triggers: stress, lights, food (notably chocolate and MSG).) Then I got one on vacation. Vacation? And that happened again -- okay so they're related to changes in stress levels, not just high stress.
Then one came on while Madelyn and I were walking in a park. A big park. Valley Forge National Historic Park to be precise. 3,600 acres of park. We chose a trail which gives a view of most of them, a five or six mile walk with no cars allowed. About a half way around "The Aura" appeared. Damn. What to do? Send Madelyn to talk the park into letting her drive in and get me? One of the problems with migraine's is that there is no visible sign of injury. If my arm was broken and the bone protruding there would be no questions, but "My husband has a headache, can I drive in and get him?" is a bit less sympathy garnering. Besides, it would take her a good while to get back to the car and longer to return to me. Maybe the aura stage would last for a while and I could tough out the rest of the way back to the car?
Well that's what we tried and it worked wondrously. Oh, it was an effort. I stumbled most of the way half in delirium. But the fresh air, circulation and mind-wanderings of the walk seemed to be helping. I kept my cookies. It took an hour and a half to get back to the car. It was strange but I felt almost like I was entering stage three already. Could that be?
It hasn't always worked and it's always an effort to recognize the impending onslaught and get up, get out and walk. It's best if it's cold or cool out and if you don't try to go anywhere in particular. Just let your feet take you. I've expected sometimes to be found incoherent in a ditch miles from home. It hasn't happened but I always carry I.D. -- and my health insurance card.
My most recent battle happened during this past Thanksgiving week (1997), on vacation again, this time at Madelyn's home on Staten Island. It's not exactly Harlem but it is part of The City: graffitti, pollution, bars on storefront windows, gruff people, traffic, homeless people, pot holes, the whole deal. I woke up with a mild headache, popped a Tylenol and ate breakfast. Then, what's that? Whose flashing the lights? Madelyn asked, "Is it a migraine?" I said, "No, I'll be all right." Then I thought, "Oh, crap;" as my knees hit the floor. "Could you get me my coat?" I managed to ask and bumbled out the door.
It was cold. It was crispy cold. I pulled my hat and gloves on and started around the block as my brain tried to seize up. Two trips around her block yielded no change so I headed down a longer street, toward the business district on Forest Avenue (at Barrett Ave). Someplace past the Pathmark grocery I started to sing. Well I don't really sing on a good day but I started to recite lyrics with a tune running in my head at least. Jimmy Buffet's "Changes in Latitudes, Changes in Attitudes" seemed to fit. When I ran out of lyrics that I knew (about 2 mangled verses) I began making them up. I expect I was a sight and a sound, in my ancient, but warm, blue down jacket with the broken zipper and my maroon ski cap (also over 15 years old). But then not an atypical sight and sound for those streets. I won't pretend that I know what it's like to be homeless. But I walked a lot more than a mile in what must be similar shoes. A disorienting pain obliterating your capability to string two complex thoughts together, penetrating cold and a fixation on what you can grasp at the moment: walk and find the next line in your mumbling. What rhymes with "heart"? The cars will stop, won't they? -- I'm crossing; keep going... build on to "The Migraine Mumble" . After a couple hours I felt stage three looming and stopped into a seven-eleven and purchased a lotto ticket, before ambling back to Madelyn's. I hit three numbers. Not a payoff, but the best I've done in a while. I wish I had had a portable tape recorder with me. I'm sure I could have cobbled the best 8 or 10 stanza's into a decent poetic lyric -- but most of it is lost to the streets of New York.
For what it's worth, this's what (usually) works for me. When "The Aura" arrives: Get up. Get out. Walk. And begin "The Migraine Mumble" . I hope it works for you too.
For plenty more information on brains in pain: Migraine - Doctor's Guide to the Internet
Addendum: I've since gotten myself a prescription for Imitrex (GlaxoWellcome's brand of Sumatriptan), one of a number of new drugs which work well for some people. It's nasty stuff that I inhale and it has it's own tendency to make me want to puke, but it has stopped a couple migraines for me in the last year (1999) and I plan to stick with it for now.
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