Through the Looking Glass

I have experienced migraines all of my life.  At times they have plagued me by both their intensity and their frequency, but thankfully as I have aged they have abated somewhat and they no longer immobilize me the way they used to.  Perhaps this change is due to more consistency in my life: engaging in regular exercise, a healthy diet and striving for adequate sleep over the past several years.  That being said I had a doozy last week that put me in bed for an evening and required four milligrams of dilaudid to compartmentalize the pain.  Several days later I am still not quite right.
 
Over the years my migraines have gone from terrifying to inconvenient - at times a major pain the ass.  The discomfort is nauseating but the aura (the prodromal stage) is surreal and at time dangerous.  Whenever I experience the visual cues that alert me to the fact that shortly I will be experiencing distress my reaction is always the same: "Of course! No wonder I haven't felt myself for the past few days. That is why I can't think straight and words are being trapped in the firewall between my brain and my mouth (otherwise known as aphasia)."

The aura is not the same for all migraineurs but there are shared characteristics for those who experience hallucinations in the prodromal phase. My experience is this:  My vision becomes blurry in a way that is similar to my glasses being unusually filthy so I remove them, see if they are smudged and then look at the exact same person, landscape or object that I was viewing seconds before sans glasses as a test.  If the blur remains then I am in for a show.

If I were looking at your face half of it would disappear and your visage would be framed by a chain of jagged pulsing geometric shapes (usually a preponderance of triangles) that are not unlike the gas light liquor signs found in the window of a corner bar.  The reds and greens dominate the blues  and yellows in this broken picture which accompanies a tightening of my jaw that begins at the occipital bone. The band of tension envelopes the temple on the opposite side of my skull from the eye that is most effected by the hallucination.  This tight polar vice is the precursor to the ice pick ramming sensation that will work its way like a worm from the inside of my rotten apple brain out through my sinuses and the soft palate of my mouth.

Often times there is an overlap between the aura and the onset of the freeze dried number 20 rusty nail driven through my skull.  This is the dangerous time because I can't really see and the pain zaps any meaningful ability to focus.  Driving is out of the question and walking is not much better.  When I was a full-time carpenter and a migraine showed up at work I had to step away from the chop and table saws for fear of losing a finger or a hand.  Once the pain takes hold the aura usually disappears.  If it fades gradually that is good, but it can stick around for the duration or it can leave and come back for a second round.

Migraines are fickle and therefore unpredictable.  In my case they can last for a few hours or the better part of a day but the remnants can be felt for a week.  I have learned much about pain management through migraines.  As a child they terrified me, not so much because of the aura but because of what those shapes and colors portended.  Into my thirties I used to throw-up every time I got one but I haven't done that for several years.  Opioids work well for me because they don't upset my stomach.  The newer drugs don't help and the two times I tried Imitrex I felt like the drug was damaging my nervous system.  The strange thing about controlling the pain is that it doesn't go away, with the right drugs you are able to package it, put it on a shelf and gaze at it.   Migraines have taught me to notice the boundaries of discomfort so that I can make decisions about how to work around them.

Out of body experiences (OBEs) are common amongst migraineurs and I am no exception.  When I experience a migraine I (the me that is not physical) separate from my material body and the more sickening the pain becomes the farther afield I wander from my corpus.  I don't know if this is my body's healthy response to the situation (physiological dissonance/neurological denial) or it is another biochemical result of the cause of the migraine, which has been likened by neurologists to an electrical storm in the cerebral cortex.  This hyper stimulation of the brain, raises blood flow by 300% followed by a below normal flow which sets off a chain reaction that alters serotonin and norepinephron levels throughout the brain.

For days after a headache the thought of chocolate or alcohol, two things I love, makes me ill.  And any time I see an MC Escher print I have to look away.  The first time I walked into the Loebe Library at NYU I thought I was going to throw up.  The first floor (the flooring) of the library is a massive Escher print made of stone inlay. I wonder if he was one of us.  Lewis Carroll (Charles Dodgson) was and apparently Through the Looking Glass and What Alice Found There was migraine inspired. And the hallucinations experienced by migraineurs has a medical term: AWS (Alice in Wonderland Syndrome).

There are two noteworthy books that I have seen excerpts of (and recently ordered on line) discussing the subject.  One is titled Migraine by Oliver Sacks and the other is a compilation of art and essays by migraineurs entitled Migraine Art by Clause Podoll.  If you are curious about the visual experiences associated with a migraine google Migrain Art - there are some disturbingly accurate depictions of an event.

The triggers for migraines are varied and for me coffee plays a significant role.  Last week I  exceeded my caffeine thresh hold by drinking a cup of coffee which is a rare occurrence.  After 50 years I now know that my body has a limit for both caffeine and stress which I cannot overstep without experiencing tangible consequences. Irregular sleep patterns - too much, too little, variations in bed-time and wake-up are triggers as are food, sunlight, smells and travel (probably because it involves the aforementioned).

There is a genetic component to this mystery that causes our ion channels and pumps to malfunction.  Ion pumps and channels are the mechanisms by which our cells ingest and expel select ions across the cell membrane that determine PH balance and the firing of neurons in addition to functions that are too numerous and complicated to discuss here. The migraineur's mind is wired differently (termed channelopathy or malfunctioning ion channels) from those who do not have this anomaly.  Our brains are "hyper excitable," which means that they do not function the same as a non migraine brain even when we are not experiencing a headache.

There is something positive to be gained from a migraine.  There is a true sense of being reborn upon the cessation of pain and visual impairment.  I often feel more creative and amorous following this experience.

So why am I putting this in my blog?  Because our abnormalities are important aspects of who we are.  We all have our issues and although we don't discuss them readily with others learning about them is more important than how much weight we lift .  Our differences are our strengths.  Through acceptance and understanding we become greater than our stumbling blocks and the lessons we learn can be used to face future challenges.  What have you learned from your exceptions?

"And then there's the butterfly," Alice went on, after she had taken a good look at the insect with its head on fire, "I wonder if that's the reason insects are so fond of flying into candles - because they want to turn into Snap-dragon-flies."
Lewis Carroll