Anatomy of a Migraine . . . From the Inside Out

People often ask me if I went into headache work because I have migraines.  No, that wasn’t the reason. But it wasn’t like I hadn’t witnessed migraine throughout my life as both my mother and my sister had migraine with aura.

But, eventually I did develop migraines.  The first one was when I took a strange job where I worked until 3 AM and then went home and tried to sleep . . . but couldn’t.  I awaken every morning, about 10 AM (after 5 hours sleep) with a migraine.  It wasn’t severe, about a 6/10.  When I went back to a normal schedule those went away, so sleep pattern change has always been my trigger.

So, throughout my life my headaches have been infrequent, so infrequent that I wouldn’t routinely mention it to my patients because their’s are so much worse.

I have been fortunate to have had about 4 severe migraines in my life (all sleep pattern change related) and I mean it when I say “fortunate.”  These experiences have taught me more about migraine than years of training.  I know exactly, from a visceral level, what patients mean when they say “I was sensitive to light and noise.”  I also know what they mean when they say they were incapacitated because I’ve been there.

My worse migraine ever, maybe until yesterday, was at a headache meeting in Las Vegas about 15 years ago.  It was another sleep related trigger.  I was in a level 10/10 pain and severe nausea, vomiting and extreme vertigo (the first time ever I had vertigo with a headache).  I was alone in hotel room and there is now way I could walk to the bathroom to vomit and had to do so in my trash can beside the bed.  There was no way I could have walked down to the street and then caught a cab to an ER.  I felt so awful that I was afraid I was going to die.  Then I felt so awful (when this had dragged on for hours) that I was hoping I would die to give me some relief.

I remember considering calling the hotel physician or even 911, but I honestly didn’t want the noise of them coming in and banging around and talking to me.  I had no medications to take so I laid in suffering for 24 hours.

The next day I was still wiped out but I felt so much empathy for my poor patients who live though this over and over . . . once a week, twice a week or more.  I was terrified that my headache would come back. So I can’t imagine how terrifying it is that any day you could have another . . . whereas for me, it is once every few years.

Well, yesterday, Thanksgiving day, I had a repeat of the Las Vegas experience.  This time I have no idea as to why.  I had gone to bed at a reasonable time. I had a good night sleep. I actually awaken feeling well, so well that I was contemplating going on a 7-mile run.  But as soon as I got up, the horrible vertigo hit me (only the second time I had vertigo with a migraine).  I HATE vertigo even more than pain.  Soon the nausea ensued and photophobia and phonophobia both came on before the headache.

My wife had to get busy preparing the Thanksgiving meal and I didn’t see much of her for the day.  I spent the entire day in bed in agony. I got up twice to stumble to the bathroom to vomit.

This time I did have some mediation . . . actually my wife does.  She sufferers from menstrual migraine and her primary care had given her Imitrex and Relpax.  I hesitated to try either (and I’ve heard patients tell me the same thing) for two reasons. For one, I wasn’t sure I could make it to the bathroom to find it. To look for it, I would have to turn on the lights.  Secondly, I had a fear the medication would make my headache worse and that terrified me.  I have not taken those medications before while I have taken Amerge and Zomig without any side effects but I didn’t have those.

It was hours later that I was able to get on my feet to stumble into the bathroom.  I had to stop and vomit along the way.  I grabbed the Relpax took it . . . and then vomited it up.  No sum gain for my efforts.

By 9 PM I felt my symptoms lifting by 25%, enough to allow me to think.  I felt fear.  I felt fear that this awful nightmare wouldn’t go away, or that it would come back.  Could I become like my patients who suffer so much?  That’s what terrified me and I related so much to them describing what we now call cephalgiaphobia.

I also related to my patients who drive themselves crazy trying to figure out the why.  What happened inside my head was enormous, effecting my senses in a profound way.  Why?  What was different between this day and the previous day?  Why did my brain go nuts like this?  I want to know why.

Now, having spent my life in headache work and going to about every scientific meeting on headache for the past 30 years, I know far more about the pathophysiology of migraine that 99.9% of even medical practitioners.  Yet, that wasn’t very satisfying.  We still don’t know a lot such as the triggers inside the brain. My mind started to race to explore every thing I had done the day before, what I had eaten, the weather, stress . . . anything. But I knew that there were no easy answers.

While some, like my family, see my migraine as having ruined an otherwise, good Thanksgiving.  I’m just glad I was in my own bed and was a day when I didn’t have a full schedule of patients depending upon me.  But I learned more about the suffering than any lecture could give me.

I’m sorry about the typos above but I’m still not feeling well and want to get away from the computer.