The Migraine Brain

by Bernstein, Carolyn; McArdle, Elaine

  What Migraine Is Not

  Throughout the centuries, migraine has been one of the least understood yet most common diseases in humankind. There has been a great deal of misinformation about migraine, some of which persists even today, including a widespread blaming of migraineurs for exaggerating their illness or making themselves sick. In the 1950s, when psychoanalysis was in full bloom, one doctor suggested that migraineurs were sexually repressed and jealous of intellectuals!

  Migraine is not a psychiatric problem. It is not a result of hypochondria. It is not the fault of the person with migraines. It is a chronic, neurological illness you were born with. You can’t cure it. But you can minimize its effects on your life.

  Don’t listen to anybody who downplays the seriousness of your disease. And remember: You have a right to make treating migraines a priority so you can lead a happier, healthier life.

  A Strange, Fascinating Disease

  Unlike most other illnesses, migraine has enormous variety in how it affects people, and the symptoms can be really strange and seemingly inexplicable. If there is any saving grace to migraine at all, at least it isn’t boring!

  As you come to understand the personality of your own migraine, you may be surprised at what you find. Certain things about yourself that you never understood—incessant yawning at odd times, or sudden euphoria or craving of sweets—may be directly related to migraine.

  In his classic book Migraine, Oliver Sacks describes patients with very unusual symptoms: a cautious motorcyclist who, before a migraine attack, would drive wildly, singing and shouting; a teenage girl who, during an episode of aura, giggled nonstop for forty-five minutes yet couldn’t speak or understand language; a man who during a migraine attack was wide-awake and hallucinating that he was on vacation.

  In most cases, we simply don’t understand the physiological basis of these symptoms. But they are interesting to share. So, if you think your migraine is weird:

  “When I’m recovering from a migraine, I always have a savage craving for salt. I eat bowls of salted pasta. That has the happy effect of wiping out what remains of the headache.”

  —Maddy, 41, home-schooling mom

  “I woke up with a migraine on Friday but I had stuff I needed to do, like going to Target to return something. When I got there, I had to put my PIN number in but I couldn’t remember it, even though I’ve had the same PIN for years. I said to the woman, ‘I’m really sorry, I need to step away for a minute.’ I stepped aside and burst into tears, which sometimes happens when I have a migraine. And as soon as I cried, the migraine went away. I felt better for four or five hours. And this is not the first time that has happened.”

  —Bethany, 32, graduate student.

  “I was seventeen years old when I got my first migraine. This was back in 1972, and I was sitting in church, in a youth group, when suddenly I couldn’t see. It was really weird. If your frame of vision is like a television screen, all I could see was the bottom left-hand corner. Everything else was blacked out. When I tried to talk, the words didn’t make any sense. It was like, ‘Pink yellow car shoe boy.’ And I couldn’t see. They hospitalized me for two days because they didn’t know what was going on. Finally a little ol’ country doctor told me I probably had migraines, and he gave me pain meds.”

  —Diana, 52, homemaker

  “When I had a migraine, before I started taking Imitrex, the only thing that made me feel better was to have my husband pull my hair really hard. That’s crazy, right? I don’t know why, but pulling on my hair helped. He’d just get it and twist it. Or I’d get the room as cold and dark as I could, and I’d lie there myself, twisting my hair. People who saw me do that thought I was nuts but it really would make me feel better.”

  —Monica, 53, retired electronics worker

  “Sometimes when I feel a migraine coming on, I can ward it off by eating really, really spicy food. Like I’ll eat a big chunk of wasabi or some really fierce salsa, and I feel like my whole head is exploding, like it’s going up through my sinuses, and that can make the migraine go away.”

  —Fiona, 49, writer

  “When I get a migraine, I see little silver streaks fluttering around in front of my face and then I lose all vision to the sides. The streaks are continuously moving. When the silver streaks first started, I was petrified because I had no clue what was happening. I was driving, and I pulled over until it went away.”

  —Irene, 41, bank employee

  “During a migraine, I can ‘see’ the sounds and ‘hear’ the light. I can feel bright lights in my ears, and I see a kind of jarring thing in my eyes when there’s a noise that feels loud to me. When I was five or six, I’d look at bright colors like yellow highlighter, and it would vibrate in my eyes and my ears. And when I’m listening to music, I kind of ‘see’ things—I feel something in my optic nerves.”

  —Nonnie, 31, temp worker

  Perhaps your migraine experiences are as unusual as these—or even more so. If you’d like to share your stories, please go to our website, www.migrainebrain.com

  Migraine Lore, Famous Migraineurs, and More

  “Three, four, sometimes five times a month, I spend the day in bed with a migraine headache, insensitive to the world around me.”

  —Joan Didion, “In Bed,” from her collection of essays, The White Album

  Migraines have been around as long as recorded medical history. The first reference to migraine in a medical text was found in an Egyptian medical scroll dating back 1,500 to 3,000 years BCE, and migraines are subject of the writings of a Sumerian poet in 3,000 BCE. Hippocrates, the famous Greek physician, wrote about migraine and its visual symptoms in 400 BCE, and noted that it could be triggered by sex or exercise (which is true for some people.)

  In early times, doctors believed migraine was caused by an excess in the digestive tract of bile, one of the four “humors” believed to govern the body. This theory had some support, because so many migraineurs vomit up bile during an attack.

  In 1873, Edward Lieving published “On Megrim, Sick-Headache, and Some Allied Disorders: A Contribution to the Pathology of Nerve-Storms,” which correctly theorized that migraines are caused by problems in the neural system. It noted the wide variety of symptoms and experiences among migraineurs, and remained the classic treatise on the disease until fairly recently.

  In years gone by, treatments for migraine were often quite painful and unpleasant. Take, for example Sophia Peabody, who along with her sisters Elizabeth and Mary were brilliant intellectuals who helped launch American Romanticism in the early 1800s. Sophia, an artist who later married Nathaniel Hawthorne, suffered from migraines almost daily without relief. In The Peabody Sisters (Mariner Books, 2006), a finalist for the Pulitzer Prize, author Megan Marshall paints a vivid picture of the terrible migraines Sophia endured. She spent many days in bed, unable to eat meals with her family because she couldn’t bear the loud sound of utensils and silverware. Her migraine attacks included fever and strange visions, and she sometimes lost consciousness.

  Today, the treatments Sophia experienced seem as bad as the headaches: her skin was blistered with hot plasters, she was forced to drink arsenic and quinine, she was restricted to a diet of rice and milk; she was even treated with leeches, which at first worked very well but lost its effectiveness. One of her physicians, Dr. Walter Channing, believed that chronic headaches in women were caused by overly sensitive nerves that arose from a woman’s uterus, Marshall writes. Dr. Channing’s theory is remarkable in being far ahead of its time: many women’s migraines, we know today, result from fluctuations in female hormones that irritate the hypersensitive nervous system of a migraineur. Dr. Channing was also a visionary in promoting a partnership between doctor and migraine patients in order to identify the factors leading to migraine attacks and the treatments that can improve them. The Peabody Sisters provides a fascinating account of migraine as it affects an artistic woman and her family, and is interesting reading as a detailed rendering of migrain
es in days gone by.

  In ancient eras, doctors did the best they could to relieve migraine pain, relying on radical procedures such as trepanning, in which they drilled or cut holes into the skull to let out evil spirits they believed caused headaches. Native Americans relied on a potion that had a scientific basis: it was made from the testicles of beavers, which contain a compound similar to aspirin. In Tudor England, an era in which few people lived to their fortieth birthday, herbs including lavender and sage were used to treat headache, as was pressure applied by placing a hangman’s noose around the head.

  In the mid-nineteenth century, doctors began to use ergot—derived from a fungus that grows on rye—to shrink blood vessels in the head during migraine, paving the way for a treatment still used today. Ergot drugs were developed in the early part of the twentieth century. While they don’t work for everyone, they were the best tool in the migraine arsenal for decades and are still prescribed in some cases.

  If you have a Migraine Brain, you’re in esteemed company throughout the ages. Julius Caesar suffered from migraines. In the twelfth century, Hildegard von Bingen, a philosopher-nun, composer, and adviser to kings and popes, was renowned for the visions she began having at a very young age. She described seeing intense lights and areas where her line of sight was blank, followed by a general sense of illness and then euphoria. Many researchers today believe that von Bingen was experiencing the visual aura of migraine.

  Migraine has held a place in important historical moments. “Bloody” Mary Tudor, who ruled England for five years in the mid-sixteenth century, endured a migraine attack on the day of her coronation. Ulysses S. Grant, Robert E. Lee, and Mary Todd Lincoln all suffered from migraines. (Mary Todd Lincoln was also depressed, and, as we’ll see in Chapter 13, there is a connection between depression and migraine.) Grant was in the throes of a severe migraine attack when he accepted Lee’s surrender on April 9, 1865, at Appomattox, Virginia.

  Some people believe there is a strong connection between migraine and creativity. Whether this theory has a biological basis, the work of writers and artists has been invaluable in understanding the nature of migraine, as they have provided a wealth of paintings and drawings that help us see what a migraine “looks” like. Visual artists with migraine include Claude Monet, Vincent Van Gogh, and Georges Seurat.

  Many writers suffered from migraine, some of whom described their illness in detail. Migraines caused Virginia Woolf, who also suffered from depression, to lie in bed sleepless at night; George Eliot wrote about her migraine attacks in a journal; Lewis Carroll, researchers believe, was inspired in his fanciful writing by migraine aura; and George Bernard Shaw, in an attempt to cure his migraines, turned to a vegetarian diet.

  Musicians with migraine include Frédéric Chopin, Peter Tchaikovsky, and modern artists Loretta Lynn and Jeff Tweedy. Some observers believe that Elvis Presley’s health problems—including hospitalization for headache, and eye problems—suggest he suffered from migraine. Presley’s autopsy revealed the presence in his body of a number of drugs used to treat migraine including Demerol, Propranolol, and LSD, which is a derivative of ergot, a medication for migraine.

  Blaise Pascal, Immanuel Kant, and Karl Marx were migraineurs, as was Friedrich Nietzsche, who suffered his first attack as a boy at boarding school. Charles Darwin suffered from migraines he inherited from grandfather, Erasmus Darwin, a physician and intellectual who researched the role of blood vessels in migraine attacks.

  Today, among the tens of millions of people in the United States who get migraines, some are very well-known, and many have begun to talk publicly about the impact of migraine on their lives. Marcia Cross, perhaps best known for her role as Bree on Desperate Housewives, is a paid spokesperson for GlaxoSmithKline, the pharmaceutical company that manufactures Imitrex. On Memorial Day 2006, while in Cambridge, Massachusetts, directing his hit movie Gone, Baby, Gone, Ben Affleck was struck with a severe migraine and was rushed to a hospital emergency room by his wife, Jennifer Garner. Actress Virginia Madsen relies on Botox injections to fight wrinkles but first used them to treat her migraines.

  At least one in ten Americans gets migraines, so we all have many migraineurs in our lives and our communities—although we may not realize that they share our disease. We’re hoping that with better public education about migraine, no one will feel embarrassed to talk about their migraine experience—because the more we share our stories, the more we know about migraine, and we all benefit.

  CHAPTER 3

  The Four Stages of a Migraine

  “I just have a sense of knowing that it’s coming. I just know it’s a migraine. There’s something about it that’s very different from other headaches.”

  —Kristen, 22, nursing student

  A regular headache is just a headache and nothing more. The pain appears and then it goes away. No other symptoms accompany the headache and no warning signals tell you it’s on its way. And there’s no hangover after it’s over.

  Migraines are so different.

  By the time you feel the head pain or nausea of a migraine, your body has already been under attack for quite some time and is undergoing a variety of physiologic changes. Hours before you get a headache, the migraine chain reaction begins making its way through your nervous system, setting off little warning shots along the way.

  I’ve never had a patient who didn’t know when a migraine was on its way. But many of them can’t explain how. They just know.

  Learning to recognize warning signals is one of the most powerful weapons you have because you can use these signs to stop the attack as soon as you know it’s begun, before it really intensifies. Many migraine medicines work best as a “preemptive strike”—preventing the pain before it starts. But to be effective, they have to be taken as soon as the migraine chain reaction begins.

  In this chapter, we’re going to figure out how to identify your warning signals and start developing your own migraine profile. You probably already know some of yours; perhaps you know all of them. But many of my new patients—while they can sense when a migraine is coming—aren’t able to specify their warning signs. They feel different, but can’t tell me exactly how because they haven’t connected all the changes in their bodies in the hours or days prior to a migraine with the attack that follows.

  The first step in profiling your migraine is to identify its characteristics: what it looks and feels like, what symptoms you experience, and when they come. Then you’ll add your personal migraine triggers into the profile. Finally, in a later chapter, you’ll identify the various treatment options that work for you. You have to know and understand your migraine intimately so that you can limit its effects on your life. It’s like knowing your enemy so you can defeat it.

  The Four Stages

  Unlike other headaches, migraines are complex. They may, but don’t always, come in four stages, like a four-act dramatic play. These stages are:

  Prodrome

  Aura

  The pain phase (the headache and nausea, e.g.)

  Postdrome, or migraine hangover

  As with everything else in migraine disease, these four stages vary greatly among migraineurs. Not everyone experiences all of them. About 80 percent never get the aura stage, and some get aura only during certain migraine attacks. Some get aura but no headache or pain stage. Some don’t get prodrome.

  However, it’s very possible that you have experienced all four stages but didn’t know it. Many patients come to me with no idea that a migraine attack has distinct phases with a host of possible symptoms in each one. Once they learn about migraine stages, they begin to piece together the pattern of their own attacks and often find many more facets to their migraines than they’d realized.

  One of my patients was certain that her migraines were quite simple: a severe headache and nausea, nothing more. But as she learned more about migraines, she found her migraine wasn’t simple at all. During her next attack, she noticed that she tripped twice while walking. She a
lso realized that she had a heavy tongue and slurred her words in the hour before the headache arrived. She’d never noticed these symptoms before and certainly hadn’t connected them to her migraine attacks. Now she realizes that her migraine is sending her specific warning signals, which she can put to good use by getting treatment right away.

  Halting a Migraine in Its Tracks

  Let’s talk about halting a migraine before it becomes painful—the “abort” part of our approach.

  In trying to abort a migraine, two time frames will help you: the prodrome phase and the aura phase. Prodrome is the warning phase that a migraine is about to attack. It’s also called the premonitory phase because you are sensing—getting a premonition—that the migraine is on its way. Aura, which comes next, is when your brain is already acting differently and affecting other parts of your body. Believe it or not, you will come to cherish both prodrome and aura. As annoying or frightening as they can be, these phases are invaluable aids for stopping the migraine chain reaction before it gets to the pain phase.