Migraine, Mystery

Reflections of a migraine sufferer.

Depiction of a Migraine Aura

The first time it happened I was teaching when all manner of small rainbows started to appear, hovering just above and to the left of students’ heads, at the edges of the whiteboard, the overhead fluorescent lights, even remaining there in the black backs of my eyelids when I closed my eyes. A half hour later my head was in a gigantic vice, neck stiffening, the normal low buzz of tinnitus in my ears hitting a fever pitch. All I could do was lay down in a dark room and swallow Advil. Back in those days, I’d get one maybe two a year, and eventually I got a prescription for Sumatriptan, which was supposed to bring relief if taken right at the moment my brain started telling my eyes to see its spectacular light show. It never helped much, or if it did help, it simply took a bit of the edge off a spectacularly painful and debilitating event. 

Mid-pandemic, something changed. The little flickers of light at the edges of my vision that grew steadily into jagged rainbows covering everything, then after 20, 30 minutes vanished, the pain beginning, started occurring every week or so, sometimes 2-3 times a week—the rush and intensity of the initial onslaught ebbing into a “migraine hangover” lasting several days, sometimes right up till it all started again.

It was time to see a neurologist, to find a new approach, which I did, and my daily dose of Nortriptyline, my “rescue” dosages of Ubrelvny, seem now to keep the worst of it at bay. Still, though, they happen, often at the least desirable of times, like the other day, bent over my laptop brainstorming ideas for future Substack posts, for my next Hemingway podcast. Suddenly there’s a glimmer of something at the corner of my eyes, a momentary flicker. No, it was nothing, just the glare off my screen, I tell myself, until another comes, and then another, until it is undeniably there—a thin, bright-hovering jagged line of light rainbowing across my field of view, and I rush to cut open a pill packet, to make a strong espresso. Caffeine, for some reason is supposed to help stave off the onrush of pain (now scheduled to occur in about 30 minutes). 

One time I was suited up for a long bike ride—lycra bib shorts pulled on, a slick smooth jersey, rear pockets bulging with power bars, spare tube and tools, cell phone, tires pumped up and chain freshly oiled—when the flickering started, and the countdown to pain began. I rode anyway, without taking anything. I didn’t want to let it dictate my life, to change course for it. So I set off, trying to see through the brilliant flashes of color and light hovering between my eyes and the road. At 24 minutes into my ride, the auras ended and part two began, right on schedule. I ended up cutting my ride short, spinning home in an easy gear, making a double espresso, taking a quick, cool shower, swallowing pills, burrowing into the dark of my bed covers. 

Migraine is an enigmatic disease. For example, caffeine inexplicably offers both relief and is a known “trigger.” By making blood vessels constrict, it’s surmised that this slowing of the flow of blood also slows the intensity of whatever it is that is going on in the deep recesses of your brain. Triggers, however, are much less easily explained. Us Migraine sufferers are supposed to keep migraine journals, to work to see if we can find patterns (however oblique) in our diets or behavior that may have something to do with why our brains suddenly turn against us. For some, it’s fairly straight forward. I drink coffee, wine, eat chocolate, sleep poorly, over exert myself, spend too much time in front of a computer screen….I get a migraine. For others, like myself, causation is not easily traceable, and I’m convinced there are no causal links whatsoever, or that they are so nuanced as to be untraceable. At random times—morning, afternoon, evening—my brain inexplicably malfunctions and causes me to stop everything and surrender to it. 

They are certainly better, less intense thanks to the drugs my neurologist recommends I toss at them, though she can’t give me any real, scientific explanation of why that is. Nortriptylene is an anti-depressant, but at some point in its pharmaceutical timeline, it was observed that those taking it for depression who happened to also suffer from migraines, started having fewer migraines. As with so many drugs, scientists can’t fully explain the mechanism that makes them work. You swallow the thing, and it has a demonstrably positive effect on x even though it was developed for y, and hence it becomes a treatment for x as well. 

The longer I’ve lived with these, the more I have come just to accept them as yet another human mystery I have to contend with, another thing science can’t really explain or solve. As a boy, I remember watching a television show about the immensity of the universe. It may well have been Carl Sagan. I had been gifted a small, handheld zooming telescope and could now zoom in to see craters on the moon’s surface, to see a hundred-fold increase in the dots of light that I was told were stars, many of them many times bigger than our own star, the sun. I faced for the first time a tangible example of the infinite, the unknown. Where did the universe end? When/how did it begin? What existed before that moment when all matter exploded outward, leading to us, to now, whatever that is? Suddenly all the mysteries I didn’t understand about my own body, why people in Vietnam were killing young Americans, why my parents inhaled smoke into their lungs and drank nasty smelling things from small glasses, why I was so fond of the red haired girl in my class who lived just down the road…were compounded by this much bigger mystery that no one, not even Carl Sagan, could fully explain. 

Living with migraines brings me back to something like that early bombardment of unanswered questions that all but overwhelmed my pre-puberty self. These blasts of discomfort, these strange, almost magical flashes of light can’t be explained away or fully understood. Something deep inside my brain occurs just as something at the deepest center of the universe occurred, something we can know bits and pieces of, that we can work to contain, but it will always remain elusive. Primitive humankind was ok with the unknown. In the age of science, where so much can be explained—no, thunder is not an angry god—we expect answers in the same way we expect our mechanic to tell us why our cars won’t start. I remember in the early days of the AIDS crisis how children with AIDS were feared. Some of their homes were set on fire. Without answers, we panic. We can no longer blame it on the gods. Science should be able to stop this. During the pandemic we waited for science to rescue us, and thankfully, it did a pretty good job—yet the virus continues to mutate and many of the drugs we throw at it have already become useless…. 

Migraines remind me that so much of human existence remains enshrouded in mystery, that the bodies we occupy are strange, flawed vessels prone to breakdowns—both temporary and more enduring. Getting older has certainly contributed to this epiphany as well. To quote a philosopher I read but can no longer remember (that precise memory, like so many, having vanished), we are “finite and imperfect.” Our fallibility and our short time here are mysteries to be embraced, to help us stand in awe of our existence, as I did just the other night on my dock on a cool summer night, the dark dark Adirondack sky spooling away above me filled with its uncountable stars, me just another tiny speck on that immense canvas.  

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