Tuesday, June 06, 2006

Migraine Week, plus Nels Cline postscript (added)

You’re lying in bed, hoping it won’t happen again. Your head and right eye still feel tender from the last time. If thine right eye offends thee… You feel something inside your head kick, like a baby, a tiny pulse of discomfort from deep within. But you’ve had so many migraines this last week that you’re constantly on guard, and you’re not sure whether this is a warning sign or not. It might not be; you’re afraid enough of them that you often imagine one is coming when it isn’t. You look down beside the bed where there is a small packet of pills and you wonder if you should take one. You decide to wait and see, but you can feel another small pulse of pain swelling up, and you think… maybe… Yes. You reach for a pill, pop it out of the foil, and down it, swigging from a jug of distilled water on the floor that you use to fill the humidifier on the CPAP machine (you’ve collected an undue share of chronic illnesses for someone who is 38). But before you even swallow you’re afraid it isn’t going to work. Only two of the nine of these pills you’ve taken have actually managed to stop the migraine in its tracks; called Sumatriptan, they’re a “vasoconstrictor” – a menacing name indeed – that can avert an immediate attack, but do nothing to prevent the next one from coming on, or the next… One doctor has said that maybe they can “break the cycle” but thus far they’ve done no good.

By the time you lie back down, the pain is unquestionably coming on, though still in its infant state. You feel it like a chill fist clenching the right hemisphere of your brain, squeezing. It is difficult to describe accurately, though. The doctor, the other day, asked if it throbs. Well, yes, sort of. Is it dull or sharp? Both, kind of. Is it persistent, or does it wax and wane? Well… It’s there all the time, when it's happening, but sometimes it’s less intense, say, if I maybe find a way to clench my jaw, or if I put pressure on my eye from just the right angle, or if I push my head into the pillow like this… There’s a new symptom too, a strange feeling at the back of your throat, at the roof of your mouth, like something in your palate has turned icy and hard, but you don’t know what to make of it. You read online that cool ice cream, held at the back of the mouth, can sometimes soothe an attack, and you’ve tried that – you’re willing to try anything – and you’ve come to think of this as the ice cream spot. Thing is, ice cream does no good, either.

You roll over, dragging your sheets and duvet with you. Your first few of these, last week, left you wanting to just lie still, but increasingly they’re making you a bit restless. Despite the pain, despite the nausea, you want to be able to DO something about it, to make it GO AWAY. You also can’t seem to decide if you’re too cold or too hot. You pull the sheet over you, but its pressure and presence are clammy and smothering, so after a few minutes you kick it off again; and now you feel the cool air on your skin, which is no better. You turn on your side, the sheet wrapped around your head to block out light. You don’t get any of the trippy visual effects that are sometimes associated with migraines, just pain, and a bit of nausea and shortness of breath. Your nostrils seem to constrict a bit, too, so you breathe through your mouth, hoping that if you gasp in big gulps of cool air, it will hit the ice cream spot and cool the hypothalamus. It’s folly, but you do it anyhow. You hold your head with your right hand, cupping your eye, and pull the sheet back over your body again. For a few minutes.

It is getting hard for you to tell the time when an attack is happening. The pain seems to inhabit some psychedelic nether region where the clocks don’t count. Five minutes of pain is equal to five hours. You look at the clock on the wall with your left eye, opening it slightly, and see that it has lasted fifteen minutes thus far. If the pill is going to work, it should probably kick in soon; it seems to round off the attacks – if it’s going to – within the first half hour. “Please stop,” you say, because you can’t think o f anything else to say, and because you want to say something. You’ve experimented – since you’re home alone, and no one can hear you – with moaning, to see if it does any good, but it doesn’t appear to. Occasionally you moan anyway.

Suddenly the migraine intensifies, the steel glove crushing, sending you into a spiral downward into a reduced state, a total helplessness; your foetal curl becomes a weak cringe. What does it WANT? You’d do anything to appease it – if there were some psychological trigger, some hidden agenda , you wish only that it would declare itself so that you could do whatever it is the migraine requires. Anything to make it go away, anything to appease the thing in your head that has decided, for no known reason, to do this to you.

And what trigger could there possibly be, anyhow? You were lying in bed sleeping off the exhaustion of last night’s attack. Now you’re having another. Maybe your migraines are giving you migraines? You thumb through things you feel guilty about, just in case the migraine has some Catholic punitive aspect, but introspection doesn’t seem to be a way out. It’s true that after nine days of these you’re taking a couple of days off work, but if work were the stresser, wouldn’t the migraines STOP, now that you’re safely home in bed? Since four of your recent migraines have actually begun when you were napping, maybe you should just try staying awake...?

The pain throbs, and you feel it move around a little in your head, shifting briefly down the right rear of your neck, then occupying the space behind your left eyebrow. Mostly it concentrates behind your right eye. You gulp air and whimper. Nothing helps.

Well, that’s not quite true. Codeine helps. You have a packet of those by the bed, too. The thing is, the doctor has advised you that it can cause “rebound headaches” – whatever they are, they don’t sound very good – and lead to other problems, including drowsiness, drymouth, and constipation. Last night you broke down and bought some anyhow, staggering to the drugstore in the grips of your midnight migraine with your right hand pressed over your eye all the way down the street, blotting out the streetlamps, the headlights, the glaring fluorescents inside the 24 hour Shoppers Drug Mart. The clerks all looked at you with apprehension, like you might be just another street crazy staggering in, but the pharmacist, a polite if officious Asian fellow, gave you want you wanted and provided you a cup of water to down two pills with. The caffeine free kind, since caffeine – or its absence – can apparently serve as a trigger, too. The migraine DID dissolve behind the drug – you lay in bed listening to John Fahey’s America on headphones, feeling pleasantly dreamy, watching as the pain slowly dissipated – but you DID feel pretty sleepy when you woke up this morning. The codeine had probably more to do with the feeling of exhaustion than the migraine per se. You’re exhausted enough after nine days of this to not need the codeine to tire you out, too.

After about forty minutes, you can feel that the current assault is starting to fade. Your mind is returning to you; you can breathe normally, can open your eyes. You glance at the clock, thinking, it was a short one, this time; maybe the pill helped? You can’t know, but most of these have lasted two or three hours.

After a few more minutes, you sit up. Well. Life returns. You’re still exhausted, but you can function, have a little window of normalcy in which to take care of some things. Maybe eat something, while there’s no nausea? Maybe.

You breathe deeply. Probably you’ll feel okay for the next nine or ten hours. It probably won’t hit again until late tonight.

Must remember to ask the doctor next time if there are painkillers other than codeine that I can take...


One of my doctors was most decisive in outlining the painkillers avaible: opiates, anti-inflammatories, and that aceto-something stuff you find in Tylenol. But something occured to me tonight, and I found a whole new option, that worked wonders; with a few puffs on the pipe, I ended up turning a migraine into a pleasant session spent listening to Nels Cline and Devin Sarno's minimal, ambient, and very beautiful Edible Flowers (see my Nels Cline interview here, and watch this blog for more of it). The Vasoconstrictor might have helped a bit, too, but the pot was also very, very useful. Pity I didn't think of it two weeks ago.

It's a shame doctors can't suggest such things openly (or maybe it was just this one guy).

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