Tuesday, February 04, 2003

I've had a hell of a time explaining to people just what having an aura or a migraine is like. Last year, the morning after a efficiently potent visitation from a migraine I sat down and wrote the following. It's as close as I'm gonna get for now.

A few words on the Migraine Headache:

It has been my lot to suffer, from time to time, the vagaries of the neurological phenomena known as the migraine headache. In my case this ailment sees fit to exhibit its charms in the form of a migraine aura, defined as “a distinctive sensation or visual disturbance that may signal the beginning of an epileptic episode or a migraine headache.” Aura’s, then, are sometimes prerequisites or bridges to headaches. Not a garden variety, mind you, but a migraine headache. Ok, it’s important we’re clear on this distinction. Both the aura and the headache are part of the larger phenomena known as a migraine, a neurological event that I profess to knowing next to nothing about (something to do with exorbitant amounts of blood rushing to the brain and causing veins residing there and, as in my case, around the eyes as well, to dilate and inflame surrounding tissue) but then, neither to do the neurologists.

I first experienced an aura almost 20 years ago while vacationing at the Chautauqua Institute with my sister and parents over the new year. Little did I know then that this occurrence was to be my introduction to a lifetime membership of occasional, highly unsettling visual disturbances, a few of which were destined to be accompanied by some of the most brutal, unforgiving pain I would ever experience. Until the next time, that is. Had I any say in the matter of my membership into this sad club I would have surely refused to pay my dues. I would have asked to speak to the manager.

These auras, thankfully, aren’t typically followed by the infamous skull burrowing headaches suffered by so many others, pain so singular in its intensity as to inspire visions of an apocalypse of the head, a blitzkrieg on the mind. I have, I’m afraid, experienced this on rare occasion, but more on that drama later. My aura episodes, lasting roughly 45 minutes to an hour, are regulated, for the most part, toward the interruption of my vision only. It begins on the cusp of my consciousness, a sense of something amiss. This particular sense of something being visually amiss has now, 20 some years down the road from its debut, become so familiar as to act as a cue, almost immediately, that an aura is on its way. Such moments have their own peculiar peculiarities, like a déjà vu that comes to resolve. The strange becomes familiar. Suffice it is to say, the length of time between recognizing that something is familiarly askew and the comprehension that an aura is launching is so slight as to be nearly negligible- “What the? Oh, shit…it’s happening!.”

Soon enough my vision begins to deteriorate causing me to completely withdrawal from whatever activity I might be engaged in. This hasn’t caused too much strife, but these aura’s have been known to pop in unannounced during work, amidst dinner parties and, most unfortunately, during movies- and so, if anything, have had a detrimental effect on my social life. In fact, so debilitating is this visual impairment, made up of whirling blades that seem to be emanating from my lower eyelids and angry squawks of jagged purple and red phosphorescence, that my best and usual course of action is to retire to bed and ride it out. This cacophonous ocular display isn’t particularly enjoyable, so keeping my eyes shut for its duration (especially given that my vision becomes so obscured by the aura as to probably make me, at least temporarily, legally blind) helps me to mitigate its effect and give me some illusion of control. If anything, these many hours lying in bed over the years, awaiting the aura’s course to be run, have proven a dull nuisance.

The aura itself, as I already mentioned, lasts roughly 45 minutes to an hour, though I have had some that have gone on for 90 minutes. Beyond the light show, they can be expected to leave in their wake a dull headache, not unlike the kind one sometimes picks up from sitting too long in front of the television (I’m convinced that such headaches, thick and obstinate irritants that they are, are derived from the lack of neuronal activity necessitated in the course of a couple hours lost in the unforgiving tundra of primetime). The aura picks up momentum until it reaches its zenith around a half hour in. At this moment, even with eyes closed, an innocuous aurora borealis melts and flutters against my eyelids.

Half an hour later, it’s gone, leaving behind the aforementioned nuisance of a headache in its wake. These singular episodes were the norm for many a year, arriving once every 3 to 6 months, lighting off some auraworks and then vanishing. Over the last several years, however, these formally solitary missionaries have been coming in evangelical clusters to set up camp several times course of several days. Where one arrives, it is now almost guaranteed, more are to soon follow. So the change here is, instead of one aura event every 3 to 6 months, there now arrives from 6 to a dozen of them in the same time span. I’m thinking of setting up a canvas and making a go of turning my colorful, geometric affliction into art. I can see it now- my first show will be entitled “My Visions Gone All Fuckin’ Wacky: Neurological Anomalies and the Art of the Inopportune Aura.” Yeah, something like that. Cheese will be available. Good Chilean wine, too.

Speaking of anomalies, there are those aura’s that prove the awful exception to the typical. These aberrant thugs are seemingly no different then their fellow brethren except for one very important distinction: they will go on to sear the inside of my skull.

Those who have never experienced a migraine can be forgiven for thinking that last sentence hyperbolic. Fellow migraineurs, however, know otherwise. To have a full-on migraine headache is to empathize with the cruel fate of Prometheus, chained up to Mount Caucasus, his liver forever preyed on and, just as fast regenerating; it is to inhibit the woozy and horrific character of Munch’s infamous Scream; it is to be torn apart in a black hole. Phew! All this to say, hyperbole is an understatement. I’ll explain, bear with me.

Actually, my earlier aside about making an art of my migraines wasn’t so far fetched. A few years back I recall that an arts based mental health organization asked migraineurs for submissions documenting their experience. Some magazine or other included several of the results, a gruesome parade of drawings: a man having nails pounded into his head from all sides; a head slowly being twisted in a vice; a young woman with shards of glass protruding through her temples; a head engulfed in flames. These drawings can be summed up as such: It hurts like a mother fucker.

The aura in conjunction with a migraine headache (the basics: a normal, garden variety headache occurs by vasoconstriction, or a narrowing of the blood vessels whereas the migraine occurs by vasodilatation, or expansion of the blood vessels) is known as a classical migraine. This conjures up Victorian ideals of the cultured and refined, doesn’t it? Hardly.

To experience an aura is to live in fear of its nefarious potential. I’m lucky in that this potential, more often then not, goes unexploited. Those times, however, when the classical migraine swells into clamorous dissonance, conducted with an efficiency for pain the likes of which I’ve never known before, are what linger in my memory and bring with every aura episode a terrible fear for what may be lurking around the corner.

One of the first signs that the conductor’s baton is being raised comes in the shape of herringbones dancing in a punkish lather about the territories of my peripheral vision. They’re thin and convoluted and seem to zigzag, flicker and pulse from the recesses of my skull like flares bleaching the landscape. Following closely behind, nausea arrives on its little cat feet, covering me in a fog of queasiness, akin to being in the cabin of a boat as it pitches woozily with the heavy seas. Now the decks are cleared for the storm. In my case this is almost always means pain that extends from the width of my forehead down to my nose and cheekbones. Sometimes the pain will languish its attention in one area, seemingly burrowing, for example, into the contours of an eye before perching atop a cheekbone. Other times it’s more general, a kind of cascade effect, a tumultuous pounding all across the upper hemisphere of my face and forehead.

Now comes the gravy. As if the aura, the nausea and the pain weren’t nearly enough, the classical migraine sees fit to rebel against my environmental surroundings. That light on out in the hallway becomes a supernova, the hum of a clock radio is now the screeching of subway breaks and the mattress, steel wool. This is when I become both paralyzed and desperate. The feeling of the sheets against my skin (or even the pillow, the blanket, the person next to me) becomes so maddeningly intolerable, my only recourse is to flee. Standing, however, is no more rewarding or forgiving and it unleashes new reinforcements of nausea and pain. This awful game can go on for as long as whatever little engine possessing me holds out, but the thing is, there is no happy medium and it’s exhausting. Eventually I collapse, preferably back in bed, and attempt to triage. At this point I might even have the shakes, similar to the feverish tremble that accompanies a body weakened by the flu.

From time to time I’ll find a pool of relief, the result of a fortuitous turn of the head that suddenly allows, if only for a second or two, the veil to be lifted and a glimpse of the end. Just as quickly these sweet pools go brackish and the pain returns. Sometimes, albeit rarely, sheer exhaustion will trump the pain and I’ll settle into an uneasy sleep. Usually you’re in it for the long haul and have no choice but to meet the pain half way and work out some course to navigate through it. Every now and again a very small voice manages to sound out to me that what’s happening is temporary and will eventually dissipate. It’s a small thing but it buoys.

The day after such classic migraines leave me feeling wiped out and dulled. Again, the feeling is not unlike recuperating from a bout with the flu. Sometimes my vision is slightly out of whack for a few days, things seem slightly sepia toned and I find myself wishing somebody could Windex out the inside of my head.

Somewhere in the vast and daunting archives of migraine research all of this has, no doubt, been thoroughly probed and documented and we still haven’t a clue as to how to stop migraines. In fact, other then calling it a ‘neurological phenomena,’ and pinpointing some of the symptoms, we’re still fairly clueless as to the cause. At the beginning of the 21st century we’re still neurological peons, popping Tylenols in hopes of banishing dragons. Of course, like so many aspects of mental health, it’s only been in the last couple decades that some of the myths surrounding migraines have been toppled (“It’s all in your head”) and it’s been proven to be a neurological disorder brought on by physiological and not, as so many of the general public still believe, psychological factors such as anxiety or depression.

I saw a neurologist a couple yeas ago. I sat in his small waiting room and could hear the conversation he was having with the patient before me. It was a older woman who also suffered migraines. The medication he had prescribed for her was, while effective in mitigating the severity of her migraines, causing detrimental side effects of enough concern to the doctor that he was taking her off the medication. “Stop taking the medication,” he was pleading to her. “But if I do, I’ll feel the pain again,” she was pleading in return. “Look,” he said, “you’re going to be feeling all sorts of other pain unless you stop taking those pills.” I was probably leafing through a well-thumbed issue of People Magazine.

When my turn came and I found myself sitting on that god-awful examining table with that god-awful crinkly paper rustling beneath my jeans and smelling that god-awful sanitized smell, I was hoping for more promising results, something that might act to, if anything, cut the length of my aura’s in half. I explained to the good doctor my abbreviated history with the aura, with all its strange lights and geometries , and was assured that it was all perfectly benign. In fact, the doctor informed me, it seemed like I suffered from an aura predicament not unlike his own. “Do you take anything for it?” I asked. “Naaa,” he replied nonchalantly, “I just close my eyes and ride it out, but I’ll prescribe something for you and we’ll see if it doesn’t help. If it doesn’t, feel free to come back and we’ll try something else…it’s kind of hit or miss with this.”

You know what? It missed. Since then, I haven’t bothered with returning to a neurologist. So long as these aura episodes regulate themselves to clusters once every 6 months or so, and so long as the potential headaches arrive in tandem only a few times a year I figure I’ll just do what I’ve been doing all these years already- I’ll ride it out. It’s not so bad a light show either.

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