Welcome To A Migraine Symphony


Senses Intensify To Heighten Performance


I am still feeling the effects of being inun­dated with migraines last week. To most people this means a bad head­ache of some kind. You might imagine the classic sharp piercing sensation on one side of the head. However, the descrip­tion varies among patients. How does a migraine feel? To get an answer, you’re invited to this orches­tra­tion identified by some neurologists and oto­laryn­golo­gists as verti­ginous or transformed migraine. Shhh. The performance is about to begin.

Conductor Taps Baton

All euphonic compositions have a cue. Tapping on the podium and with the grip of the baton nestled between the thumb and first two fingers, the conductor pauses after raising his hands. The mute orchestra is transfixed as musicians await his slightest move­ment. The migraine symphony commences:

Awakening later than usual, I feel unrested with the sensa­tion of a heavy head. Pressure is increasing some­where beyond the depths of a squinting eye, while the other open eye attempts to distinguish blurry digits on the clock. The faint notion of rotating my face to the other side on my pillow to alleviate the discomfort becomes an unpleasant score.

Rating 6 out of a possible 10 on a pain scale, my migraine has not yet peaked but it is definitely uncom­for­table. This is my aura—a fore­boding that the orchestra of an unplea­sant variety has assembled. Almost 80% of migraine patients have no aura. My most optimistic hope is that I will feel well enough to attend an engage­ment of a different kind much later in the evening.

Migraineurs must read the baton gestures correctly so as not to get caught in a complex arrange­ment like auto­mobile traffic or in other bright and loud public places when the full-blown symptoms play out. Don’t let someone force your hand with pleas that they need you if you realize you will soon become incapa­citated. Cancel appointments for the day.

A Brief Interlude

Staggering to the kitchen, I forage for any remedies available in a futile attempt to prevent the inevitable. Most medications are best taken daily as a preemptive measure. That’s something I avoid because of the relative infre­quency of my attacks. Once the cacophony begins, most natural and some pharma­ceutical options are incon­se­quen­tial. It’s like requesting a concert ticket refund after you’re already seated.

In profes­sional concert halls, food and drink are not allowed. Should I try a Feverfew capsule or a prescrip­tion? With restraint, I choose the herbal option. A swallow of water concludes my breakfast since I cannot think of food, let alone prepare anything.

The First Performance

Migraine Symphony

Meandering down the hallway with apparent dis­equili­brium, I compose my orchestra pit. Shades are drawn tightly before burying myself beneath all the soft pillows I can gather. Now the sense of hearing is heightened. Otolaryngologists call this hypera­cusis or sonophobia. I am reminded of how Gustavo Dudamel demonstrated the superior acoustics of the Walt Disney Concert Hall by having an LA Philharmonic percus­sionist softly drag his finger across a drum as part of the spec­tacular orchestral arrangement.

My wife rubbing lotion on her arms become soft violins in the strings section. There’s the abrupt baritone of a clearing throat in the brass section. Sliding clothes hangers are a crescendo of bells and clashing symbols. The periodic woodwind of pressure squishing deep within my tympanic cavity completes the symphony. A soft peck on the cheek with no verbal, “Goodbye” is the preferred decres­cendo for my wife’s morning departure as I slip back into slumber.

The Second Performance

When my eyes reopen, it’s past noon. The pain has reached level 8 during this intermis­sion. The ringing in my ear suggests that the orchestra played at full volume while striking me in the head with their instruments. My ability to concentrate or articulate has dropped to nearly 30 percent and that left eye is still closed. A trip to the restroom coincides with a hunt for pres­crip­tion pills. Optimistic of relief with stronger meds in my system, I slide beneath the covers as the conductor raises his baton for the next performance.

The Third Performance

It’s mid-afternoon before I awaken again. Nausea has joined my migraine for a double concerto. I prepare some ginger tea to sip while checking online updates. Thankfully there are no messages requiring complete thoughts. I’m off to sleep again.

The Final Performance

By 5:18 p.m., with less than two hours left to attend my evening engage­ment, the hyper­acousis and nausea have reached the end of their sheet music. Photo­phobia (light sensitivity) is somewhat lessened as nightfall arrives. There’s less intense pressure on the left side of my head (like the residual effects of being smacked in the temple with a trombone).

After a half hour of email responses on a mobile device, I rouse enough strength to shower, shave, get dressed and drive to the meeting with 70 percent lucidity. My presence is beneficial though participation is limited by discomfort.

Upon my return home, it’s too late for dinner. So I head to the refresh­ment stand for popcorn while catching up on email. At 11:30 P.M. my headache is finally gone. As the symptoms wear off, it is common to evaluate what may have been the trigger or if there was an earlier sign. The prior evening, I recall lowering the volume on my car radio as my ears were more sensi­tive than usual. Can’t do much more thinking now. Even though, I slept most of the day, my body is exhausted.

The conductor takes his bows along with the various orchestral sections. This was the second show this week. Hopefully there are no encore perfor­mances tomorrow, as these headaches have been known to cluster (migrainous neuralgia). Scientists do not know exactly what causes cluster head­aches, but they appear to be related to the body’s sudden release of histamine or serotonin.

Season Tickets

As mentioned, patients experience different types of migraines. For some, distinct aura symptoms may include one or more of the following: flashes of light, blind spots (scotomas), brief vertigo, numbness, typically felt as tingling in one hand or on your face, difficulty with speech or lan­guage or muscle weakness. It may be trig­gered by a food allergy, sounds, smells, certain medica­tions, emotional stress, environ­mental toxins, or even teeth grinding. Some migraineurs endure nearly constant pain while others experi­ence less frequent episodes averaging once a month or so. Fortunately, mine are infre­quent (except for when they cluster).

Migraine TypeTypical Charac­teristics
Migraine with Aura (MWA)Lasting from 10 to 30 minutes, an aura is a series of visual, sensory and cogni­tive changes that precede a migraine headache.
Migraine Without Aura (MWOA)Lasting from 4 to 72 hours, throbbing or pulsating pain is most often one-sided, and it is generally accompanied by nausea or vomiting.
Hemiple­gic MigraineMore common in children, symptoms include slurred speech with temporary paralysis on one side of the body, reminis­cent of a stroke, prolonged aura, vertigo, or sensation of one's surroundings spinning, muscle incoordination, impaired consciousness, generally accompanied by a headache about 10 to 60 minutes later.
Basilar MigraineBegins with impared speach, loss of balance, double vision, temporary loss of sight, weak muscle control, confusion normally lasting up to 60 minutes accompanied by intense headache at the base of the skull. Caused by dilation of the basilar artery, frequently appears in young women throughout the week leading up to menstruation.
Abdominal MigraineTypical migraine headache signs and symptoms other than the head pain. Rather, the patient experiences abdominal pain.
Ophthal­mople­gic MigraineMalfunction of the occulo-motor and abducens nerves results in pain focused around the eyes. Other symptoms include droopy eyelid, bigger pupil, as well as double vision. More common in children.
Status MigrainousMay last 72 hours to weeks, often activated by a number of pain medications. Sufferers are frequently hospitalized to help overcome the accom­panying nausea and vomiting.

Less common forms of migraine, such as acute confusional migraine of childhood, vertiginous migraine, and nocturnal migraine, remain unclassified by the IHCD-II.

As a recovering caffeine “addict,” my treatment of choice is fresh brewed coffee when forcing myself to avoid rest or even during the second perfor­mance of an all-day migraine bout. Interestingly, caffeine can be both a trigger and a remedy. An encore that spills into a second day is also an excuse for a cup of black java. When there are three episodes in one week, two cups of coffee is elevated to my first line of defense.

If there is an increase in the frequency or intensity of your typical migraines, talk to your doctor. He or she may just have this wonderful Migraines and Headaches poster in the office. I have compas­sion for fellow migraineurs, regardless of the specific type. Let me know how you deal with migraines in your comments below.

To support the writing of useful articles about otolaryngology, ClinicalPosters sells human anatomy posters, scientific posters and other products online. You may sponsor specific articles, remit a small donation, or leave an encourag­ing comment to keep the work going. Stay safe and A Bit More Healthy.

This article was originally published October 11, 2012 on ClinicalPosters. Since then, I am happy to report, migraines are no longer a problem. The trigger, in my case, is an allergic reaction to certain spores. Mold remediation was the cure. If you are plagued with migraines, consider asking your doctor about receiving allergy tests.

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Kevin Williams is a health advocate, local editor, and writer of hundreds of articles for multiple web­sites, including: A Bit More Healthy, KevinMD (WebMD), and Sue’s Nutrition Buzz. He was a 15-year Neutrogena Research and Scientific Affairs graphics con­sul­tant.

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