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Monday, 27 August 2012

Anatomy of a Migraine Attack

It starts off with a dull copper taste in your mouth, like you dipped a coin in blood and then tucked it between your cheek and tongue. You feel a bit cranky, a bit ... other. Almost hungover, but not quite. No pain yet, and if you are very, very lucky and realise what's going on and take a tablet immediately, it might stay that way.
(Most of the time you don't; no matter how many attacks you've had in the past. Part of it is selective amnesia; that taste is so faint to start with it's easily dismissed and it's not until the light show starts that you remember it, the way your teeth suddenly felt a bit furry and you were growling at the keyboard and ignored it as some weird irritation because you had to go shopping, and now you realise that that was your warning sign and ignoring it was a very bad mistake.)

Your vision starts to first blur, then double. The taste in your mouth is suddenly hot and biting. You have trouble stringing a sentence together. That sense of other, of being dislocated from your physical self is stronger. If you're in the supermarket at this moment, you watch your hands pull things from shelves and out of the fridge as though you are standing next to yourself.
There is still no pain, but there is a humming in your ears,  like being enveloped in a thousand flickering lights or surrounded by a cloud of mosquitoes and your face feels like it's just been slapped. The skin tingles and burns and fades to numbness around your nose and mouth.
You head for the till, rest of the shopping be damned, because now you know what's happening and you need to get home. You pick the self-serve scanner because you can no longer hear what people are saying to you properly, everyone sounds like they are under water, and the line there is shorter. This is good, because your sense of smell has just gone and thrown a party; the scent of the guy next to you with the deodorant that coats the back of your throat with a chemical taste; the sudden reek when someone at the back of the shop opens the milk and cheese fridge. You pass someone with meat in their trolley and all you can smell is blood and raw flesh.

You feed your money into the till and the god of pain hammers a spike into the space between your right eyeball and your occipital bone. It's a slice of white light that freezes you in place for a few seconds. Your vision clears, then begins to star-burst. If it wasn't for the pain, this would be pretty; fireworks exploding against the walls of your skull in dozens of colours. Especially white, for some reason. Everything goes to white.
When you grab your bags your sense of touch has changed. Plastic feels like silk, paper feels like steel-wool. Most of your skin feels like the pores have vanished and left only nerve endings, raw and screaming, in their place. You fumble your sun-glasses on, cloudy day or not - when you have one of these, it feels like you are under a spotlight from hell, and light can trigger an attack of nausea that will have you on your knees retching on the pavement - and lurch out of the shop.
And by lurch I mean there is almost no sensation of having feet. You have some dim awareness of moving, of the fact that your body is moving itself, but there is no sense of co-ordination. The lines of communication between hind-brain and limbs has diminished while your brain is clawing and screaming at the choking cage of your skull, which is suddenly two sizes too small.

You step into daylight and the pain god swings a hammer at the side of your skull. Sometimes you'll be lucky and he misjudges and gives you a nose-bleed. This is lucky because it seems to relieve some of that awful pressure, that sense that your brain has turned into a swelling balloon that rubs and chafes against bone. One day, you think/pray dully, one day it will find a sharp bit and pop and this will be done with.

You can no longer feel your face. That taste in your mouth is now burning liquid. You are aware that you are sweating because your shirt is clammy and stuck to your body and you are panting, ever so slightly. Like a beaten dog, collared to your pain and no way of pulling this tether loose.

You get into the blessed darkness of the flat, pull yourself up the stairs by the hand-rail - there is no way you can blindly trust your feet to get you there - and stumble into the bedroom. You pull the curtains closed before you take your sunglasses off and scramble for the migraine tablets. There is very little rational thought left at this point; if you bought anything that needs refrigerating it's just plumb out of luck, because trying to re-shelve anything would require co-ordination and is beyond you right now, and your vision is almost totally gone. The world is white, like an overexposed polaroid.

You lie in bed in the foetal position and feel the bed throb and wait for the pills to knock you out, because let's make this very clear - those pills don't cure a migraine. They don't stop it. You might as well throw a child's fishing net in front of a speeding juggernaut. What they do is take you away from it by removing you from the world of conscious thought, for the four hours the pills are in your blood stream. Once they wear off, you either sleep through the rest of it, or the pain wakes you up and you have to take more.
 Part of you mourns your plans for the day - the Skype chat, the writing, the t.v. show you had lined up - but it's a very small part. The rest of you wants oblivion, wants the world to go away, wants the mini-death of being unconscious.

You know that when this breaks you will spend a couple of days with hyper-sensitive skin, hyper-hearing and a sense of smell that would stun a blood-hound, and the fun risk of a rebound attack. You will wake up with crud - there is no other way to describe it - gumming your eyes together. If it's a very bad attack, you will occasionally wake up with blood in your ears and rimming your nostrils. You will have bouts of mild elation and depression, sometimes within minutes, and no way to know which one is coming up next.

There are some triggers you know about and avoid - high-cocoa chocolate, red wine. But the attacks lately don't seem to have a food trigger, happen during all temperatures, weather, times of year and day. The only pattern you can find right now is that there is no pattern, and if that doesn't kick your irony button nothing will.
A mild to medium attack will leave you slightly functional - you slur your words a little, you move very slowly, but you can do things. A bad one.. A full blown migraine attack leaves you begging for death. And if you get these on a regular basis, you will do almost anything to stop it. (Actually, strike the almost. You will do anything. Anything.)
Sometimes you start off with a medium attack and it fades, and then it comes back and stomps you into a little blubbering pile of pain and bile and nausea. It's like replacing a great white with a megalodon. Neither one is fun, and you can't swim away from either of them, and hello, over-kill.

If you have a condescending ass of a doctor, one who doesn't believe in migraines, you can discount any hope from that side. Friends and colleagues who have never had an attack wonder what all the fuss is over what they reckon is a bad headache, at which point you earn negative karma points by hoping they experience one in all of it's glory, and soon.
 Feverfew supplements help to a point, but it takes a few weeks to kick in, and although they help reduce the severity of the minor attacks, they don't touch the big ones, the ones that leave you wondering if the next time your brain will simply leak out of your ears and leave you a functioning cabbage. Botox injections helped - there was a whole glorious year of no attacks - but the odds of me being able to afford Botox right now are about the same of me wearing my underwear on my head and doing the can-can through a nunnery.

So you fade into darkness, you ride the tablet into unconsciousness and you know you will wake up checking your pillow and sheets for blood, checking your ears and nose and bleakly thinking about stroke possibilities and haemorrhaging and waiting for the next one.

And you hope you recognise that taste of blood and copper in time.