What is a migraine? Really, who knows. It’s a serious kind of brain fart. Something sets off the brain, maybe a change in neurotransmitters (the chemicals that nerves communicate with), or blood flow, or hormone levels, or nutrients, or… so many options. The end result is a pulsating, throbbing, stabbing pain in one side of the head, often befriended by nausea, fatigue, intolerance to light and sound, visual disturbances and lots of other symptoms to demonstrate that the brain is having a meltdown.
For example, my brain under the influence of migraine finds it difficult to process words. Sometimes I can think of a sentence but can’t seem to articulate it. Sometimes I have a concept of a sentence, but can’t think how to form it. This has helped to develop a saintly patience in my beloved partner Tony. The fatigue is extreme, often preceding the pain and lingering long after it. Every movement and every thought is weighted with lead. You lie down but can’t sleep. You get up and want to lie down. If you’re out tramping, you lean on your walking poles, crawl over obstacles that you would otherwise joyously jump past, and fail to navigate rivers with dryness.
Migraine affects around one in ten people, but more women than men. According to the Migraine Research Foundation, migraine is the 3rd most prevalent and 6th most disabling disease in the world. A little startling to know, then, that the first medication specifically designed to prevent migraine, was only approved in 2018 (CGRP pathway monoclonal antibodies). Before that, migraine preventive treatments had been second-hand drugs – anti-hypertensives, anti-depressants, anti-epileptics, anti-wrinkles (Botox). I haven’t tried the new CGRP wonder drug – I’m waiting, but not with bated breath because I might pass out. New Zealand is always the last to fund new treatments. I’ve tried pretty much everything else that is available, prescription and otherwise (if you want a list, it includes amitriptyline, nortriptyline, timolol, propanolol, atenolol, sodium valproate, topiramate, lisinopril, candesartan, pizotifen, verapamil, melatonin, venlafaxine, fluoxetine, ibuprofen, butterbur, riboflavin, magnesium, coenzyme Q10, feverfew, acupuncture, chiropractory, osteopathy, ayurvedic medicine, massage therapy, even cannabis, just quietly). None of it helped appreciably, and/or had unpleasant side effects. My episodic migraines persist.
Preventive treatments are supposed to reduce the frequency and severity of migraine attacks – but acute treatments are used to stop an attack in its tracks. I’ve had more success with these. Sometimes, aspirin or ibuprofen, maybe with the assistance of a stiff coffee, beats the migraine back. More often, I use a triptan (rizatriptan is my substance of choice). Mostly that works. Sometimes it doesn’t, and the pain can drag on for days. For me, this was commonly around my period – known as menstrual migraine. The relationship between female hormones and migraines is complicated – but for me, hormone replacement therapy has been a godsend. I do still occasionally get the prolonged, unresponsive migraines, but not every month. For those, I use a TENS machine to ease the pain – the cefaly. Tony tried it once to see how it felt – you can probably tell from his face. We call it the Wonder Woman device, but it doesn’t convey any superpowers, only a replacing of the migraine pain with a nerve-stimulating drill-like buzzing. You take what you can get.
A wee historical note – the triptans, which were the first drugs developed specifically to treat migraine, came to market in the 1990s, the same decade that saw the launch of Viagra, the blockbuster drug for erectile dysfunction. Hmm. Migraine is the 6th most disabling disease in the world; erectile dysfunction doesn’t even rate as a disability (unless you are a veteran in the US, where you may be eligible for a monthly payment for loss of a creative organ); but no one has to take time off work because they can’t get a hard-on (ok, unless they are a porn actor). Why was there not more research and drug development for a condition like migraine, that causes so much pain and suffering; and why was there so much research and drug development for a condition like erectile dysfunction? Hypothetical question: we know the answers.
If you want to know more about migraines, check out some of these links: