I woke up with a headache this morning. I thought it was probably from caffeine withdrawal, but after Holly Ann brought me a cup of coffee, it was still raging. Still, just a headache, so I got up and got dressed and before I reached the kitchen realized that if I didn’t lie down right now I was likely to vomit on our favorite rug. I made it back to bed, struggling against the glare of the (still pre-dawn) sunrise.
“Do you think it might be a migraine?” Holly Ann asked. Well, duh. It’s a true testimony to my addled state that I had dismissed the possibility of a migraine. So I took some sumatriptan and announced my intention to go to choir rehearsal. She has this really cute “for a smart guy, you really have stupid ideas” look. I started to argue until another wave of nausea illuminated the absurdity of my plan. She closed the drapes, told me she would record the rehearsal, and left me to suffer and die in blissful, dark, quiet solitude.
After a bit more than two hours, I repeated the sumatriptan dose as I didn’t feel any better. Thanks be, the second dose stayed down and was effective.
migraine presentation
I have migraine only rarely — zero to two times a year. They tend to be classic migraines, with a distinct visual aura that causes me to think I’m going blind until I remember what it is. I failed to recognize this episode as a migraine because I didn’t have (or slept through) the aura.
Left untreated, I then get the rest of the classic presentation: photophobia (”please can you turn down the brightness of the nightlight?”), phonophobia (“please bring me a sumatriptan, and don’t slam the lid!”), a pounding headache, and waves of heart-stopping nausea.
In very many ways, I’m lucky. The episodes are rare (I’ve had patients who had migraines every month or more), short lasting, and respond well to first-line treatment (sumatriptan). In fact, this is the first time I remember needing a second dose. I don’t think of myself as a “migraine sufferer,” but I sure have empathy for those who are.
Over my years treating patients with migraine, I discovered that migraines can be strange. I had one patient whose only symptom was losing the ability to speak. He’s had multiple stroke workups and even ended up in a mental hospital once. I tried migraine medication as a hail Mary pass, and it cleared his symptoms completely. Another patient had pain shooting down his back for which he had been prescribed opioids. He had other migraine symptoms, and when we treated those the back pains went away. But even the classic visual scotoma, headache, nausea, vomiting, photophobia, and phonophobia can be enough to ruin a life when they’re too frequent or enduring.
—2p