Wednesday, July 23, 2008

Anatomy of a headache

Within the last week or so, Colleen and I have both been laid low for a day or more by migraine headaches. I'd had them several times a year since I was a kid, then I went through chemo and went for seven years without one. The first one I had after that lovely respite felt like such a betrayal! I felt the karmic debt I'd paid during cancer treatment should function as a lifetime "Get Out of Migraine Free" card, but no. I lay on the bathroom floor weeping more from rage than pain. Because pain I could handle. I'd learned to deal with pain because...wait a minute...the vague realization came to me through the haze of searing pain:

That that is is.

My oncologist taught me something during chemo that I've since applied to migraine -- well, not relief exactly, but copiness. "Understanding and acceptance," she said, "physically defuse the body's sympathetic response to pain."

Here's the way it's explained on
A migraine headache is a form of vascular headache. Migraine headache is caused by a combination of vasodilatation (enlargement of blood vessels) and the release of chemicals from nerve fibers that coil around the blood vessels. During a migraine attack, the temporal artery enlarges. (The temporal artery is an artery that lies on the outside of the skull just under the skin of the temple.) Enlargement of the temporal artery stretches the nerves that coil around the artery and causes the nerves to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery. The increasing enlargement of the artery magnifies the pain.

...The sympathetic nervous system is controls primitive responses to stress and pain, the so-called "fight or flight" response. The increased sympathetic nervous activity in the intestine causes nausea, vomiting, and diarrhea. Sympathetic activity also delays emptying of the stomach into the small intestine and thereby prevents oral medications from entering the intestine and being absorbed. The impaired absorption of oral medications is a common reason for the ineffectiveness of medications taken to treat migraine headaches. The increased sympathetic activity also decreases the circulation of blood, and this leads to pallor of the skin as well as cold hands and feet. The increased sympathetic activity also contributes to the sensitivity to light and sound sensitivity as well as blurred vision.

It always used to seem like my worst migraines came with the worst possible timing -- because they did! The more distressed I was about the inconvenience -- nay, injustice! -- the more agony I was in. Somehow knowing the nuts and bolts of the physiology as those reactions cascade actually is comforting for me. It's an enlarged blood vessel, not Satan's fuck-finger. There's nothing fair or unfair about it. Nothing evil or malicious. It's just a really, really bad headache.

It just is.

Accepting this helps me. The headache itself isn't less painful, but the less anger I feel, the less side- and after-effects I experience.

Now if only I could apply this zen approach to the publishing industry.


Colleen Thompson said...

All I can say is arghhhh... This morning is not good.

Two things give me headaches: eating chocolate and tropical thunderstorms. I haven't had the pleasure of the former, so Goodbye, Dolly already.

Gillian Layne said...

How amazing--my father has suffered from these all his life. He has visited many doctors and pain clinics, but I don't think they've ever talked about this connection.

I hope the fall brings you both a bit of relief.


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