Just Finished Reading: Migraine by Oliver Sacks (FP: 1970)

I’ve had headaches for as long as I can remember – way back into my childhood. Looking back on them I think that a goodly proportion were probably eye-strain related. They were always worse in the summer with the heat, dryness and strong light. Getting glasses in my late teens was probably more than a few years too late. But growing up the headaches were the least of my worries. From time to time, apparently randomly, the headaches would develop into something altogether more painful and disturbing – a migraine. For those of you lucky enough never to have experienced such a thing a migraine is not just a bad headache – even a very bad headache. A migraine is something much worse. Imagine the worst hangover you’ve ever had…. Now double it and double it again. Then extend it for 24-36 hours followed by another 24-36 hours of a brain filled with cotton wool. That’s the kind of migraines I used to get. But reading this book I realise that I’m one of the lucky ones.

My migraines were intermittent. I have no real idea what caused them – something I ate, weird summer weather, stress – but I could go months or more without one. In this interesting if difficult read I was appalled to discover than some people experience migraines weekly – or even more often. To me that sounds like Hell. Likewise I discovered that my symptoms are towards the milder kind – pounding head pain, nausea, and (sometimes) visual pyrotechnics. I could always feel one coming hours ahead of time. The quality of the light changed and things became hyper-real. There was a sense of unreality about things and an almost hushed anticipation. If I was lucky I could head things off with some serious pain killers (a codeine based pill was best I discovered) but too often the only solution was to go to bed and suffer through it. Often, after 24 hours, the storm would have (largely) passed and I could function again. A day after that and it was like it never happened. My brother, unfortunately, is usually flat on his back for 3 days before recovering and that’s with the strongest pain killers on the market. Again, compared to some poor brutes mentioned in the book, we both get off pretty lightly. Not only do some people need sedating during an attack but the after effect can last long enough to melt into the start of another attack. Heavy duty drugs are the only way to deal with it. I honestly hadn’t realised just how complex migraines are. Although the book was rather dated (although it did contain some postscripts from later editions) it did make a fair fist at trying to understand how migraines appear and how they progress through their leisurely development so unlike the lightening surge of epilepsy.

What I found both bizarre and fascinating were the visual effects of a migraine episode. I sometimes experienced flashing lights of brilliant intensity like star-shells going off on the edge of my visual field. Even in the last 6 weeks or so I experienced vivid zig-zag patterns marching across my visual field that failed to develop into anything further (edged off screen by a quick pair of Ibuprofen tablets I always carry with me). But these are very minor events compared to some who suddenly see things in black and white, in 2 dimensions, pixelated or with visual experiences not dissimilar to painting by Picasso. I couldn’t help wondering how many artists throughout the 20th century – especially after the physical and psychological shocks of WW1 – suffered from some type of migraine symptoms which gave rise to whole new art forms like Cubism. More research needed I feel.

Probably the only real downside to this book (apart from its age) is the fact that it felt like (and I believe it was true) that the book was written by a doctor for other doctors – in this case from a professor of neuroscience to a General Practitioner audience. The book is peppered with medical terminology none of which is explained and pointers about patient care are constantly brought up. I did find myself softly skimming some areas of dense language once I got the gist of things which was manageable after some effort and concentration. Most of the book naturally revolved around the biology and neurology of migraines with only a small section at the end offering some advice on particular drugs and other techniques to reduce the severity of the attack or to head it off at the pass completely. I’m not sure how useful this was but I’m going to try a few things if I ever suffer another migraine event. Presently (apart from the recent light show) I’m migraine free and have been for several years – probably in the region of 3-4 I think. If you are a sufferer or know/care for someone who is I think this book might be of some limited value but I’d look for something a bit more modern as well as something a bit more non-medical professional friendly. Interesting over all but definitely hard going in places.