Image: David Kohn
By contributor
updated 3/2/2009 8:38:18 AM ET 2009-03-02T13:38:18

Being in the grip of a migraine feels like a hammer is pounding away inside your eyeball. The world becomes almost threatening: The lowest light feels like a strobe; the gentlest sound is as grating as a jackhammer. When you’re in the throes of an attack, all you want is to lie down alone in a dark room and suffer in silence.

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For as long as I can remember, this, once every week or two, has been my lot.

As a kid, I’d lie in the dark, head hard against the pillow, and fantasize about slicing my temple open with a scalpel, peeling the skin back and removing whatever it was that was making my head ache. It was a comforting reverie — the idea that I could quickly remove the cause of my agony.

One of my earliest memories — I must have been 4 or 5 — is of being allowed to stay up until midnight (midnight!) the night before I was to have some kind of brainwave test to make sure my headaches were migraines rather than a brain tumor. Who knows why they wanted me to stay up; probably some theory that a tired child’s brain reveals more of its true nature.

I still remember bits and pieces about the tests themselves. One, I suppose, gauged my ability to think logically. In one story, a boy got sick and then got better. In the next, he got sick, died, and then got better. Which one was correct? "What a stupid test this is," I remember thinking as the tester waited for my answer.

Getting migraines young is not unusual. I was a little early: they usually start at age 11 in boys, age 15 in girls. Interestingly, women are three to four times more likely than men to suffer from migraines. It’s not clear why.

As a child, I tried a medicine called Cafergot, a foul-tasting pill that had no effect at all on the headaches. In the '70s, it was the best defense medicine, or at least my doctor, could offer. Until the age of 8 or so, I couldn’t swallow pills; once a week, I’d force a Cafergot down with four or five sugar cubes; the sugar, I remember, did nothing to mask the pill’s bitterness.

When the Cafergot failed, as it always did, I lay down with an ice pack and prayed for sleep, pressing my temple hard to my pillow. More often than not, I’d get up at some point to throw up.

Eight or 10 hours later, I’d wake up feeling drained, hungry, and blessed, absolutely blessed, to be free of the pain. The world had been remade. There are few pleasures sweeter than the absence of a migraine after having one.

Thinking back, I realize how migraine permeates my life. There was the time I tried to take part in the boxing tournament in my best friend’s playroom. Direct blows to the temple, I discovered, are a migraine trigger without peer. There was the Halloween when I — dressed in an unwieldy skyscraper costume made of cardboard boxes — tripped while trick or treating, banged my head on a tree root and got a headache. Less candy than usual that year. There was the migrainous prom night; I gutted that one out.

It sounds distressing, but it didn’t feel that way. When you’re introduced to something as a child, it seems routine. Migraines were my default, an unremarkable and regular occurrence. I had no other frame of reference.

At some point — I was around 10 or 11 years old, I think — I gave up on the useless Cafergot and simply endured. Who knows why my pediatrician didn’t try other medicines. I never asked — I was a kid, and I had no idea there were other options. I wasn’t alone: studies show that a significant number of migraineurs aren't adequately treated.

Over the years, I’ve learned that certain substances and activities can be relied on to trigger an episode. Roller coasters, spinning too long in our rotating kitchen chairs, staying up too late, all elicited attacks. Over the years, the list has grown: red wine, MSG, chocolate, vinegar, oranges, mineral water, avocados, cigarette smoke, even the aroma of gasoline. I do my best to avoid these, some better than others. Chocolate in particular leads me to periodic ruin.

In my 20s, I discovered chemical help. First came Butalbital, a combination of caffeine, aspirin and a muscle relaxant. A marvelous blend: It took away my headache and left me simultaneously alert and relaxed. For the first time since I was a small child, I wasn’t losing two, three, four days a month to a headache.

After five years, the Butalibital quit working. I switched to something called Imitrex, which constricts the throbbing blood vessels in my temples and calms overactive facial nerves. It leaves me drowsy and prone to staring into the middle distance. But it’s a miracle drug. I get about 50 or 60 headaches a year. Imitrex takes care of 95 percent of them within an hour: erasing the headache or at least transforming it into a tolerable throb.

Every few months the medicine fails to work, and I suffer a full blown attack — ice pack, dark room, etc. The pain overwhelms me. I whimper, I pray, I count off the seconds. At these moments, I get some faint sense, I think, of what it must be like to buckle under torture. I am, in short, much less able to handle the same pain I tolerated without complaint as a 10-year-old.

Inherited agony
What’s most distressing now about my migraines is that they’re not just mine. I’ve bequeathed them to my 7-year-old daughter. When she got her first one three years ago, I knew immediately what it was. I knew what she was feeling, and it brought tears — of empathy, frustration and guilt — to my eyes. I’m responsible for her suffering: It’s my genes, after all, that are causing her pain. So far, thankfully, her migraines usually respond to over-the-counter pain relievers.

Recently doctors have realized that migraine raises the risk of stroke and heart attack . I worry about what my headaches, a few thousand in total over the years, have done, and are doing, to my veins and arteries.

I don’t get an aura, the visual disturbance that precedes an attack. That’s good news — those with auras have higher cardiovascular risk. But in recent years, I find that my hands and feet get cold and tingly easily and often — sometimes a sign of vascular problems.

Not everybody with migraine will have a stroke or heart attack. In fact, most migraineurs will avoid the chamber with the bullet in it. But whether through genes, fate, or lifestyle, some unlucky souls will find that their bodies haven’t held up to the decades of wear, the water dripping gently onto the rock, weakening it until it cracks.

Drip drip drip.

David Kohn is a health and science writer. His work has appeared in The New York Times, Popular Science, on BBC's The World and on National Public Radio.

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