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Monday, November 14, 2011

My Migraines: A Visual Handbook

One interesting characteristic of my migraines is that I can categorize them in terms of colored light. Migraines lower than a 5 out of 10 on my personal pain scale generally do not have a colors, but once the pain starts to climb, the migraines shift from best being described verbally to a pain that I understand as a visual experience. This is not to say that I literally see colored lights (blinking blue aura lights are a different matter entirely) or the visual distortions experienced by some migraine sufferers, but it's how I see the pain in my mind. This made it very hard to explain my migraine pain to doctors during my first couple years as a migraineur because it seemed silly, when asked to describe my headaches, to say that they felt like columns of green light, but it really was the best possible description and I have since read that seeing migraines this way is not unheard of. Just as the nature of my migraines have changed over time, I have found that my migraine colors have changed, too. I do not get green lights migraines anymore, but for my first year and of half as a migraine sufferer, it was green lights and nothing else. 

Those early migraines were monsters. They always lasted for three days and the pain was immense, averaging an 8 out of 10 on my personal pain scale. Once during this period I had a migraine so severe that I actually accepted death and gave myself permission to pass on if I needed to; it seemed impossible that you could be in so much pain and not die. I was horribly light sensitive, noise sensitive, and nauseated during those three days and so I would lie in bed as time melted away and watch my green lights for hours.

A green lights migraine.
What I saw was a theater of sorts for my headache: the dark stage represented my skull and the backdrop was a velvety blackness of unknown depth. As I watched, columns of green light would swell forth from my skull, slowly rising and falling, blooming and fading. I had the sense that the interior of my skull was bursting with utterly sickening and blindingly bright green light, but all that I saw of it were these shafts of light that pierced the surface. It's difficult to precisely convey the brilliance and terrible luminosity of this green light; to reach for another metaphor, it was like watching an aurora borealis of pain. I also had the sense that a low, roiling, icy fog of pain constantly blew through this landscape of green columns, a pain that was different from the pain of the lights, a pain so cold that it cut my brain like a razor blade. I must have occasionally eaten a little during those three-day migraines, and surely slept, and sometimes daylight must have seeped into my room, but all I remember is watching this endless light show: the bloom
and fade of the columns as they rose and fell, the sickening pain of the blowing fog as it passed through the illuminating shafts of light, the blackness against which the the lights put on their show, and the total silence of the dead, black air in that space. It was beautiful, this pain, green and translucent and haunting and complete, and when the lights faded at last after three days, I would have a sense of emerging from the underworld.

The first time I had a migraine without the green lights, I initially insisted that it wasn't one. When asked at the ER if I would characterize it as the worst headache I'd ever had (for those who've never had a migraine, this is a standard diagnostic question; if you answer "yes," there's an excellent chance that you're suffering from a migraine), I explained that I'd had migraines before, but this headache was totally different. It had no colors and it burned right on the surface of the scalp. It was my first "transformed" migraine, too: it lasted for fourteen days before finally succumbing to a regimen of anti-inflammatory injections given every six hours for two days. While I would have many more migraines, lasting for longer and longer periods of time, I would not experience a migraine in terms of color again until the onset of chronic migraines two years ago.

A blue lights migraine with beams, cracks, blotches, and patches.

These days, when I have a migraine severe enough to shift into colors mode, the light is almost always blue. Think, perhaps, of the blue flames emitted by a gas burner when imagining the color and translucency, though a blue migraine is not a burning one. The shafts of light are much smaller than those of a green lights migraine, more beams than columns, and more irregularly scattered across the stage that is my skull, and tend to rise and fall less dramatically. Sometimes these beams of blue light are located along glowing fault lines of blue, but sometimes a crack emitting blue light will appear without any shafts of light emanating from it. Patches and blotches of luminous blue pain that seem to hover just above the surface of my skull may also appear with or without the presence of blue beams. In the parlance of my migraines, a blotch is a area of pain generally not much larger than a quarter and sometimes much smaller, while patches can be as large as the palm of my hand. Blue beams only appear out of the top of my head, while patches are generally located only on the back and sides. A really bad blue lights migraine may morph into a twin mohawks migraine, where either spikes or hundreds of painful pinpoint beams will shoot out in parallel lines running across the top and partway down the back of my head. The pain of a blue lights migraine is similar to that of a green lights migraine, but, like the shafts of light themselves, somehow thinner.

A blue twin mohawks migraine.
I also get red lights migraines, which are different from blue light migraines because the pain stays close to the head and is more of a burn than an ethereal agony. Most often a red lights migraine (which, to be specific, is an orangish-red rather than a true red) closely resembles the element from a toaster: a red-hot crinkly wire that casts a reddish-orange glow of pain around it. Red lights migraines can also form large smoldering patches.

A red lights migraine "element" and patch.
Just as a blue lights migraine has a worst form, the twin mohawks, a red lights migraine can transform into a dreaded brain-in-flames migraine. This is a migraine where the burning sensation covers the entire surface of the scalp and has reached an intensity that makes it feel like a match has been touched to the highly flammable lining of the brain. Rather than a bright blaze, a brain-in-flames migraine is a low, hot fire, nearly translucent, with a blue base to the small orange flames that never rise more than an inch or two above the head. Virtually the only way to get rid of a brain-in-flames migraine is to sleep it off, though sleep can be hard to come by when one's brain is on fire.

A brain-in-flames migraine.
Patches occur in both red and blue migraines, though the sensations are quite different. A "horns" migraine can be composed of either red or blue light and has a similar sensation in both colors. In short, it feels like an evil, painful pair of devil horns has sprouted from the temples. A horns migraine is a very bad one, not quite as bad as a twin mohawks migraine, but blue horns are sometimes the precursor to those terrible spikes and dreadful enough even if it doesn't make that final transformation.

A red horns migraine.
All of the migraines I have so far described are translucent, thin, glowing, and emanate outward from the head or, in the case of patches and elements, hover just above the scalp. While there is the occasional "verbal-only" migraine that can be described as a paper cut on the surface of the brain (other "verbal-only" migraines, or migraines without color, include the somewhat inward oriented "tightening scalp" and "collapsing eye" type pains), all of the rest of the migraines project outward at various speeds, distances, and intensities. It was not until I had my head injury this summer that I encountered a new sort of migraine: a thick, opaque, yellow-orange headache of a decidedly inward orientation.

A thick, opaque, yellow-orange migraine.
A yellow-orange migraine appears to me as a fat scribble on the brain, as if someone took a blunt oil pastel (which is thicker and greasier than a crayon) and made a vicious doodle. Because of the association between this migraine and the head injury, it is located as shown in the illustration above, starting roughly at the hairline above the right eye and extending more or less along a line that passes over the injury site, which was on the right side of the crown of my head about as far back as my ear. While the thick, opaque, yellow-orange scribble itself does not seem to penetrate the brain, it is accompanied by the sensation of having one's head smashed in by a baseball bat or large, blunt ax or of the brain being violently attacked by chain or circular saw. While the luminous light migraines have an otherworldly sort of awfulness, I find this opaque migraine more disturbing. It may just be because it is associated with the extreme nausea, light sensitivity, noise sensitivity, and fatigue that went with the concussion or that I'm so used to having translucent migraines, but when I had an opaque, thick, yellow-orange migraine last week for the first time since those weeks following the head injury, there was something very nasty and just wrong about it. I work hard to prevent my headaches from escalating to the twin mohawks or brain-in-flames point, but I'd prefer to have either of those over a yellow-orange migraine!

And that, in short, is the lexicon of my "visual" migraines: green lights, blue lights, red lights, and opaque yellow-orange scrawls. I hope that this illustrated guide is illuminating for those who have never had a migraine or who suffer from a different kind of migraine, offering a glimpse into the world of colored pain that lurks inside my head.

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