You say MEgraine, I say MYgraine

by Perry Gretton

"You say MEgraine, I say MYgraine,
You say it's just a pain,
I say you're insane,
MEgraine, MYgraine, just pain, insane,
Let's call the whole thing off."

Ira Gershwin never wrote those lyrics, but anyone who's been told it's "just a headache" will understand the sentiment behind the words. Especially Tom ...

It was a beautiful spring day. Low humidity and a clear sky made everything stand out in sharp relief - ideal conditions for a game of golf. Tom was with John, his boss, and Maurice, an important customer, on the ninth hole when he received the first suggestion of an attack.

From the tee he watched his ball curve through the air and drop to the right of the fairway before rolling towards a stand of trees. He marched down the fairway and approached where he'd seen the ball land.

Sunlight strobed through the canopy as he explored the deep shadows. He saw the ball at the periphery of his vision but as he turned to face it, it disappeared. He turned away and saw it again out of the corner of his eye. Without bothering to look, he swung his club hard at the spot where he thought the ball should be. The ball flew towards the fairway, although not quite in the direction he had in mind.

As he walked back to the fairway, his sight deteriorated into a fractured shimmer. He was barely able to focus by the time he caught up with the others.

"I'm really sorry, guys, but I can't play any more. I've got a migraine coming on and I can't see properly."

His boss gave him a strange look. "Are you sure you can't play?"

"If I could I would, John, but I can't see clearly and my head's starting to hurt."

"Oh c'mon, Tom, you can manage another couple of holes, surely. I've played with some god-awful hangovers before."

"It's not a hangover, John."

"You're not going to let a beautiful day like this go to waste, are you? Just hang in there and you'll get through it." John started to walk away.

Tom knew that while the visual aura never lasted beyond twenty minutes, the headache would increase in intensity until it was unbearable and he wouldn't be able to tolerate any light or sound. John had no idea.

"I'm sorry. I hate doing this, but I really do have to go."

Maurice, who'd stood back and watched the exchange in silence, intercepted John and put his hand on his shoulder. "It's okay, John, just you and I can carry on." To Tom he said, "My wife gets migraines, so I know a bit about what they're like. I hope you get better soon. We have a few things still to discuss about the contract."

Tom was grateful for the customer's support. He wished his boss would be as understanding.

* * *

Tom had been having migraines since he was a child. Sometimes they came in clusters of two or three; other times he could go for months without an attack.

They followed a similar pattern, usually beginning with a visual aura. About one in four migraine sufferers get these and they can be quite frightening, especially when they first happen. Occasionally, Tom would get the aura and not the headache, and if he woke up with a headache he wouldn't get the aura.

The pain built up gradually. His head would feel as if someone had placed a metal band around it and was slowly tightening it.

The pain might be on one side of his head or the other, or move from one side to the other, or occupy both sides. He would feel nauseated and tired. Physical effort made it worse. Sometimes it took two or three days for it to go.

When Tom left the golf course, he headed to his car and retrieved a packet of ibuprofen. He bought an orange drink from the clubhouse and swallowed the pills. Taking medication before the pain had chance to get established sometimes helped alleviate the symptoms, but it was important he took it easy for the rest of the day.

By the time Tom arrived home, however, the pain had grown worse. He now worried about his work. He'd used up all his sick leave, mostly because of the severe headaches. His doctor had previously suggested taking a newer type of medicine, known as triptans, if the condition became debilitating. Tom realised the time had come to phone his doctor and make an appointment.

The doctor explained how triptans work. Although the illness isn't yet properly understood, it seems that somehow the brain's vascular system is affected. Blood flow in the arteries leading to the brain is constricted, leading to a reduction in oxygen supply, which then causes arteries in the brain to dilate. It's this expansion that triggers the pain-producing chemicals.

Triptans are believed to work by binding to specific serotonin receptors to reduce swelling in the blood vessels. Although they are best taken early on during an attack, they can be used at any stage to relieve symptoms. Triptans don't work for everybody but most people get significant benefit. Some people respond better to high dosage painkillers taken early on.

Tom knew there was no cure for migraine. His doctor told him that it often ran in families. Tom's mother was a migraine sufferer too.

Tom also knew certain activities or events could initiate an attack. Stress is a well-known factor. Tom didn't get on well with his boss and this could have created subconscious tension; the strobing effect of sunlight in the trees probably tipped the balance.

Eating certain foods sometime triggered his mother's migraines. She no longer ate yoghurt or nuts, for instance, although these didn't seem to bother Tom.

The triptans soon made an impression on Tom's migraine and the symptoms gradually eased. By the following day, Tom felt well enough to return to work, and he and Maurice sorted out the contract to everyone's satisfaction.