Sunday, June 8, 2008

편두통: "All the fun of LSD, but legal"

Following the example of Expat Jane's excellent series on diabetes and treatment here in Korea, I'm going to spend a bit of time blogging about my most persistent health problem. Most Koreans I've talked to (like most Americans) have only a vague idea of how a 편두통 differs from a regular, ordinary 두통. Actually, I have yet to meet a Korean person who has been diagnosed as a migraineur. . .
In America, at least, approximate 15% of the population suffers from some kind of migraine headache, and at least 80% of those people have family members who also get them. In other words, this problem has a very strong genetic component. In my family, it's more unusual for someone to NOT have them - all of my immediate family get them, as well as my paternal grandparents, and my aunts on both the maternal and paternal side. They are also more common in women than in men (who are more likely to get cluster headaches, however)
There are several different kinds of migraines, but the two most common ones are classic migraines (i.e. migraines with auras), and common migraines (without). In a classic migraine, the headache may be proceeded by a brief period of visual disturbance. Common auras include seeing bright zigzag lines or moving points of light. My aunt describes them as "all the fun of lsd without the illegality." Usually the aura lasts for less than an hour, and is followed within the hour by the onset of the headache. Common migraines don't have any associated auras. Having the auras seems to me to be a good thing: it's an important and painless clue that a migraine is coming, and in many cases is means you can use medications that will prevent the painful headache phase. My grandfather carries medicine with him, and can take it at the first sign of the aura, and usually doesn't have to experience the actual headache anymore. My grandmother used to get only the aura, but not the headache phase (rather obviously named in medical terminology "headache-free migraines". DUH!) I, on the other hand, have experienced auras but mine are NOT reliably followed by the pain phase. Drat. I really don't mind the aura (usually small pinpoints of light that swim and dart around in my field of vision) but I wish it were more strongly connected with the pain phase.
Lots of people think the pain phase of a migraine is just a really, REALLY bad headache. It's not. They're a very distinct medical phenomena, and they feel totally different. A normal headache is a sense of tension and pain that spreads throughout most of the head. Sinus or cluster headaches can often show up in more confined parts of the head (usually around the eyes and sinus cavities) but the distinction of a migraine is a pounding, throbbing sensation on one side of the head only. When I get a migraine, usually the left side of my head feels completely normal. There's no pain at all. The right side of my head, on the other hand, will feel like there's a small elf in my brain trying to push my eyeball out by bracing his feet against the back of my head. My mother describes hers as someone running piano wire over one side of her skull and then playing "chopsticks." Badly.
Not all of mine are severe. For a long, long time mine were so mild that I barely noticed them. Heck, I taught classes of rowdy, noisy high school students during some of my headaches. But when they're bad, they're awful. The worst of them will basically leave me bedridden for a day or two. Luckily those are very, very rare for me.
The pain or headache phase is also usually accompanied by other problems: nausea, photophobia(sensitivity to light), and phonophobia (sensitivity to sound) are pretty common. I experience all three, and it's usually the nausea and photophobia rather than the headache that really cause my problems. One of the real tricks with medicating migraines is that because of nausea it can be hard to effectively use oral medication. By the time I know I'm getting the headache, my stomach has already shut down. That's one reason why when treating migraines caffeine is your friend.
Next time: Triggers and Treatments

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