Jottings - Slice of life - 300 - (a meditation on migraines - a personal odyssey and salvation)

(Jottings - Slice of life - 300 - a meditation on migraines - a personal odyssey and salvation)

One of my earliest childhood memories, until about thirteen or fourteen, is the excruciating pain I experienced at frequent intervals on the left-hand side of my head. These were splitting headaches unimaginable in intensity. It would start with general feeling of uneasiness in the body, a loss of interest in whatever I was doing, a sense of withdrawal from the world outside, difficulty focussing on anything; a mild nauseous sensation in the stomach followed by increased salivation and a taste of bile around the mouth, few bouts of vomiting and an intense dislike of food, growing insensitivity to light ( it would become extremely painful to look at anything bright), and above all a piercing pain in the left eye with star-like formations, and holographic figures flitting across my vision with unhurried movement, often blocking areas of vision. This entire episode would last anywhere between three to four hours, during which time, I would be physically prostrated. Such episodes would most often start right in the middle of the school. When the first signs of uneasiness manifested, I instinctively knew the chain of events that would inevitably follow, and prepared myself for the attack. Once the pain is triggered, it ran its course. Nothing one could do would lull, or halt the course of the attack. I would rush home as soon I could, throw my bags, refuse to eat anything, compulsively vomit - emptying the stomach of nothing in particular ( only bilious liquid), pop in a mild pain killer my mother would give, and lie down with sheets pulled over my eyes with hands or pillows pressing tightly on the left side temple. It is difficult to communicate in words the overwhelming desire during such an attack to be enveloped in complete darkness and fall into a deep sleep with no disturbance from anything or anyone. “Just leave me alone” would be a right description of that state. This flat-out, intense sleep would be dreamless and almost comatose in nature, and the duration of the sleep would range anything between three to six depending upon what time of the day the attack commenced and the intensity of it. The mysterious thing is that after this period of dreamless sleep, I would wake up doubly refreshed. The depths of pain, depression, and isolation that preceded the sleep would give way to euphoria and positive energy with no signs of the debilitating symptoms as before. No trace of pain or uneasiness whatsoever. On the contrary, I would feel as though I was reborn. The right metaphor to explain this rejuvenated state would be that of an intense wave passing though the body and throwing it out of balance. Once the wave has passed through, a new equilibrium is achieved. The district feeling I remember after each such episode is that of being cleansed, healed, and of tremendous peace.

In medical literature, the headache and the bodily unease I described above is known by the name of “Migraine”. Millions of people around the world experience symptoms of Migraine in greater or lesser degree, in different forms and shapes; but all of them uniformly feel a disturbance in their psychophysical system, an imbalance, which occurs during the time of migraine, and a rebounding of the physical health immediately after the paroxysms of pain and disturbance pass way in the aftermath of deep sleep. This key sequence of pain-withdrawal - revival is the key to understanding the complex neurological basis of migraines. The symptoms of migraine as paroxysms of pain was recorded nearly two thousand years ago by the Greeks. And since then references to visual scotoma or auras, nausea, constipation, localized pain have been adequately documented. However, it is only in the 19th century that a systematic study of Migraines began, and a general understanding of its mysterious purpose and a possible diagnosis emerged.

What is very important to realize is that migraine is not merely a biological or chemical process, but equally a psychological and behavioral manifestation. To understand the symptoms of migraine only in technical terms without an underlying study of the person experiencing the migraine is almost futile, and can never lead to a lasting cure. This is one of the greatest revelations of the twentieth century, especially, after the study of the human psyche became an acceptable domain in medical science. Migraines have a specific pattern, whose causes are entrenched in specific behavioral, emotional and physical patterns of the individual. Some people get a migraine when they eat fatty foods, others have an attack based on psychological stress; many others fall prey due to specific distortions in the sensory field - too much light, sound or smell; and a significant minority experience a migraine when their nervous systems are simply exhausted and require readjustment. When the right conditions converge, the body forces itself to go through a series of restorative convulsions to achieve a homeostatic equilibrium. Doctors cannot do much about migrainous attacks if they only look to achieving a biological cure. A pain killer can temporarily alleviate the pain and bring the attack to a close. But no amount of medication cannot prevent the occurrence of the next attack. The important characteristic of migraine is its frequency and cycle of recurrence. An individual can sense the onset of a migrainous attack much in advance. Like a Tsunami, the indications of an impending migraine are very clear to the patient, and interestingly, they can watch the slow gathering of momentum as one by one, the symptoms of the attack manifest themselves and renders the patient helpless in its irresistible grip. At the most, the patient can contain the effects of its outcome by not participating in activities that could aggravate the condition; but once triggered, the attack will run its course, no matter what, until the psychophysical balance is achieved.

For years, I suffered from such attacks. I would go to school perfectly normal, and during the course of the day, in the middle of something trivial, I would sense the first indications of the attack: a dull pain around the left temple, a dimming of vision, nausea, and finally a visual aura that would resemble geometrical shapes, like stars, slowly forming at the outer edge of the cornea and gradually filling a portion of the eye. When this stage is reached, the pain around the left temple reached throbbing intensity, as though someone was hammering away around that region. When I reached home, all that I could communicate was that I had a splitting headache. The other symptoms accompanying it were incomprehensible to me and hence uncommunicable to others. If my vomiting was severe, we would visit a doctor, who would treat it as a headache and prescribe mild pain killers and sleep. I don’t remember any doctor talking to me or my parents on the mysteries of migraine, the way it works, and its therapeutic effect. At some point, when my attacks grew more frequent and interfered with my studies, I was taken to a neurologist, a specialist in town, to check if I suffered from any nerve related issues. The doctor tapped my nerves with a tong and concluded that my reactions were all right. The only advice he had for me ( and for my mom) was to avoid any food made out of condensed milk, which, unfortunately, included chocolates, kheer, rasagullas, milk halwa and all the rest of my favorite goodies. An advice, I detested and blissfully ignored whenever I could. Finally, it was a homeopathic doctor in Chennai, who told us that I will naturally outgrow the intensity of the attacks as I grew older. He gave me a tablet, more as a placebo than anything else, to ingest for a year or so, which I meticulously did. The homeopathic doctor was right. Around my late teens, when my priorities, lifestyle, and physical structure changed, the frequency of migraines also decreased, and even if it occurred, I was mentally and physically better equipped to handle the discomfort.

At the back of my mind, however, I have always carried the experience of the migraines I have had, and a gnawing desire to understand the symptoms and effects better - especially the visual auras, nausea, the need for isolation, and more importantly, the sense of euphoria and well-being after the attack. The excruciating discomfort experienced during a migraine was in stark contrast to the state of extreme well-being afterward. The splitting headaches during the attack were normal enough, but the kaleidoscopic variety of symptoms that accompanied the ache pointed to a deeper meaning. There was something in those migrainous episodes that didn’t quite look like illness and more of self-healing therapy. As the years passed, and my intellectual interests expanded, I came across a book by Dr. Oliver Sacks, the great neurologist. The title of the book is “Migraine”, and this was Dr. Sack’s first book written in 1968. Dr. Sacks himself was prey to migrainous attacks, and in the prologue to this book, he mentions that he wrote the book on Migraine over a period of two weeks in an attempt to understand and condense the literature available on Migraine, and its mysterious medical trajectory. I read “Migraine” over two consecutive nights. I couldn’t put the book down. It had all the answers to the lingering questions and doubts I had about my own condition during those attacks. For those of you, who have read Dr. Sacks books ( The man who mistook his wife for a hat, or Awakenings, or Musicophilia to name a few) you know the beauty of his language, and the rigor of his descriptions. Like the late Stephen Jay Gould, the evolutionary biologist who wrote for the educated reader without comprising on the technical accuracy of the subject, Dr sacks also presents his medical cases with great flair and scientific authenticity.

Each page of the book validated my experience of Migraine. The visual auras, the uneasiness, the state of painful excitement, the compulsive need for darkness - all of this have been documented and studied. Dr sacks present the evidence with sparkling clarity. That these symptoms are not signs of illness, but of a catharsis, an attempt by the psychophysical organism to regain its neural balance; and that Migraine was compared by Dr Liveing - the first neurologist who understood and studied migraine from a holistic perspective - to a “nerve storm” which sweeps through the body leaving it flushed and clean; and that a headache is not the principle symptom of a migraine, but one among many; and that the visual auras - those geometrical figures that flit across the eye, is not a defect of the eye, but a play of the neural system in an unfathomable way to visualize the objective world in a fractal manner; and finally, the overall experience of Migraine as a metaphor, a window, a clearing in the perception of our senses to glimpse into the interplay between the physical and the inner sense of beingness.

Over the years, since I read Dr sacks, I am deeply convinced, that many of the mystics, who have claimed visual experiences and who have come out such experiences transformed and healed, could have experienced migrainous episodes. There is no doubt that during a migraine, a new perception of reality is vouchsafed to us, and for those privileged few, who could witness and not consider themselves victims of the fascinating drama that unfolds during a migraine between the body and the mind, would no doubt explain their experience as something extraordinary. Towards the end of Dr. Sacks’ book on migraine, in an appendix, he presents the case of Christian mystic Hildegard of Bingen, a nun, and mystic with commendable literary powers. Hildegard has left behind vivid drawings of her spiritual ecstasies - which she called “visions”. In the light of modern day understanding of visual auras during a migrainous attack, it is evident that Hildegard’s etchings are reflections of the visual auras she experienced. This is not to dilute the quality of Hildegard's spiritual maturity as nothing but illness, but to argue that Migraine in its profound manifestations can be a door to a deeper and clearer understanding of one’s being and relationship to the universe. Innumerable Indian mystics, including the contemporary Ramakrishna Paramahamsa, have spoken about visions and trances that would leave them elevated and exhausted at the same time, as though a psychological hurricane has passed through and left them irrevocably changed. Perhaps, these experiences and visions drew them to achieve a newer and more stable psychophysical equilibrium than the rest of us. Perhaps, enlightenment or spiritual illumination is understanding the language of the psychophysical system better. In Dr. Sacks brilliant prose, he summarizes the experience of Hildegard in the following words:

“(Migraines) provides a unique example the manner in which a physiological event, banal, hateful, or meaningless to the vast majority of people, can become, in a privileged consciousness, the substrate of a supreme ecstatic inspiration”

Illness, disease and physiological events can hold out a mirror to reflect on our sense of identity, and who we are. I can vouch for this from my personal experience. One learns a lot about oneself during convalescence after an illness. As the body recuperates and heals itself, the self is again and again forced to question its own identity. One of the tragedies of Man is the dichotomy between the mind and body. We think of ourselves as a “ ghost in the machine” in Arthur Koestler’s famous description, but the reality is that there is no mind apart from the body, and vice versa. We tend to look upon illness as an outsider, suffering the pangs of pain and nervous prostration, as though the body is something alien and can be mended independently of the self. Thomas Mann in his classic ‘The Magic Mountain” draws on this dichotomy to create an epic tale of illness as a metaphor to life and living. Until the nineteenth century, medicine was holistic; the twentieth with its tremendous surge in technological innovation converted medical science into one of measurements and tools, but the good news is that in the last two decades few pockets of doctors around the world are returning to the understanding that disease, illness, and possibly death are not enemies; but gentle reminders of an inner unity, a coalescing of the mind and body to a less contaminated state of being.

God bless…

yours in mortality,

Bala