When there is a volcano in the head

Migraines are very common, and democratic, affecting the poor and famous alike but can be tackled with medication and lifestyle change

“I need you to help me with this headache I’ve had for a decade,” a friend pleaded.

“As long as you’re not referring to your wife or boss, I’m happy to try!” I shot back, knowing his protracted predicament with both of them. He was my age, only better looking and with more hair.

In his mid-twenties, he’d started developing a peculiar throbbing pain on the right side of his head. It was typically associated with a few zig-zag shadows he perceived before the headaches heightened. Lights and sounds worsened the discomfort and he’d prefer a dark, cool environment during an attack. “When I massage that part, the ache mysteriously scrams to another part of the head, never really going away,” he said, describing his dilemma.

“The nausea is so severe, I need to force myself to vomit, often half a dozen times, shoving several fingers down my throat to induce the last remaining bits in my stomach to be expelled. It is only when my stomach is absolutely empty that the throbbing headache finally eases. Then I gargle, have a sip of water, and sleep it off, waking up only several hours later.”

His medical test reports were unblemished and his scans spotless. Yet, over time, his migraine worsened in frequency and intensity, from once in 3–4 months to every 3–4 days and lasting the entire day. He promiscuously popped pills but reached out to me only when he realised he was hanging on to the end of a burning rope and needed someone to douse the fire.

“One can get a headache from taking too many headache pills,” I cautioned. “It’s called MOH or medication overuse headache,” I smiled, bemused by this obvious paradox.

“Isn’t there any surgery for this stuff? Sometimes I feel that cutting my head open will relieve the pain,” he asked helplessly.

I went on to explain that in ancient Greece, headaches were considered powerful afflictions. Victims prayed for relief from Asclepius, the god of medicine. If the pain continued, a medical practitioner would drill a small hole in the skull (trephination) to drain the confined demons. Unfortunately, this dire technique often replaced the headache with a more permanent condition. And to relieve that, they applied raw potatoes, cabbage, and onions to the head.

I went on to explain that some deeper medical insight into the anatomy and physiology of the pain producing structures in the cranium have led us to understand that migraines involve alterations in the subcortical sensory modulatory systems that influence the brain widely. “Whatever that means,” he flared up, confused, wanting to simply rid himself of the periodic curse.

“Just like your zig-zag lines, the distortion of perceptions described in the famous 1865 novel Alice’s Adventures in Wonderland is believed to have stemmed from Lewis Carroll’s own experiences with episodes of micropsia (the visual perception of objects appearing smaller) and the constitutional auras resulting from his migraines,” I said, thinking I’d lighten up the conversation with some trivia.

Patients are almost instantly relieved when they know that someone famous suffered from the exact same ailment as theirs. Darwin, Nietzsche, Freud, Caesar, Napoleon, Van Gogh, Picasso, Thomas Jefferson, Virginia Woolf, and Elizabeth Taylor were all famous migraineurs. “I’d rather feel nothing than feel the pain I’m feeling,” revealed Elvis Presley, resorting to gargantuan amounts of drugs to battle chronic headaches, an overdose of which was speculated to be the cause of his death.

Neurologists call this distortion of perception that precedes the migraine headache the Alice in wonderland syndrome, and they think it’s due to an abnormal amount of electrical activity that results in excessive blood flow to parts of the brain that process visual perception and texture; I wonder what JK Rowling went through when she wrote the Harry Potter series!

Migraine needs to be treated medically with a two-pronged approach of medication and lifestyle modifications. The medication I prescribed was a combination of prophylactic and abortive therapy to be taken for 3 months; the prior to be consumed daily and the latter just before an attack. In addition, one is expected to sleep adequately and eat in moderation, avoiding chocolate, cheese, coffee, and wine – all circumspect triggers for migraine. “Why does everything enjoyable have a price to pay?” my friend lamented. “A migraine ‘shot’ is also available now, which you can take once a month to dampen symptoms,” I added, “but we’ll keep that for later.”

I also asked him to maintain a headache diary with monastic ferocity to document the vivid details of his auras and time periods of each attack in relation to the medication, in an attempt to analyse how to alter treatment if required. He also needed to document his sleep timings, travel habits, and foods that triggered his headaches.

Various forms of neuromodulation such as transcranial magnetic stimulation and non-invasive vagal nerve stimulation have also been attempted when medication alone does not suffice. Modern surgery involves trigger point deactivation, which essentially involves transecting or blocking a sensory nerve responsible for the affliction, which, like all surgery, comes with its risks.

My friend returned 3 months later, regaining full control of his life. Now, he worries only about an occasional, easily manageable headache: no auras, no vomiting, no having to skip important life events. He was well, but I noticed that he wasn’t beaming. “You’re more than 99% better and we managed that without drilling a hole in your head!” I exclaimed. “Why aren’t you more delighted?”

He replied, tongue in cheek, “I can’t blame my wife or my boss for anything anymore!”

28 Comments on “When there is a volcano in the head
  • Supriya Correa says:

    Well written, Dr Funnybones… Now if only you were neurosurgeon to Trump from the last 4 years. The world would have been rid of a very big headache indeed…

    Reply
  • Debashree Turel says:

    Wives and migraines shall forever remain inextricably linked it seems 😘

    Reply
  • Gloria Msampha says:

    Why does everything that tastes good make you feel bad?🤔🤔. The connection between chocolate, wine etc and migraine is difficult to understand. Migraines are the norm I guess when you have a stressful job and your boss expects you to perform miracles. No matter how many painkillers you take it doesn’t go away. Great article.

    Reply
  • Dr. Vinod Desai says:

    As always, superb !

    Reply
  • Dr Pradeep Doshi says:

    Thanks for enlightening baba Mazdadev

    Reply
  • Sahil Shah says:

    Excellent article Dr Turel ! It is astounding how debilitating a migraine can be !
    One can run away from a boss or partner for a few hours, but the migraine will follow like a shadow and remain (hidden) even in the dark.

    Reply
  • Shrutin Shetty says:

    Really well written, and nicely solved without surgery. Great work, Mazda!

    Reply
  • Dr uma says:

    Exact symptoms and agreed with etiology
    Meditation and alternate nostril breathing helpful, don’t know the scientific reason though.

    Reply
  • Dr uma says:

    Exact description.for me alternate nostril breathing and drugs helped

    Reply
  • Chandrashekhar Deopujari says:

    Racy prose.

    Might try non neurosurgical writing

    Reply
  • Armaiti Mistry says:

    Love reading your articles Mazda! I get them from your mom, or Huti, or sometimes from friends in RB. You really are a multi talented guy! Keep it up! 💕

    Reply
  • Harish M. Belani says:

    You Expound Exceptuonally Well .. Hope you teach classes regularl4y.

    Reply
  • Hutoxi Doodhwala says:

    So well explained Mazda. Didn’t know migraines can be so troublesome.
    Looking forward to more of your articles.
    Cheers!

    Reply
  • Katrin says:

    I am a migraine sufferer too (Had exact symptoms as described in peak seasons) and realized that my migraines are directly connected with sleep deprivation and smartphone usage at night. Also high blood pressure can trigger a migraine for me which is again linked to not sleeping well (racing thoughts) and not well managed stress. What helps me are lifestyle changes ( that reduce stress) and being more disciplined keeping eyes shut at night. When my mind is still racing and I can’t get sleep I revert to audio books that take my attention to something else and eventually lull me back to sleep. Great article Mazda!

    Reply
  • Rita singh says:

    Very well expressed.The age old relation between wives n headaches made reading more enjoyable.as usual ur diagnosis is always correct.

    Reply
  • Avinash Karnik says:

    Very well tackled as always.

    Reply
  • Megan Correa says:

    As a long suffering patient of migraines once upon a time, your article resonates with me. You would have been a very little boy else I would have come to you as a patient!! Especially with articles such as these! Well done

    Reply
  • Anjali says:

    My son suffers from migraine and you’ve described the entire thing perfectly. I initially thought my son was malingering. As usual dr Mazda, informative, interesting , with that splendid touch of humour. Kudos

    Reply
  • Hosie & Jeroo Mancherjee says:

    Thanks for sharing this very informative and well written article. We love reading them every Sunday a.m
    Wishing you happy 🪔

    Reply
  • Dr Shivkumar V Dalvi says:

    Very nicely written with grt dramatisation.i knew of some persons who used to hit their heads literally against the wall.Salman khan is another famous person to have suffered this agony.Some reference to causative intracranial vascular anatomy in easy to understand way also wud help, i feel.Congrats for eminently readable medical article as usual.

    Reply
  • Chandan Sanjana says:

    So well written, so well described as to what a patient goes through with a Migraine attack. I have two friends who suffered terribly with this condition. The nausea was terrible the pounding headaches, I have seen them going through this period. For one she made a big bottle of Jeera water and drank it and she swore that over a time this is what cured her. But as she was going on in years the intensity of the pain lessened and slowly the Migraine released from her and God bless her she has not got another attack since the past ten years. She is no now 71 years old
    I enjoyed reading Debashree’s comment.

    Reply
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