Oliver Sacks Migraine Quotes

when the attack is “due” (or a little overdue), it will occur, explosively, whether or not there is any provocation.

The drowsiness which often accompanies or precedes a severe common migraine is occasionally abstracted as a symptom in its own right, and may then constitute the sole expression of the migrainous tendency. The

Far commoner, and perhaps the most intolerable of all aura symptoms, is intense sudden vertigo accompanied by staggering, overwhelming nausea, and frequently vomiting. The

This state is thus one of an excruciating overall sensitivity, patients being assaulted by sensory stimuli from their environment, or

Many patients may confess that they feel “strange” or “confused” during a migraine aura, that they are clumsy in their movements, or that they would not drive at such a time. In short, they may be aware of something the matter in addition to the scintillating scotoma, paraesthesiae, etc., something so unprecedented in their experience, so difficult to describe, that it is often avoided or omitted when speaking of their complaints. Great

Presiding over the entire attack there will be, in du Bois Reymond's words, "a general feeling of disorder," which may be experienced in either physical or emotional terms, and tax or elude the patient's powers of description.

We may see very clearly how the wrong sound, or “anti-music,” is pathogenic and migrainogenic; while the right sound—proper music—is truly tranquillising, and immediately restores cerebral health. These effects are striking, and quite fundamental, and put one in mind of Novalis’s aphorism: “Every disease is a musical problem; every cure is a musical solution.

It may, in its natural course, exhaust itself and end in sleep; the post-migrainous sleep is long, deep, and refreshing, like a post-epileptic sleep. Secondly, it may resolve by “lysis,” a gradual abatement of the suffering accompanied by one or more secretory activities. As

You keep pressing me,” he said, “to say that the attacks start with this symptom or that symptom, this phenomenon or that phenomenon, but this is not the way I experience them. It doesn’t start with one symptom, it starts as a whole. You feel the whole thing, quite tiny at first, right from the start.… It’s like glimpsing a point, a familiar point, on the horizon, and gradually getting nearer, seeing it get larger and larger; or glimpsing your destination from far off, in a plane, having it get clearer and clearer as you descend through the clouds.” “The migraine looms,” he added, “but it’s just a change of scale—everything is already there from the start.” This business of “looming,” of huge changes of

Du Bois Reymond spoke of “a general feeling of disorder” at the very start of his attacks, and other patients speak, simply, of feeling “unsettled.” In this unsettled state one may feel hot or cold, or both (see, for example, Case 9); bloated and tight, or loose and queasy; a peculiar tension, or languor, or both; there are head pains, or other pains, sundry strains and discomforts, which come and go. Everything comes and goes, nothing is settled, and if one could take a total thermogram, or scan, or inner photograph of the body, one would see vascular beds opening and closing, peristalsis accelerating or stopping, viscera squirming or tightening in spasms, secretions suddenly increasing or lessening—as if the nervous system itself was in a state of indecision.

Thus it is awkward to call motion-sickness a migraine attack, but we may very conveniently term it a migranoid reaction, and note, in support of its affinities, that a large minority (almost 50 per cent, according to Selby and Lance) of adult migraine sufferers experienced severe motion-sickness in

Chorea—a twinkling movement or motor scintillation—does not have its origin in the cerebral cortex, but in the deeper parts of the brain, the basal ganglia and upper brainstem, which are the parts that mediate normal awakening. Thus these observations of chorea during migraine support the notion that migraine is a form of arousal disorder, something located in the strange borderlands of sleep—a disorder which has its origin deep in the brainstem, and not superficially, in the cortical mantle, as is often supposed (a

Sudden fright, or rage, or other strong emotion may disperse and displace a migraine almost within seconds. One

Characteristic of such affective equivalents is their brevity—manic-depressive cycles, as generally understood, occupy several weeks, and frequently longer. Monthly

Thus Aretaeus describes it, under the name of Heterocrania: And in certain cases the whole head is pained, and the pain is sometimes on the right, and sometimes on the left side, or the forehead, or the fontanelle; and such attacks shift their place during the same day … This is called Heterocrania, an illness by no means mild … It occasions unseemly and dreadful symptoms … nausea; vomiting of bilious matters; collapse of the patient … there is much torpor, heaviness of the head, anxiety; and life becomes a burden. For they flee the light; the darkness soothes their disease; nor can they bear readily to look upon or hear anything pleasant … The patients are weary of life and wish to die.

The hateful mood of a migraine—depressed and withdrawn, or furious and irascible—tends to melt away in the stage of lysis, to melt away with the physiological secretion. “Resolution by secretion” thus resembles a catharsis on both physiological and psychological levels, like weeping for grief. The

in these few minutes one gets an overwhelming impression of the absolute identity of Body and Mind, and the fact that our highest functions—consciousness and self—are not entities, self-sufficient, “above” the body, but neuropsychological constructs—processes—dependent on the continuity of bodily experience and its integration.

PERIODIC MOOD-CHANGES We have already spoken of the affective concomitants of common migraines—elated and irritable prodromal states, states of dread and depression associated with the main phase of the attack, and states of euphoric rebound. Any or all of these may be abstracted as isolated periodic symptoms of relatively short duration—some hours, or at most two or three days, and as such may present themselves as primary emotional disorders. The most acute of these mood-changes, generally no more than an hour in duration, usually represents concomitants or equivalents of migraine aura. We may confine our attention at this stage to attacks of depression, or truncated manic-depressive cycles, occurring at intervals in patients who have previously suffered from attacks of undoubted (classical, common, abdominal, etc.) migraine.

McKenzie once called Parkinsonism “an organized chaos,” and this is equally true of migraine. First there is chaos, then organization, a sick order; it is difficult to know which is worse! The nastiness of the first lies in its uncertainty, its flux; the nastiness of the second in its sense of immutable heavy permanence. Typically, indeed, treatment is only possible early, before migraine has “solidified” into immovable fixed forms.

We have seen that there are two forms of stimulus which are particularly prone to evoke migrainous reactions in predisposed individuals: inordinate excitations or arousals, and inordinate inhibitions or slumps. Within certain “allowable” limits (which vary greatly from person to person), the nervous system maintains itself in a region of equilibrium, homeostatically, by means of continuous, minor, insensible adjustments; beyond these limits, it may be forced to react by sudden, major, symptomatic adjustments.

Transient states of depersonalisation are appreciably commoner during migraine auras. Freud reminds us that “… the ego is first and foremost a body-ego … the mental projection of the surface of the body.” The sense of “self” appears to be based, fundamentally, on a continuous inference from the stability of body-image, the stability of outward perceptions, and the stability of time-perception. Feelings of ego-dissolution readily and promptly occur if there is serious disorder or instability of body-image, external perception, or time-perception, and all of these, as we have seen, may occur during the course of a migraine aura.

According to chaos theory, although it is impossible to predict the individual behavior of each element in a complex dynamic system (for instance, the individual neurons or neuronal groups in the primary visual cortex), patterns can be discerned at a higher level by using mathematical models and computer analyses. There are “universal behaviors” which represent the ways such dynamic, nonlinear systems self-organize. These tend to take the form of complex reiterative patterns in space and time—indeed the very sorts of networks, whorls, spirals, and webs that one sees in the geometrical hallucinations of migraine. Such chaotic, self-organizing behaviors have now been recognized in a vast range of natural systems, from the eccentric motions of Pluto to the striking patterns that appear in the course of certain chemical reactions to the multiplication of slime molds or the vagaries of weather. With this, a hitherto insignificant or unregarded phenomenon like the geometrical patterns of migraine aura suddenly assumes a new importance. It shows us, in the form of a hallucinatory display, not only an elemental activity of the cerebral cortex but an entire self-organizing system, a universal behavior, at work.*3

fossilised” dream-sequences preserved as such in the cortex, precise replicas of past experience; they appear to be mnemic images which unfold, given the initial activation (epileptic, migrainous, experimental, etc.) at the same rate as the initial perceptual experience.

Whichever method is utilised—violent physical, visceral, or emotional activity—the common factor is arousal. The patient is, as it were, awoken from his migraine as if from sleep. We shall further have occasion to see, when the specific drug therapies of migraine are under discussion, that the majority of these too serve to arouse the organism from a state of physiological depression.

By what warrant, therefore, is such an attack to be termed an extended epilepsy rather than a quite brief and severe, let us say, a condensed migraine?

Compact and clearly defined at its center, migraine diffuses outwards until it merges with an immense surrounding field of allied phenomena. The only boundaries which exist are those which we are forced to adopt for nosological clarity and clinical action. We construct such boundaries and limits, for there is none in the subject itself.

Attacks characterised by little more than malaise are likely to be regarded as mild viral illnesses. Attacks characterised by alteration of affect and consciousness—mild drowsiness or depression—may be taken for purely emotional reactions. Both

many cardinal characteristics of migraine aura, in its visual (scotomatous), tactile (paraesthetic) and aphasic forms. We

I stayed, as always, at 37 Mapesbury, and on publication day my father came into my bedroom, pale and shaking, holding The Times in his hands. He said, fearfully, “You’re in the papers.” There was a very nice essay-review in the paper which called Migraine “balanced, authoritative, brilliant,” or something of the sort. But so far as my father was concerned, this made no difference; I had committed a grave impropriety, if not a criminal folly, by being in the papers. In those days, one might be struck off the Medical Register in England for any indulgence in “the four As”: alcoholism, addiction, adultery, or advertising; my father thought that a review of Migraine in the general press might be seen as advertising. I had gone public, made myself visible. He himself always had, or believed he had, a “low profile.” He was known to and beloved by his patients, family, and friends, but not to a wider world. I had crossed a boundary, transgressed, and he feared for me. This coincided with feelings I had had myself, and in those days I often misread the word “publish” as “punish.” I felt that I would be punished if I published anything, and yet I had to; this conflict almost tore me apart.

This gave me a feeling of what seemed wrong with American medicine, that it consisted more and more of specialists. There were fewer and fewer primary care physicians, the base of the pyramid. My father and my two older brothers were all general practitioners, and I found myself feeling not like a super-specialist in migraine but like the general practitioner these patients should have seen to begin with.

Some patients I could help with drugs, and some with the magic of attention and interest.