Thinking about migraines

Trevor Blüm

I was asked what causes my migraines? Biting my tongue, I withheld the comment, “what sort of cause do you mean?” and simply said I did not know.

I get migraines. When young I got them coming home from school. Some would last days, be so severe that any movement caused increased headache; every sound was an attack, every smell increased nausea. Light was pain. The answer was to lie as still as possible in as quiet and smell-less as possible a room until it passed.

Now, in my very mature years, the associated pain no longer occurs. Now my vision breaks up, my mental processes become slowed and a dark, still rest of half-hour or less usually dispels the disabling vision symptom, leaving me free to function but with a reduced efficiency.

So what causes these? I do not keep a diary, so I cannot correlate migraine with prior activity, food, stress or anxiety with any accuracy. It does appear that 80% cocoa chocolate which I love, precipitates a session within a half-day or overnight. The stress of driving along country roads at night, in rain, with ongoing traffic seems a fairly reliable predictor. Caffeine withdrawal may be a component.

To return to my opening remark, for migraine, as for many medically recognised afflictions, there are two types of causes. The cause “in fiere”, the initial cause, and the cause “in esse”, the supporting cause. Clearly, I have driven in difficult circumstances without migraine developing. I also have driven in clear daylight and had a migraine develop that forced me to stop and wait for it to settle before I could once again see the road ahead of me.

Let me speak of “triggers” or primary causes as ones which give rise to an effect with certainty. These may be then be evaluated on purely logical lines. Does the effect occur without the “cause” being immediately. closely or uniquely prior? Does the effect never occur if the “cause” is remote or absent? Hammer blows on thumbs, pins in fingers, obvious displays of infidelity, are in this class. What of hangovers? Are they “caused” by alcohol the night before? Have you NEVER drunk and awoken clear-headed? Have you NEVER awoken with a headache after a sober night?

What of “supportive” causes, those which do not themselves fit in with the trigger definition, but without which the triggers are ineffective? Immune disorders, for example, are not triggers of disease, but allow disease to establish when other individuals with similar levels of exposure are unaffected. Are hangovers in this class? If you drink water as well as alcohol, do you still have the effect? Is it presence of alcohol or absence of water that gives the throb? Older people in hot climates often suffer very hangover-like headaches because they dehydrate.

This leads me to the notion of causal interactions. Maybe the hangover happened because, through the week, you were too busy to drink, so by Friday night, your body had no adaptation to alcohol. This is of course, testable. Extend the “off-time” or increase the “on-time” and observe any change in pattern. Whether you record this in the form of composite variables (5 drinks plus 4 days dry) or as separate charts for the various delays (my choice for ease of comparison), is up to you.

Of course, if you were clubbing every night, your life-style changes might introduce a whole heap of extra variables that could be having the effect, like less time at the gym.

Causal Chains

“I know an old lady who swallowed a fly”. The fly didn’t kill her, but if she had not swallowed it and embarked on a ill-advised treatment schedule, each link in the chain more extreme than the previous, she might still be spitting up fly-legs today.

Here is an example of a single initial cause. The assumption that the whole dismal strategy could not have begun at all in an insect-free environment hardly needs testing. After all, she was an OLD lady, therefore one assumes that in all her 70+ years she never swallowed a fly before. The verse does not specify this, of course, but it appears a reasonable assumption. One could not expect a folk author to begin with “I know [and that should be knew, surely] an old lady who, on this one occasion of swallowing a fly, decided to take remedial action which she had never before contemplated. Perhaps she had been fortunate in all her years to never swallow a fly, bee, wasp, ant, dandelion seed or mosquito before this.

Tragically, whatever her prior medical history, she did in this one instance follow a self-administered treatment regime with lethal consequences which would have been foreseen and, presumably avoided, had she sought appropriate professional guidance at any point in the process before the terminal horse. It is, of course not known to this author whether she acted from necessity, there being no medical centre within reasonable distance, or from credulity, being advised by her immediate family members.

That the old lady’s heirs would no doubt benefit from her demise and may have been impatient at her tardiness in making a more graceful or traditional exit I leave as an exercise for the reader.

A simple lapse of attention, momentary dementia or indeed, a mistaken belief in her own ability to accurately identify a correct course of action in view of her extensive record of surviving all prior events to the time of the initiating ingestion, these might have been the major underlying factor.