Migraine is one of the most common neurological disorder which a neurologist encounters during his or her practice. It is not without reason that it is often referred to as the bread and butter of neurological specialty. My parents are both physicians. My father is a neurologist and mother a pediatrician. Growing up I remember my mother coming back from the hospital and complaining of a throbbing migraine. She would lie down in a quiet dark room and ask me or my sister to press her head. Sometimes she would ask me to tie a “dupatta” (a shawl-like scarf worn by Indian women) tightly around her head in a vice-like grip. She never threw up during a migraine attack, but I remember she was always drained afterwards. My sister is 4 years older than me and when she entered high school and later medical college she too complained of severe migraines.
Following my father’s footsteps, I chose neurology as my specialty. My first recollection of getting migraine headaches is when I was in medical school. During residency training it was not uncommon for me to have a throbbing unilateral headache after an overnight call. By 10 am I would sign-out to my co-resident and head home. I would feel sick and realized quickly that if I ate a good breakfast, took an over the counter non-steroidal anti-inflammatory drug and fell asleep, I would wake up later that afternoon migraine free. I am now in my mid 40’s. As an academic neurologist, I see a wide variety of neurology patients including those who suffer from migraines. I am now able to better appreciate and characterize my own headache disorder. I suffer from common migraines. My typical migraine attack has no preceding visual aura. Just like the textbook description my headache is throbbing, pulsatile with pain radiating to the ipsilateral eye. I am light sensitive though sounds do not bother me as much. Most of my migraine attacks are left temporal. My migraine attacks share some characteristics which have been reported in the scientific literature. Professor Lance famously described the Red Ear Syndrome in migraineurs. Just as he described it, my ipsilateral ear becomes red and burns when I get a migraine attack. Sometimes both my ears become red and the red ear precedes the headache. I do not suffer from the Red Forehead Dot syndrome, a syndrome which I described along with my father. I have noticed things which have not been described in the migraine literature such as that I tend to tolerate my left temporal migraines better than the rarer right temporal ones. When I do get right temporal headaches, I feel very uneasy and irritable. On those occasions you may find me a bit short-tempered. When my migraine does not abort and persists for a long period of time, I develop subtle signs of cerebral dysfunction. I subjectively feel that my speech is off and that I am slurring, my typing skills deteriorate, and I frequently hit the wrong key. Very rarely I feel my balance off.
Over the years I have identified my migraine triggers. Stress at work especially when I am pressed for time and miss a meal is my most common trigger. Others include lack of sleep, dehydration, and red wine. An unusual one is perfumes with strong fruity fragrance. Recently an article highlighted the link between smartphone use and primary headache. Smartphone use does not trigger my typical migraine attack but when I am having a migraine attack, I am quite sensitive to my iPhone screen and ringtone. Multitasking on the computer and iPhone apps such as answering multiple text messages, e-mails and phone calls all increase the severity of my migraine attack. Overtime I have learnt to adapt to these necessary technological evils. My office computer and iPhone screen brightness are set to low, ringtone to Chimes and the Night Shift turned on from 7:00 pm to 7:00 am. I have my office lights dimmed at all time. Doctors are said to make the worst patients. I am guilty as charged and have resisted a drug for migraine prophylaxis. Recently due to an increase in the frequency of migraine attacks, I started amitriptyline 10 mg at night. The results have been gratifying. My migraine frequency has dramatically decreased but I wake up feeling groggy. My illness has made me better appreciate the impact of this chronic common neurological disease.
Nitin K Sethi, MD, MBBS, FAAN