Category Archives: migraines

Sleep with Me Podcast: The Best Free App for Insomnia Relief

We’ve all experienced insomnia at some time in our lives. Whether caused by excitement over good life events or by anxiety over bad ones, this sleep disorder can hit children, teens, adults, and the elderly. Our racing thoughts about an impending wedding (or divorce), vacation, cross-country move, new job (or the loss of one), or approaching exams can keep us awake long after we’ve gone to bed or keep us from falling back asleep after we wake in the night. Many life events can trigger short-term or “acute” insomnia, as can common illnesses or other disorders and diseases. Colds and sinus infections can cause insomnia; migraine, asthma, arthritis, heart disease, high blood pressure, depression, and Parkinson’s are all known to cause short bouts or extended periods of sleeplessness. Both over-the-counter (OTC) and prescription medications can bring on this sleep disorder, though not necessarily for everyone: antihistamines, decongestants, anti-smoking aids, SSRIs for depression, and drugs to treat or control ADHD have all been known to trigger insomnia. Herbal remedies such as St. John’s Wort or ginseng can, for some users, interrupt or prevent sleep.

In both men and women, trauma, whether physical or emotional, can have lifetime negative health effects, including post-traumatic stress disorder (PTSD) and insomnia, while childhood trauma, including divorce or sexual abuse, contribute to insomnia in childhood and adulthood. Even the blue light in our computers, laptops, smartphones, tablets, and flat-screen televisions has been found to cause insomnia when the devices are used too close to bedtime (or in the middle of the night upon awakening) because, though any light can suppress the hormone melatonin, involved in circadian rhythms of waking and sleeping, blue light suppresses melatonin more powerfully.

Apparently, the brain has its own, mutually exclusive, wake and sleep cycles: when one cycle is “on,” the other is “off.” Researchers are trying to determine whether insomnia may be due to the brain itself not being able to “stop being awake.” Since both the quantity and quality of sleep affects our health, and since insomnia can lead to “decreased quality of life, increased rates of depression, and even increased risk of heart disease,” insomnia, especially when it becomes chronic, should not be dismissed. Chronic insomnia, medically defined as an inability to fall or stay asleep for at least three nights a week for three months or longer, is not just extremely unpleasant: it’s dangerous to our mental and physical well-being.

As a survivor of childhood trauma, including sexual abuse and rape, I’ve suffered from insomnia from the time I was three years old. The insomnia worsened a few years ago, however, when I was taken off a class of drugs I’d been taking for complex PTSD and panic disorder: benzodiazepines, which had been deemed potentially dangerous for anyone over age 50. While withdrawing from the medication, I was literally not sleeping at all, day or night. In the past, prescription sleeping pills had worsened my insomnia, and my usual herbal sleep aid, valerian, wasn’t helping, even when I doubled and then tripled the dose. Desperate and fearing for my mental and physical health, I turned to the Internet, where, to my absolute astonishment, I found relief for my insomnia, the strangest relief I ever could have imagined: Drew Ackerman’s Sleep with Me Podcast.

Drew Ackerman, a life-time insomniac, has dedicated himself to helping fellow insomniacs fall asleep by telling “ingeniously boring bedtime stories,” causing plenty of adults, kids, and pets to fall asleep. Of course, that means you may not ever hear an entire story, but because Drew is a writer, and a good one, he makes each episode, as disjointed and haywire as it might seem, feel complete. That way, if you really can’t fall asleep some night, as happens to me during a migraine, for instance, Drew is there “to keep you company in the deep, dark night,” as he often assures you in the episode introductions.

Drew Ackerman, creator of Sleep with Me Podcast. Photo © Natalie Jennings.

Each Sleep with Me Podcast episode begins with an introduction, where Drew explains that you don’t really have to listen to him and that it’s perfectly all right if you fall asleep while he’s talking, and then he usually wanders off onto some tangent or other topic, just so you begin to wonder what he’s talking about… if you’re still awake. After 7-15 minutes of an introduction that is often as entertaining as the story which follows, Drew, performing as “Scooter,” tells a bedtime story, which lasts about 45 minutes, making each podcast episode approximately an hour long. “Your goal is not to get your listeners to stay with you to the finish,” Drew told The New York Times: “[Your goal] is to lose them [to sleep] along the way.” It’s this combination of slow, lulling delivery, seemingly pointless introductions, and rambling stories that make Sleep with Me Podcast such a success with its listeners, who download episodes about 3 million times each month.

Drew Ackerman. Photo © Chris Duffey

Most of the Sleep with Me Podcast episodes feature original stories written or improvised by Drew. To stay creatively motivated, Drew writes and tells various types of stories, some of which are developed into multi-episode series, like After the Glass Slipper, about Cinderella’s stepmother Agatha after Cinderella’s marriage to Prince Charming; Big Farm in the Sky PI, about a private investigator, Simon, working to solve mysteries in the afterlife; and SuperDull, about a group of superheroes sitting around waiting for their chance to save the earth whenever its greatest hour of need arrives.* (Links to the episodes mentioned here appear at the end of the article, for your reading ease.) Though some of the original series are comprised of multiple episodes, each episode of any series is independent: you don’t have to know any of the previous sections of a story to understand — and be put to sleep — by any current episode. And really, since the point of this wildly popular podcast is to make you fall asleep, it probably helps if you don’t know what happened to any of the characters in previous episodes.

Some episodes of “the podcast that puts you to sleep” are stand-alone stories, improvised stories based the social media trends, or re-caps of movies or television shows. During an episode of Sleep with Me Podcast, Drew has been known to open games and try to figure out how to play them without reading the instructions,* give you the entire chronicle of seltzer / sparkling water,* and tell you all about the history, the rides, and the food of the New York State Fair.*

In his Real Time Recipes,* which are among my favorites, Drew metaphorically walks you through grocery-shopping for all the items necessary to make the meal, and then talks you through preparing the meal. In his on-location* episodes, Drew talks while he’s actually walking around some public place (he has permission to record there). Initially, when I listened to these, the ambient sounds, though faint, prevented me from sleeping. Then I noticed I was waking up after having been asleep for a few hours despite any faint ambient noise. Now I love the on-location episodes, if only because Drew doesn’t perform these as Scooter: he simply tells us what’s going on as he roams around. Guided Meditations* are some of the most sleep-inducing episodes, if only because Drew slows his sleepy delivery even more than usual, and these are among the most popular episodes.

Photo © Drew Ackerman

Drew sometimes reveals some personal details about his life that were painful or especially exciting for him, and these episodes are some of the most endearing. You might think that listening to someone talk about his personal life and some of its painful events would keep you awake, but, because Drew’s delivery makes you fall asleep, I’ve often had to listen to these episodes several times to hear the personal information (and Drew sometimes hides these tidbits in stories that don’t seem to be autobiographical.)* And in case the changing seasons or the holidays give you insomnia, Drew has plenty of Halloween* and Christmas* episodes, too.

Some of the Drew’s bedtime stories are suitable-for-all-ages recaps of television dramas*. Though the shows themselves might deal with adult topics or include violent scenes, Drew soothes them all into all-age-appropriate bedtime tales. Of all the television series that have been recapped on Sleep with Me, I have only seen Game of Thrones, though I’ve happily been “bored” to sweet dreams by all of Drew’s recap-podcasts, including any episode of Game of Thrones / Game of Drones,* Breaking Bad, Star Trek: The Next Generation,* and Dr. Who.*

Drew has many stellar stand-alone episodes* that make me sleep better than any prescription or natural sleep aid ever did. I wish I could tell you what happened to the residents of the Lost Village when they discovered that the geography around their village had changed overnight,* or how to assemble a wall-bed,* but I’ve never managed to stay awake through either episode. And Sleep with Me Podcast retrospectives* cover the content of hundreds of previous episodes, if Drew can remember what they were about.

The DreamQuilt, from SWM listeners, which inspired Drew’s story, “The Bear with a Comet on His Belly.” Photo © Drew Ackerman

One of my absolute favorite stories is the three-part The Bear with the Comet on His Belly* which was inspired by Drew’s listeners thanking him for “curing” their chronic insomnia by making him a quilt featuring images from his original stories: the DreamQuilt, Drew calls it.

Even when a Sleep with Me story is fascinating, I can’t stay awake long enough to hear it all, and that’s one of Drew’s gifts: writing engaging stories and delivering them with a “droning” — in the best sense of the word — delivery by “Scooter” so you drift off into dreams. The first time I ever listened to a Sleep with Me Podcast episode, I didn’t even know there was a story at the end. While listening to the introduction, I found myself thinking, “How on earth am I supposed to fall asleep to something that is so interesting?” When I awoke, hours later, and realized that I had, in fact, fallen asleep, I played the episode again. I fell asleep even more quickly the second time. The next night, I put the episode on and also queued it to play a second time — and I slept longer before awaking in the night. I began queueing up 7-10 episodes at a time, so they’d play all night long. Since I live in an isolated area where the Wi-Fi connection is unreliable at best, the podcast shuts off each time my Internet connection goes down, waking me up. Now, I’ve downloaded many of my favorite episodes, rather than streaming them, so that I can queue them up to play all night long without interruption.

Sleep with Me Podcast currently has over 755 episodes, all free, partly because of advertising (only in the first minutes of each episode) but mostly because of the financial support of the show’s patrons, whom Drew calls “rebels with a cause” because we pay for a free show so that others won’t have to. I’ve been one of those “rebel” patrons for five years now, ever since I realized that, listening to SWM all night long, I was sleeping better than I ever had in my life. Patrons get ad-free versions of the shows.

You can listen to any of the Sleep with Me Podcast episodes on the SWM website or subscribe for your device: Apple Podcasts, GooglePodcasts, RadioPublic (listen on site or send to iOS or Android devices), and Spotify. You can also listen to all the Sleep with Me Podcast episodes on its YouTube Channel. (Note: Because of the limitations of podcast apps, you may not be able to scroll back far enough to find some of the earlier episodes on your phone or tablet.

You can reach Drew — aka Scooter — on Twitter, where he is very responsive, and you can reach his equally responsive account managers, all volunteers, on Facebook.

Sweet dreams, my Lovelies.

Episodes mentioned in this article
(please note that this is not an exhaustive list of all 750+ episodes)

*Multi-episode series
• After the Glass Slipper: A Lesson in Opportunity to be like Cinderella s2e4
• Big Farm in the Sky PI: The Dog That Chased the Moon 553
• SuperDull: The Siren and the Professor 508

*Unboxing
• Fairytale Gloom Game Unboxing655
• Tokaido Unboxing 747

*Seltzer / Sparkling Water History
• Mars, Moranis, Curry Seltzer: Pitching Roman 689

*New York State Fair
• As Fair as a State Fair 692
• Fun Food and Fun Houses at the Great New York State Fair 695

*Real Time Recipes
• Under Pressure [Corned Beef] 652
• Salad 537
• Stuffing and Mashed Potatoes 474

*On-Location
• Kayak Cruze 588
• Lake Ontario: Can I Call You Teri 570
• Dusk featuring Slurp and DJ Echo Bass 540
• Faux Cousteau Visits Sea Life Orlando 522
Quasi-On-Location
(recorded shortly after visits, not during them)
• On Summer’s Horseback 594
• La Brea Tar Pits (534

*Guided Meditations
• Comforting Chair 576
• Sand’s Day at the Beach 564
• Bird Bath 395

*Autobiographical
• Things I Might Have Wrote as a Kid 591
• My Life with HBO 567
• Spruce Museum (introduction) 525
• Video Games and Me 501

*Christmas
• Laurel and Hardy’s March of the Wooden Soldiers 473
• The Christmas Tree that Took a Walk 468

*Halloween
• Costume Nostalgia 609
• Lulling Analysis of The Great Pumpkin 456

*Recaps

*Game of Thrones
• The Wolf and the Dragon” 584
• 7-Hour All Night Game of Thrones Season 7

*Star Trek: The Next Generation
• Elementary, Dear Data 557
• 10-Hour All Night All Night Star Trek: TNG Volumes 3 & 4

*Dr. Who
• Dickens and Dr. Who 625

*Stand-Alones
*Lost Village 442
*• Realtime Wall-Bed Assembly 433
*• Lulling Retrospective of the First 500 Shows 502

*The Bear with the Comet on His Belly
• Bear with a Comet on his Belly, Inspired by the Dreamquilt [Part 1] 414
• Sleeping Rude Gods [Part 2] 417
• The Local Borefriend [Finale] 418

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Filed under #CSA, chronic pain, health, Insomnia, Memoir, migraine, migraine self-care, migraines, Podcasts, Stories, Storytelling

Five Things Restaurants Can Do to Eliminate Migraine Triggers

I love going out to restaurants. It’s a real treat not having to cook an entire meal myself or enjoying dishes that are too complicated or time-consuming to make at home. Every once in a while, I like having someone wait on me, even if I’m only having a cup of tea or coffee with a fresh muffin while I read a book. No matter how much I may love dining out, however, there are many times when visiting a restaurant has triggered a migraine. Though I avoid known triggers and call potential ones to a manager’s attention when I’m out, it’s sometimes too late: the migraine has already started. I don’t want restaurants to become sterile, uninviting places, but I do wish that all restaurant owners, managers, and employees knew some of the most common triggers of migraines so these triggers could be eliminated before people with the neurological disorder of migraine even walk in. Their customers would then feel safer enjoying that meal away from home.

1. Control the Temperature

Temperature control is very important for most people who suffer from migraines since extreme variations and quick changes can trigger those pounding, one-sided headaches. For some of us, heat is a trigger, so, no thank you, we don’t want to sit at that table with the full sun shining on it. If there are blinds or shades, please do put them down even if our table is not right next to the windows. For many of us, that cold air blowing down from the air-conditioning unit will trigger a migraine. We’re not trying to be difficult when we ask to be moved to a different spot. We just want to enjoy our meal without getting stabbed in the head by the icepick-pain that is our migraine. Moderate temperatures probably work best for all customers, but it’s imperative for those who suffer from migraines. Please keep the restaurant at a more moderate temperature, neither stifling hot nor freezing cold.

2. Eliminate Any Flickering Lights

Whether it’s from those romantic candles on each table, from that television hanging in the corner above the bar, or from a failing fluorescent bulb in a ceiling fixture, lights can cause debilitating headaches in almost all of us diagnosed with migraines. If I ask to be seated someplace where I can’t see the flashing lights of sporting events or commercials, I’m trying to take care of myself, not annoy you. I can blow out a candle on the table to keep its flame from triggering a migraine, but I can’t fix that flickering fluorescent light on the ceiling, and moving to another table doesn’t always keep that blinking light from my peripheral view, and that, too, can trigger a migraine. Please check all the ceiling lights before opening each day, and replace any bulbs that are humming or flickering. Don’t light candles on individual tables unless the patrons request it or agree to it when they’re seated. We, too, may love romantic lighting, but nothing kills romance faster than the excruciating pain of a migraine. Please be aware that flickering lights are triggers, and eliminate them whenever possible.

3. Turn Down the Noise

I’ve only walked into a sports-bar restaurant once, and I immediately left because there were big-screen televisions everywhere, each turned to a different sporting event, all with their sounds blaring. When popular restaurants have the sound on the bar’s television turned completely off (sometimes with closed-captioning on for patrons who want to watch television while dining out), I’m very grateful. But that loud music pumping through the restaurant’s speakers can cause just as many headaches for those of us who suffer from migraines, and not because we don’t like whatever music you happen to be playing. If you have live musicians and we ask if their microphones could be turned down, we’re not trying to insult your musicians. We just want to eat our meal without having a migraine triggered by the noise. When patrons talk even louder to be able to hear each other over the already loud television volume or music, the migraine triggers are compounded. Keep ambient noise to a lower level so everyone can enjoy their dining experience, not just those of us who have migraines.

4. Avoid Strong Odors

Of course, anyone may encounter unfamiliar smells at a restaurant, especially if it serves ethnic food or other dishes with which patrons may not be familiar. Those kinds of smells don’t usually trigger a migraine for me, but that chlorine bleach or Lysol with which you cleaned your restrooms almost instantly causes a migraine. Cleaning product odors can trigger fierce headaches for countless people with migraine. I realize that you have a large volume of traffic in your restaurant, and that you want to keep your patrons safe from germs and contagious illnesses, but there are plenty of natural products free of such triggering odors, products that also disinfect and keep germs at bay. If you are prohibited from switching to more natural, less offensive-smelling disinfectants for some reason, you might clean your bathrooms a few hours before opening, and avoid cleaning them with strong-smelling products while diners are present in the restaurant to keep those powerful odors from triggering a migraine in the middle of a patron’s meal.

5. List All Food Ingredients & Additives

There are many food ingredients, natural and manufactured, that can trigger migraines. Those artificial sweeteners in your restaurant’s diet sodas and desserts may be fine for most patrons, but they cause migraines for many of us. Food allergies can trigger migraines — or worse, anaphylactic shock ( a life-threatening allergic reaction). As someone allergic to bees, I can’t have honey, raw or cooked, but honey is rarely listed as an allergen in restaurant foods.

MSG is a known migraine trigger, and restaurants that specialize in oriental foods are not the only ones that use it. MSG could be in the packaged gravy mix your cook uses for the homemade meatloaf, in the seasoned salt he sprinkles on the fish or meat, or in the bouillon cubes he tosses into the soup to make it taste richer. Other ingredients, like soy or yeast extract, can also trigger migraines even if the patron is not actually sensitive to MSG.

Some restaurants have their wait-staff memorize the ingredients in each dish; other restaurants have all ingredients hanging in the kitchen so the list can be consulted if patrons have questions. The wait-staff needs to be informed about such food and beverage triggers, and then trained to be diligent and knowledgeable when serving patrons. Even better, having every ingredient in every dish listed and available to patrons on request will protect all your patrons with food allergies, not just your customers with migraines who might be triggered by a dish’s ingredients. Any initial expense of printing all the ingredients would soon be recouped by loyal patrons who know they can eat your restaurant’s meals without fear of having a migraine triggered.

Though I don’t go out to eat regularly, I appreciate having a safe environment when I do go out to a restaurant. If the manager monitors the ambient noise level, is aware of climate control, and watches for any flashing or flickering lights, they can protect customers from being inadvertently exposed to migraine triggers. Additionally, I scrupulously avoid known food triggers, so when the wait-staff, cook, or manager can readily provide me with the complete ingredient list of any dish I order, they’re helping me take care of my own health and inspiring customer loyalty.

Related Posts

For more of my migraine articles,
see my Migraine & Chronic Pain page.

This article originally appeared on The Mighty and
was subsequently published on MigraineMantras.

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Filed under chronic pain, health, hemiplegic migraines, migraine, migraine self-care, Migraine with Aura, Migraine Without Aura, migraines

Why Getting a Medical ID for Hemiplegic Migraine Made Me Feel More Vulnerable

“You’re getting a migraine, aren’t you?” said my physician last year during one of my regular visits. “If you were pulled over, a policeman would think you were drunk or on drugs. If you were taken to a hospital, they would think you were having a stroke. Time for you to get a medical ID bracelet.”

I was so shocked that I just sat there staring at him, and not just because he’d said I sounded impaired. I was first diagnosed with migraines at age five and have suffered from the throbbing head pain, vision changes, vomiting, and sensitivity to light, sounds, and smells all my life, as have many of the women in my family.

When I was 9, a doctor realized that I was having seizures when I had a migraine attack, though he did not give the headaches I was experiencing a different name. In my mid-thirties, a migraine specialist determined that I suffer not only from complex-complicated migraines but also from familial hemiplegic migraines, which are rare.

Hemiplegic migraines mimic strokes by causing temporary paralysis or numbness on one side of the body, loss of balance or coordination, and confusion or an inability to understand speech. Hemiplegic migraines can also cause speech difficulties such as slurring, dysphasia (words get mixed up or switched around in sentences), or aphasia (an inability to speak).

Most frightening, this type of migraine can cause changes in consciousness including seizures or coma. No one in my family who suffered from migraines ever carried anything other than pain medication, and though migraines with aura significantly increase the risk for stroke, no one in my family ever wore a medical alert. Now, however, medical ID bracelets are being recommended for people diagnosed with hemiplegic migraines since so few physicians are familiar with the symptoms.

Once I got over my initial shock at my doctor’s suggestion that I wear a medical ID bracelet, I welcomed the idea of the bracelet, if only because I thought I would feel safer wearing a medal with “Hemiplegic Migraines, Aphasia & Seizures” inscribed under my name and emergency contact numbers. To my surprise, I was terribly depressed upon receiving the bracelet. For months, I was so depressed that I found myself constantly “forgetting” to put the medical alert bracelet on. Because my doctor insisted I wear it, I had to figure out why the medical ID bracelet depressed me. This is what I came up with.

My medical condition was no longer private.

Many people describe migraines as an “invisible illness” because the suffering can’t be seen, and I suppose I felt more comfortable having a condition that most people didn’t know about. With the medical ID bracelet, instead of my life partner and close friends being the only ones who know I have migraines, everyone who sees me now knows something’s wrong with me. I’m wearing a bracelet that says so. Even though the bracelet is for my safety, it felt like an intrusion into my privacy.

I felt like a failure.

I take care of myself by getting plenty of sleep, avoiding dietary and situational triggers, and by walking, doing yoga, and meditating almost every day. I’ve tried every anti-depressant and anti-seizure medication on the market to get my migraines under control, but wearing a medical bracelet listing my condition made me feel as if I hadn’t done enough. The bracelet didn’t change the frequency or severity of my migraines, but it made me feel I have somehow failed to prevent them.

I felt like my migraines were my fault.

Migraines are neurological conditions, and researchers are still investigating whether all types of migraines may be inherited. Both sporadic (not inherited) and familial (inherited) hemiplegic migraines definitely involve genetic defects or mutations that upset neurochemicals in the brain, causing the symptoms of the aura and the pain of the migraine. Despite knowing all that on a conscious level, having to wear the medical ID bracelet made it somehow seem as if the migraines were my fault, which I had never felt before.

I felt like I was wearing a sign on my forehead.

I readily admit that I’ve had to make a lot of lifestyle changes and adjustments because of my migraines. I can’t go to concerts or movie theatres because the high volume triggers a migraine. I avoid grocery aisles with humming or flickering fluorescent lights that can instantly cause both a severe migraine and its associated seizures. I use only unscented lotions, soaps, or shampoos, nor can I be around anyone who’s wearing perfume because it causes migraines. I have to know every ingredient of every dish I eat that I don’t make myself to avoid food triggers like artificial sweeteners or additives (e.g., MSG): those things can cause migraines, and hemiplegic migraines can cause seizures which can lead to coma.

I’ve been called “neurotic” by more than one person in my life, including doctors who dismissed my symptoms as “all in my head” when they didn’t know anything about hemiplegic migraines. I guess I never minded being considered “neurotic” because I knew that I was taking care of myself. Though I’m unable to work when I have a migraine, I never considered myself to have a chronic illness let alone a disability. Wearing the medical ID bracelet made me feel like I was chronically ill as well as disabled. Further, the medical alert made me feel like I was wearing some shameful Disabled sign on my forehead for everyone to see.

To my surprise, my life partner was very pleased when I got the ID bracelet. He admitted, for the first time in almost 25 years together, that he has always been concerned about my having a migraine-induced seizure: he worried that he would be unable to adequately explain hemiplegic migraines to medical personnel. The instructors in my T’ai Chi and Kundalini Yoga classes looked so relieved when I showed them the bracelet that I felt quite guilty for not having gotten it sooner. When I went to a new dentist and then to an oral surgeon to have a dying tooth extracted, both doctors immediately asked about the medical alert and were then pleased to know that my medical condition, which neither had ever heard of before, was clearly indicated on the bracelet.

One day when I went to the grocery last month, I actually forgot to put my bracelet on. After I realized that I’d left it at home, I became anxious that I might experience an aura and have difficulty speaking while I was among strangers. That was when I understood that my initial depression over wearing the medical ID bracelet had completely disappeared.

After wearing my medical ID bracelet for almost a year, I can honestly say that I am happy to have it. I wear it every day, even at home, and have it on 24-hours a day when I have a migraine in case of seizure. I feel only safety wearing the medical alert bracelet now, and I encourage anyone who has a severe, chronic, or rare medical condition to wear one.

Related Posts

For more of my migraine articles,
see my Migraine & Chronic Pain page.

This article, in a slightly altered form, was first published
on  The Mighty and reprinted on MigraineMantras.

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Filed under health, hemiplegic migraines, migraine, migraine self-care, Migraine with Aura, Migraine Without Aura, migraines

This Is Your Brain on Migraine

Impacting not just the head but the entire body, migraine is the most common neurological disorder, affecting 10-15% of the adult population. For comparison, epilepsy is the fourth most common neurological disorder (after migraine, stroke, and Alzheimer’s disease). Unfortunately, few people completely understand the mechanism of migraine. Even doctors, neurologists, and scientists who specialize in migraine research do not necessarily understand everything about this disorder, if only because few of them have ever suffered its agonizing pain.

To make the process of migraine clearer for everyone, let’s imagine your body as a house run entirely by electricity. When the power supply works well and is uninterrupted, you have all the modern conveniences: light, heat, air-conditioning, refrigeration, computers, and Internet. The brain’s 100 billion nerve cells (neurons) are your body’s power system: its wiring and its electricity. Neurons enable you to breathe, move, and think. The neurons in the brain’s outermost layer — the cortex — process information from the senses, regulate body temperature, initiate movement, and enable such complex processes as memory, attention, speech, analytical thinking, and problem-solving. Electrical power makes your house and your body run more efficiently.

Now, imagine your house during an electrical brownout. Too little voltage, as in a dip, and lights noticeably dim, fans slow, and electronic devices sound a warning. Too much voltage, as in a surge, and appliances and electronics can be damaged. This is your brain during an aura. Cortical neurons fire abnormally, in dips and surges, causing symptoms which can include visual disturbances, nausea, clumsiness, or vertigo. Strange tastes, unusual smells, rapid fluctuations in body temperature, and speech difficulties are relatively common. The irregularities in your brain’s electrical system during an aura’s brownout can cause insomnia, depression, irritability, anxiety, brain-fog, and fatigue.

Of course, if you aren’t home during an electrical brownout, or if you’re asleep during an aura, you won’t notice the electrical havoc. Only 20-25% of those with migraines report aura, though some researchers suspect that migraine sufferers may not always notice aura symptoms or associate them with subsequent head pain. Some people with migraine may not associate fleeting irritability, occasional insomnia, or mild depression with an aura because, just as electrical brownouts are not always followed by a complete power outage, auras are not always followed by the crippling pain of a migraine.

Now, imagine your house during a complete power outage. Though the house is still standing, nothing in it that depends on electricity will work. That means no light, no washers and dryers, no television or computers. Without electricity, almost all modern conveniences are unavailable or inoperable. This is your brain on migraine. Instead of firing abnormally, in dips and surges, the cortical neurons across the brain begin to shut down completely. In a wave called Cortical Spreading Depression (CSD), the neurons in the brain’s cortex — the nerve cells that process sensory input, control movement, and enable both speech and thinking — go into “electrical silence” and don’t fire at all. It’s a power outage in your brain.

Why is this neural blackout in the brain so painful? Research indicates that migraine pain is likely due to inflammation of the trigeminal nerve — the largest nerve in the head — responsible for motor control, touch sensation, and pain perception in the scalp, face, eyes, nose, sinuses, cheeks, jaw, teeth, and gums. This inflammation of the trigeminal nerve appears to be directly triggered by the brain’s electrical blackout during Cortical Spreading Depression. When deliberately induced in the brain of a rat, a CSD neural blackout activated the pain-transmitting trigeminal nerve system in the meninges: the sensitive membranes covering the brain. Trigeminal nerve pain, as anyone who has ever experienced a migraine knows, is excruciating and debilitating.

Usually, after a blackout in a residential area, electrical power is restored, and life in your home returns to normal. Since people rarely die during power outages, they are usually not life-threatening. You don’t suffer physical pain during a power outage either, so it’s merely an inconvenience. This is where the analogy ends.

People with migraine suffer incapacitating pain during CSD’s neural blackout. Even after a migraine, when the neurons start firing relatively normally again, it’s highly probable that another wave of CSD and its associated pain will strike. Despite taking medication, effecting lifestyle changes, and avoiding as many triggers as possible, people with migraine cannot entirely eliminate the auras or the pain. Unlike the electrical system of a house, which can be upgraded to reduce brownouts and power outages, our brains cannot be upgraded to reduce abnormal neuron-firing, Cortical Spreading Depression, or CSD-triggered migraine pain.

There is some good news, however. In 2017, an international team of researchers discovered a “genetic particularity” that is more common in those who have migraine, with or without aura. This is the “first irrefutable genetic link” regarding the most frequent forms of migraine. Perhaps, one day soon, researchers will be able to determine ways to adjust and regulate the brain’s complex electrical system, reducing or even eliminating the neural brownouts that are thought to cause aura, as well as the CSD neural blackouts that trigger the incapacitating pain of migraines.

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[Illustration of trigeminal nerve branches credit:
Trigeminal Nerve Branches, by John Charles Boileu Grant,
An Atlas of Anatomy, by Regions, 1962. Public Domain. Courtesy of Wikipedia]
(A version of this article was originally published on MigraineMantras.)

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Filed under chronic pain, hemiplegic migraines, migraine, Migraine with Aura, Migraine Without Aura, migraines

What Is Hemiplegic Migraine?

The smell of smoke woke me in the middle of the night. I got out of bed fast, prepared to evacuate my apartment. I heard people talking and assumed that others were already leaving the building. When I got to the hallway, however, it was empty: there was no smoke, and there were no people.

Cautiously, I went to the floors above and below mine, where I could still smell something burning and hear the hum of voices. I went to the parking lot, thinking people were congregating outside. No one was around, and all the apartments in the building were dark. I went back to my place, firmly convinced that there was an electrical fire in one of my outlets.

After an hour of crawling around smelling each outlet, I was more confused than ever. No smell seemed to be coming directly from any of the outlets, yet when I stood back up, I could most definitely smell electrical fire. I could still hear people talking, too, though no one seemed to be close enough for me to hear them clearly: I couldn’t make out the actual words of the conversation. I was up most of the night, crying and waiting for disaster to strike. The next day, when I smelled gasoline and still heard several voices faintly talking to each other, despite my being at home alone all day, I thought I was losing my mind.

Gasoline, cigarette smoke, electrical fire, propane gas – I’ve smelled all of them for no reason in my life, and it took years before I was brave enough to admit it to anyone. Even then, I only told my doctor because I was also experiencing such dreadful tingling and weakness in my left hand that I kept dropping things, and because my left foot was numb so often that I limped and stumbled along, unable to feel my foot.

When I finally admitted smelling strange, non-existent odors, along with hearing “voices” without understanding the words, my doctor began to question me about other possible symptoms. She mentioned strange tastes, temporary mental confusion, an infrequent inability to speak, instances of my words coming out jumbled and mixed up, or my losing consciousness without warning.

I’d been having non-convulsive seizures during the migraine attacks at least since the age of 9, when a doctor noticed that I sometimes lost consciousness during migraine. Because I was diagnosed with migraine at age 5, and because virtually all the women in my family also had migraine, the doctor said she thought she knew what was causing all those frightening neurological symptoms.

After sending me for multiple medical tests to ensure that I was not developing multiple sclerosis and that I had not had a stroke, the doctor diagnosed Familial Hemiplegic Migraine, a rare form of migraine disorder.

Hemiplegic Migraine

Hemiplegic Migraine (HM) is caused by mutations in one of at least 4 genes, preventing the neurons from firing normally, causing partial numbness, tingling, or paralysis on one side of the body (hemiparesis) along with the other migraine aura symptoms such as visual disturbances or speech difficulties. HM can also cause impaired consciousness, ranging from confusion to profound coma. Familial HM is inherited: other family members with migraine have similar neurological symptoms. Though Sporadic HM can occur after head trauma, and though he same genetic mutations are involved, Sporadic HM is not inherited, so it does not run in families.

The pronounced neurological symptoms of Hemiplegic Migraine make it a subdivision of Migraine with Aura, which can cause heightened sensitivity to smells and to light, as well as nausea and vomiting during the migraine itself. Although the debilitating pain of migraine does not always follow the aura symptoms of light sensitivity or nausea in other forms of migraine, virtually everyone who experiences the one-sided neurological symptoms of Hemiplegic Migraine, whether familial or sporadic, has the excruciating one-sided head pain after the aura.

Though it’s uncommon for the neurological symptoms to remain after the pain of the migraine has passed, HM can cause prolonged weakness, extended memory problems, or mild but permanent difficulties with movement and coordination. A few doctors and researchers seem to believe that Hemiplegic Migraine “disappears” after age 50, but most people do not get miraculous relief from these migraine attacks as they age. Unfortunately, triptans and ergotamines, which are sometimes used to prevent or treat other forms of migraine, are contraindicated in those with Hemiplegic Migraine because those prophylactic medications often trigger strokes.

Despite the worrying symptoms, a diagnosis of Hemiplegic Migraine can actually be a relief for migraine sufferers. Their strange neurological symptoms are part of a rare migraine disorder that not only has a name, but is a recognized illness and disability.

(This post is an excerpt of my post originally published on MigraineMantras.)

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Filed under health, hemiplegic migraines, migraine, Migraine Treatment, Migraine with Aura, Migraine Without Aura, migraines