Confused about migraines? So was I.

I have recently realized that I have been a migraine sufferer since early childhood.

This may seem like a very odd thing to say, especially if you know that I am almost sixty four years old as I write this. How could I possibly be unaware that I experience migraines?

I'll tell you that being a typical clueless male helps. Being very astigmatic also played a part in it, as did my parents. Doctors never pointed me in the right direction, either. Given all that, it occurs to me that if I was unaware and misled for nearly six decades, possibly others are also.

There's a reason why this is important. Actually, there may be several reasons why it is important, but one stands out in my mind most strongly. I'll get to that a bit later. First, let's go back to the early 1950's and observe a much younger version of me playing in a sandbox in his yard.

The first headache

The first headache I ever remember hit me like a hammer. I mean that precisely; it seemed to me that someone had struck the upper left rear of my skull strongly with a blunt object. It couldn't have been a hammer, though, because the impact seemed to come from inside.

That one didn't last long and I just shrugged it off as something odd. I'd had pain before, perhaps nothing quite like this, but it wasn't persistent, so why bother anyone with it? I continued playing in the sandbox.

A few weeks later, it happened again and then once more a few days later. This caused me to ask my father about it. He told me that it was "growing pains". My head was growing, he explained. Nothing to worry about. So I didn't. I'd experience them at random times with varying severity, but I basically ignored them.

My father wasn't horribly wrong: growing pains can be a cause of headaches. However, that goes away when you stop growing. Mine never did stop.

Debilitating?

I was certainly aware of migraine headaches. I was always a voracious and eclectic reader; I had read about migraines. I never thought of connecting them with my headaches.

Part of the problem was that sufferers would describe their headaches as debilitating and long lasting. My headaches did sometimes spread from the initial slamming at the back left part of my head, creep across toward the front and throb for a few hours. I just never thought of that as debilitating. It's just a headache, sheesh!

Yes, sometimes that initial shock could make me want to sit down and had even brought me to my knees once when there was no place to sit. But debilitating? No, I'd shake it off, ignore it, soldier on.. this certainly wasn't a migraine. A migraine would send you to bed in agony - these were just headaches and they were fairly rare anyway.

I'd also sometimes get a throbbing ache behind my left eye. That was more frequent, but I attributed that to a childhood accident where I slipped and had smashed my eye into the rounded bumper of a parked car. Old wounds, I thought. That the throbbing sometimes made me a little nauseous was something I barely took note of. Sure, the migraine descriptions mentioned nausea, but this was minor. No migraines here!

I mentioned these things to my doctors over the years. They never came back with migraines as a description. They never asked the right probing questions, either. So much for the value of doctors.

Vision problems

I have serious astigmatism. My ophthalmologist has warned me that I may go blind someday. As a normal male with a stunted brain, I choose to ignore that warning entirely. Realistically, what can I do about it anyway? There's no sense worrying about it.

Actually, astigmatism can provide some amusement. When I am a passenger in a car at night, I can get a wondrous light show simply by removing my glasses. However, in 2007 I experienced my first serious eye problem.

It began as a bright arc that would appear only if I looked hard to the left. Over the course of a few hours, it became brighter and larger and I didn't have to look to the left to see it. I sent email to my eye doctor and he told me I was likely experiencing a "posterior vitreous detachment" (PVD). He told me to expect a large "floater" and that did follow along. He also told me to come in for an exam.

I did, and he confirmed the "PVD". The arc had gone away by then, though the floater continued to annoy me for several days.

Not again!

Imagine how upset I was when I had similar symptoms a year later. This was an arc similar to that depicted in the picture below. As PVD's can sometimes (though rarely) foreshadow more serious retinal tears that can lead to the blindness my ophthalmologist had warned me about, I made an appointment immediately.

However, this time there was something different. The arc had gone away quickly and there was no large floater. My doctor peered into my eye from every angle, almost standing me on my head to see as much as he could, but there was nothing to be seen. Finally he said "Ocular migraine" and briefly explained what that meant.

Ocular migraine

I knew from my reading about migraines that sufferers sometimes experience arcs and other eye related symptoms. But I don't get migraines, I protested.

My doctor explained that ocular migraines are not necessarily associated with headaches and are actually thought to have a different cause. Migraines are nerve related, ocular migraines may be related to blood vessel constriction. Nobody seems to be 100% sure about any of it, but he assured me that whatever the cause, I could have ocular migraines without any headache.

This upset me.

How do you know the difference?

A PVD may be a minor event. On the other hand, it could be the beginning of something serious. Every eye doctor who has ever examined me has warned me that I need to react quickly if I ever do experience retinal detachment. The sooner you get to treatment, the more chance of saving your vision.

I'd like to save my vision, of course. On the other hand, I can't go running to the doctor every time I get an ocular migraine. I need to be able to distinguish these.

Ignored symptoms

As I investigated this more deeply, I realized that I have had vision symptoms in the past and that they do often coincide with those headaches. My tendency is to ignore the headaches except when they are unusually strong and because of the astigmatism, I haven't paid much attention to vision issues, either.

However, I have had issues. I'll get a "clouding" in my right eye where I can't see as sharply as I normally can. Sometimes a "blind spot" will appear in the center of that eye and I have had times where bright lights hurt my eyes and one memorable time where bright dancing spots filled my vision for a few seconds.

Until that first arc (I've had more since then), I just never paid much attention to any of that. Lately, I have been paying attention.

A little walk

When my eye "acts up" (as I used to think of it), I'd often quit work and take a little walk. I chalked it up to "computer eye strain" and if I had a headache with it, that was probably from the same cause.

Today I noticed a blind spot in my right eye. I quit work, got my coat, and headed out for a walk. It was time to get the mail anyway and nearly fifty degrees and sunny.

Because I'm now looking for symptoms, I also noticed that I did have a headache. It was actually fairly sharp, but I hadn't let it really enter my consciousness. I've had these things for so many decades that I seldom do take conscious note of them - they are like someone else's conversation at a party. I can hear them, but I am not paying attention. That's the way I have treated the headaches.

I noticed that I was slightly nauseous, too. I realized that I often feel that with these headaches, but again, I ignore it. It's just been "normal".

I never made the connection with my thunderclap headaches and feeling hangover like symptoms later. Those "washed out" feelings can also follow migraines; I just assumed I was over tired or had a little "bug".

I know, you are probably shaking your head with amazement. How could anyone just ignore this stuff? I can only tell you that I have been ignoring it and I bet I'm not the only person to have done so. It can all be very confusing, especially as these were spread out over months in years. It is only recently that they have become more frequent.

By the time I reached our postal center (a half hour walk), my vision had cleared up and the headache was only a dull shadow. I still felt a bit dizzy, but I have tendencies toward that anyway. Yet another reason to not believe I get migraines, of course. Too many other excuses to blame each symptom on.

A smile brightens things up

As I was walking down, thinking about all these symptoms I had been pushing aside, I noticed something odd. I was grinning widely.

Anyone passing by would think I was telling myself the funniest jokes because I could tell that I had a big, bright smile on my face. What on earth was causing that? I tried not smiling, but it kept coming back.

On the way back, after my symptoms had eased somewhat, I noticed that I was still smiling, though not as much. I could feel less tension in my mouth. Again, I forced myself to a somber look, but as soon as I relaxed, a little grin crept back.

What the heck was this? I don't know, but I do have a theory.

As we know, we smile when we are happy. What we have also learned more recently is that forcing a smile causes your brain to release endorphins. Could my unconscious grinning be a defense mechanism that I had learned accidentally to combat migraines? I don't know, but it certainly seems to make sense.

Other people have told me that I sometimes seem to smile for no reason. Could I be having minor migraines and reacting to them in this way? That's something I intend to try to notice.

Migraines vs. PVD

I think that I am now able to distinguish a migraine event, ocular or otherwise, from a detachment. The ocular portion of the migraine doesn't last long and in every case so far has been accompanied by some nausea and at least some headache, no matter how minor.

I've looked around and have found no description of PVD's or retinal detachments that include those symptoms. That calms my fears a bit: if I do have associated migraine symptoms and the vision issues disappear quickly, I have no need to rush to my doctor.

The short persistence of the eye distortions or arcs is important, but so is the fact that these are in one eye only. If it affects both eyes, this is something quite different called scintillating scotoma.

It is of course important not to ignore medical symptoms. It's possible that migraines cause brain damage similar to a stroke. I already have other problems, including RSBD and the fainting mentioned above that may be nerve related.

That I have survived sixty plus years of these symptoms does give me reason to think that I don't need to take them too seriously, but now that I am more aware of their meaning, I will discuss them with my eye doctor and my medical doctor the next time I see them.

If any of this rings any familiar sounding bells in your brain, you should do the same. Other symptoms may include gastrointestinal upset and irritability; this Mayo Clinic link gives a full list.

I'm still partially denying this

In spite of all the evidence, I still find it hard to use the word "migraine". That word just has more emotional attachment than I'm willing to put on my symptoms. Rationally, I can accept that I'm being silly: this is what happens to me. The fact that I tend to ignore it, suppress it and minimize it in my consciousness doesn't change reality.

It is amazing what we can "get used to", though.