By Robert T. Cochran Jr., M.D.
Author of Understanding
Chronic Pain: A Doctor Talks to His Patients Uk Can
Migraine, as every victim knows, is a disorder characterized by episodic headache. The pain is throbbing in character and is often unilateral, confined to either the left or right side. It is attended by nausea and vomiting and frequently heralded by strange distortions of vision with the appearance of a spot of blindness bounded by sparkling scintillations of light. These visual effects usually subside over the course of a few minutes, but the headache lasts much longer, hours or even days, during which time the victim experiences photosonophobia – that is, exposure to sound and light worsens the headache. The sufferer, therefore, seeks the comfort of a dark, quiet room. Then, when this remarkable cascade of events is done, the victim returns totally to wellness.
The occurrence of migraine is dictated, most physicians believe, by cells within the brain base that persuade, for a while, the rest of the brain and the arteries which supply it to go haywire. Fortunately, this behavior can be placated by the administration of a number of drugs. Some, known as triptans, (Imitrex, Zomig, Maxalt, Axert, Frova, and Relpax) relieve migraine by tempering the irritability of the arteries which are responsible for the characteristic throbbing pain. Taken at the onset of the attack, they can frequently abort the event. Other drugs, most of them anticonvulsants (Depakote, Neurontin, Topamax, and Lamactil), are prophylactic. They prevent the occurrence of migraine by sedating, if you will, those brain cells responsible for the disease.
So far, so good, but the brain is a vastly complex place, and the workings of its various systems are interactive and interdependent one upon another. Thus, those brain cells which control the periodic misbehavior that is migraine are interactive with those that control mood, sleep, and appetite. Migraineurs (those who suffer migraine) are well aware of the effects that their disease can have upon mood, sleep, and appetite. The onset of the headache is frequently attended by irritability, insomnia, loss of appetite, and a sense of despondency. Curiously, when the attack is done, there is not infrequently a sense of euphoria. The only good thing about a migraine, victims say, is the way you feel when it is over.
Just as migraine can influence mood, so can mood influence migraine. If a migraineur enters an interlude of depression, those cells dedicated to the creation of migraine fall under the persuasion of a brain force even more powerful than their own. When this happens, they lose their unique capacity for expression, and the migraine headache is actually transformed into another form of pain. The characteristic throbbing pain is replaced with an incessant boring or squeezing, not on one, but on both sides of the head. The visual effects disappear, leaving only an occasional trace of their legacy, scintillations in the periphery of the visual field. When this kind of evolution occurs, and the time interval can usually be measured in days or weeks, the victim enters a state of chronic head pain, usually attended by insomnia, appetite change and despondency.
This is the disease known as transformed migraine. It is a unique illness, a combination of depression and migraine. It has features of both but is totally neither. It is, most of the time, refractory to treatment with either triptans or anticonvulsants. Fortunately, however, there are drugs, and very good ones, for the treatment of transformed migraine. They are known collectively as tricyclic antidepressants (Amitriptyline, Imipramine, Nortriptyline, Desipramine, and Doxepin), and their employ is usually attended by diminution of headache, restoration of sleep, stabilization of appetite, and improvement in mood. That is to say, the victim returns to wellness. When this happens, those brain cells responsible for migraine are once again unfettered and free to exercise their periodic mischief.
This scenario plays out rather frequently. Many victims of migraine, through the course of their lives and their interludes of depression (the two diseases do seem to run together), will experience intervals of typical migraine and intervals of transformed migraine.
Dr. Cochran is the author of Understanding
Chronic Pain: A Doctor Talks to His Patients Uk Can
(Providence Publishing Corp., ISBN: 1-57736-302-7, 224 pages, hardcover). For more information, please see Dr. Robert Cochran’s website,
www.understandingpain.com.
