Weaver's Web

This is not going to be a good day.

My husband's CPAP woke me almost an hour ago. His mask was ajar and between the hiss of a now leaky seal of mask with face and the beeping alarm of his machine, which was supposed to alert him, but never does, I AWOKE. After adjusting his mask, I spent 1/2 an hour tossing, trying to find a comfortable position to go back to sleep, without success. I got up to take a leak, came back to bed and picked up my phone to check the time, only to find I could not focus on the screen. WTF?

I don't mean I couldn't concentrate on the screen. I couldn't see it clearly. Rubbing my eyes didn't help. I had to look at the screen not directly, but from the side, first with one eye, then the other, just to read the time.

Crap.

There are times when being an MD is a curse. The mental wheels started turning. Mom has macular degeneration, as did her mother and her brother, as did her father-in-law, so I have it on both sides of my family. Never mind that my last eye exam was absolutely normal, other than I'm nearsighted as all hell. Macular degeneration was right where my mind went. Thanks to the pandemic, and social distancing, I've put off preventative care. I'm six months overdue for a recheck on my eyes and I've been waiting for my second vaccine to reschedule my next eye exam.

I spent 15 minutes in the dark, wasting precious time while debating what to do about my sudden onset of bilateral macular degeneration, time I could have spent medicating myself. Sixty-five years old, almost half a century after my first, I failed to recognize my sudden visual issue was my old friend, migraine.

My aura is almost always long enough to medicate and prevent the headache. Once upon a time I used ergot, which gave way to triptans, but I learned 20 years ago, I usually respond to a large dose of caffeine. My migraines are infrequent, triptans are prescription only, usually expensive & often leave me nauseated (as can the migraine itself), and I didn't always have them on hand when the rare migraine hit. In my 20s, they were frequent, sometimes weekly, but by the time I hit my 50s, they spaced out to only a few times a year. Coffee and tea in my home are omnipresent, and if I'm out, Starbucks are everywhere, so I always have that option.

This was a first for me. I can't remember having a migraine in the middle of the night before. The aura didn't waken me; actually, I don't think it started until 15 minutes or so after I awoke. In the darkened room, & without my glasses, I didn't recognize the visual aura nearly as quickly as I should have. Lack of sleep can be a trigger, and thanks to LJ's CPAP, I'm definitely short on sleep right now. I'm finishing my first cuppa joe, a fresh pot is brewing, so soon I'll be having my second, and if needed, a third thereafter. My head is throbbing, albeit it not horrifically. I'm mildly homophobic, but my vision is starting to return to normal, though I'm not sure if that's the coffee, or that the aura is ending and the headache phase beginning.

My day however, is screwed. Once my headache is down to a point where I might be able to go back to sleep, the caffeine I'm slamming is going to prevent any shut eye. I have Zoom meetings scheduled from 10 till 4 today, with a virtual lunch with a friend at noon. This is going to be one long ass day.

I stopped drinking coffee after 6 pm years ago. Unless it’s decaf, that is. I even have decaf tea in the house. I already have trouble falling asleep as it is. Caffeine too late in the day compounds the problem.

After dinner tonight, I thought I’d try finishing the spinning I need to do for the baby blanket I’m planning for the baby our niece and nephew are having in January. Mother Nature had other ideas for me tonight.

I get classic migraines. Classic in that not only do I get the warning aura in advance of the headache, other than my gender, I could be right out of the textbook. It’s all there: family history, visual aura, onset in adolescence, reliably predictable triggers. Red wine? It’s death in a glass as far as I’m concerned. My very first migraine happened at a wine and cheese party when I was 17, less than 45 minutes after my very first (and last!) glass of red wine. Along the way, I learned to avoid op art, and strobe lights, triggers mom also has. I discovered the hard way, never drive across a suspension bridge at dawn or dusk.

As a young man, the headaches were a plague. They were relatively frequent, but early on I proved to respond pretty reliably first to ergotamine, and then, later on to triptans. They almost never failed to abort a headache, or block one if I got the meds into me fast enough. My aura usually lasts 20 minutes before the headache begins, often longer. Generally it’s enough time to take the meds. That is if I have them. Tonight, I didn’t.

Caffergot was the first Med they tried on me. It was ergotamine with a hefty dose of caffeine. Worked like a charm, most of the time. That was followed by Ergostat a sublingual preparation that worked faster than the oral. It was made by a pharmaceutical company at their plant in Puerto Rico, a factory taken out by a hurricane just weeks before the first triptan hit the market. Imitrex proved equally effective.

Fifteen years ago, in a trip to San Diego I was caught in aura with no triptans on hand. We were at the SD Zoo with our then young godchildren, so leaving for an ER wasn’t a viable option. Further, my aura royally distorts my vision. Driving is not an option when it happens. In panic I turned to caffeine to see if I could break the aura and it worked. It took a whole bloody pot, and I was in an out of the men’s room for an hour, but that was preferable to the abject misery I would have been in otherwise.

As I’ve aged, the migraines have become infrequent, rare enough they catch my off guard. Right after I sat down to my wheel after supper, I went into aura. I put the fiber down & asked my husband to pour me a cuppa joe. I downed it, and asked him to get me another. While he went off to the kitchen, I Brailled my way to the bathroom, fetched what I thought was the NoDoz, and returned to the bedroom. I had Lanny check the bottle, to be certain I had the caffeine tablets. Like I said, my functional vision is shot during migraine aura. I downed two of them with the next mug of coffee and then got horizontal with a pillow over my eyes.

It worked. 45 minutes of aura, but no actual headache tonight. The downside? It’s almost 5 hours later and I’m wired, staring at the blasted ceiling, as my husband lies next to me, out cold.

Morpheus, oh Morpheus! Where fore art thou, Morpheus?

It’s going to be a long night.

I was looking at my 3rd patient of the morning when his face disappeared.

I know this sounds somewhat Kafka-esque, but it's actually more Oliver Sacks. I was in migraine aura.

Instead of any functional vision, I was in the middle of a light show. When this happens to me I have about 30% of my visual field, usually on the right, so I cannot look at anything directly. I have no prayer of reading anything. There's no central funtional vision. Also, usually within a few minutes I get way photophobic, and need to dim all the lights.

Today, I popped a Maxalt and got one of my staffers to shadow me, reading stuff to me and depending on my hands to examine folks and give me the diagnostic stuff I need to diagnose problems. Fortunately, I was not in any pain, so it was just a matter of waiting for the meds to kick in and my eyesight to return to normal. This morning that took an hour.

Two of the four people I saw treated during that hour were also migraineurs, so they were familiar with my problem. Amen, this is not a common occurrence for me anymore; this was the first migraine I've had in nearly a year & this time it was just the aura. The Maxalt aborted the migraine before the headache started.

Well this is interesting.

I'm in the midst of my first migraine aura in about a year. I was sitting here at my desk just about to start the afternoon when a phone call came. While on the phone, the flashing lights started in my left field of vision. Within a few seconds it affected almost everything I could see. No headache, but much photophobia & just a degree of nausea.

I saw two patients, both of them by braille. Fortunately they're two people I've known for a very long time. The first was in for a muscle tension headache. How ironic! Fortunately, I was able to press on several meridians & pressure points and give her a fair amount of pain relief. Those are all things I could feel for. The next was a man here for follow-up of alopecia areata. w/
With him I could feel the bald spots on his scalp with my fingers and actually feel new growth of hair in two of his bald spots.

Next was a signature for a pharmaceutical representative, who was detailing the very medication I had just taken, and which I am still waiting to 'kick' in. She actually had to put my hand on the place on her computer tablet where I needed to sign.

I hope this happens soon; I'm beginning to have some very severe head pain moment it feels to have an ice pick boring into my right eye and a vice stretched across each of my temples.