The Bipolar Coaster

Adventures in a Manic World

The Pain in My Brain

Bipolar Disorder and Migraine Headaches

Carotid Artery and Migraine Headachs
A woman with the bipolar condition asked me if I got migraine headaches. At first I said no. Migraine headaches weren’t something I experienced. Then I thought about pain in my brain and how often I experienced it. I feel a severe and deep ache in my head when a massive depression is coming. I can expect this pain to come at least two times times a year and sometimes as many as three or four. There are times, like right now, when I get even a little depressed that there is an ache in my head. The ache is not great, but there is sensitivity just above the left eye. When a big one comes the horrid ache starts immediately above my left eyebrow near the end of the eye away from the bridge of my nose. The pain extends up my forehead and over the top of my head somewhere below the skull and on the surface of the brain. I can sense the pain flaring off from the trunk into tendrils spreading out through the left hemisphere of my brain. Is this a migraine headache?

When this sharp and pounding ache appears, I am in for what I call the “Attack of the Black Brain.” Nothing is good. Everything is negative. Suicidal thoughts consume me. Why, I ask, am I afflicted like this? All I want is to be left alone in a dark space (light is painful to see) that is dead silent (sound, too, is painful to my ears). Until this mood and this pain passes all I can do is hibernate. I crawl into bed, lower the curtains, turn off all the lights, and dampen my ears with a pillow. I feel like a vampire, dead in life and wishing life to be dead. Luckily this time of extremes doesn’t last long. The headache comes at the onset of a depression and usually catches me by surprise. I will be feeling down, but not too down, when suddenly the blast of pain bursts through my left temple. I look at the calendar and realize it’s that time of year again. In mid- to late January I can count on an attack, or in mid-September it always comes. Occasionally another off-schedule attack will happen. I retreat to my dark and silent place to wait it out. But the time of suffering continues until the pain abates. After a day, maybe two and sometimes three, the ache will fade away and gradually I will resume normal functioning. This is a migraine headache. My research on the web confirms it.

Here is a description from the web that makes sense to me. A migraine headache is a form of headache involving the blood vessels on one side of the brain. The blood vessel (I think it must be an artery) enlarges, which tightens and pressurizes the nerve fibers wrapped around the blood vessel which causes the nerves to release biochemicals, and this in turn causes inflammation, pain, and further enlargement of the artery. As the artery enlargement increases and the nerves are stimulated the pain increases. Looking at circulatory system, the artery that becomes inflamed must be the common carotid artery. There are two such arteries on either side of the head. These two arteries further divide into an internal and external carotid artery. The internal artery is buried deep in the brain, while external branch is closer to the surface. In my experience it appears that it is this external artery that evokes the migraine headache.

I can find no satisfactory explanation of why these migraines occur, but I have found some interesting information. 28 million Americans suffer from migraine headaches. More women than men experience migraine headaches. The percentage breakdown is 75% women and 25% men. In women the occurrence of migraines may be related to their menstrual cycle. Those afflicted with migraines can have them occur as frequently as multiple times a month or at a minimum of only a few in a life time. Most migraines alternate between on side of the brain to the other, but about a third of the time pain can be bilateral. Nausea, vomiting, and diarrhea are often associated with migraines. 20% of migraine headaches are associated with aura. An aura is seeing flashing, brightly colored lights spreading out from visual field.

My migraines never alternate from side to side. They only occur on left side of my head. I do not get nauseated nor do I see auras. My migraines are associated with tiredness and extreme mood change. I have bipolar migraines, and a recent study found that people with Bipolar Disorder are at a higher risk for migraine headaches. Lawrence Robbins, M.D., at Rush Medical College in Chicago did this study. He concluded those with migraine headaches and bipolar disorder were twice the number statistically classified as having Bipolar Disorder in the general population. Another study revealed that one in five patients with Bipolar Disorder I had migraine headaches while more than one in three patients with Bipolar II had comorbid migraines.

It is now believed that migraine is an organic disorder with a clear genetic background even if environmental factors are involved. Migraine has a basis in the nerve system, although the carotid artery is also involved. The doctors researching the link between Bipolar Disorder and migraines believe that certain aspects of brain chemistry are same for both conditions. So that is the good news. The bad news is that none of the researchers know how this brain chemistry works. They know that certain medicines block the symptoms, but they have no idea of a cure.

They have no way yet of separating migraine chemistry from bipolar chemistry. They have no idea why some persons suffer monthly from the problem of migraines yet aren’t bipolar. They have no idea why I would get migraines only a couple of times a year and be Bipolar I. It’s all a great mystery. Our witch doctors have sophisticated chemical tools, but just like the shamans of old they can’t tell you why a certain root prevents or heals an illness. The brain and its function remain an incompletely explored continent perused by medicine men with tools as rudimentary as a saber-tooth tiger’s jaw. Yet somewhere out there or in the future will come a scientist who will light the way like the aura some see.

Since I already take the medication that’s an inexplicable miracle for my bipolar condition, I am loath to add more for the migraines. It’s more cost and unlikely to end my twice-yearly cataclysmic downs. The medication I already take hasn’t ended them. It has only dampened the attacks for which I am very thankful. The migraines I would rather wait them out. Until there is a solution I will deal with pain in my brain in the darkened room with the pillow earplugs with the knowledge they will end soon enough.

Carlton Davis is an architect, artist, writer, and public speaker about mental illness.

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