The train pulls in front of me, chewing up the grass. Smoke hisses and belches from its cast iron wheels. A conductor steps down in painful, blazing white and blue stripes. He looks straight at me. Come aboard, boy.
"I don't want to," I say. "I don't have a ticket."
Yes you do. He points. It's in your hand. I look. Yes, it is. All aboard the migraine train, he yells in my ear as I climb the wobbly stairs.
The inside is lit as bright as a theater stage, lights from every open spot on the wall pointed directly at me. I'm alone in the interior. I don't get to sit, the train's noises are ferocious and repetitive. If I look out the window the scenery blurs by. I recognize some things...If I squint I can see a person, or a tree, but they look different, detached perhaps. They move in a stop-and-go quick animation, I can't seem to focus.
A...man?...enters the cabin, carrying a clattering tray of utensils. I think I may be served dinner, but all he does is hold the tray up in my face and shake it, sending waves of crashing sound at me.
The train bounces, and the lights flash even brighter.
And so another trip on the Migraine Train. I used to be a frequent rider, taking a trip once or twice a week. I see a neurologist now, Nurse Practitioner Amy Larson. She's tended to my dad and I, and knows her way around the brain. I'm seeing her on Nov 5th for a checkup.
Migraines are a personal event. Everybody gets hit differently. I start with grey zones in my vision, a clear sign of the approaching train. It's like the whistle from off in the distance. I can tell how painful the migraine is from how much vision is obscured. If it's a little circle, or a crescent, I can expect a couple of hours. But sometimes a big portion, quarters or halves of my entire vision is gone, and I know I have a long day ahead of me.
Here is an examples of what you might experience with these auras:
These auras are strange. It isn't as if you can't see, it's as if your eyes are collecting the information, and it's just being let loose to wander around in your brain for a bit of sightseeing. I sometimes think "take a picture of the corpus callosum, that's something to show to your grandkids." You're getting the information, but your brain has no idea what to do with it.
Then, as illustrated by the train, things start to change. The vision obstruction disappears, and the pain gains a foothold closer to the front of the brain. You see, the back side of the brain holds the optical center, and as a migraine progresses, it moves from the back to the front. So it starts with the vision, then barges in next door. I gain sensitivity to light and sound, and during one particularly powerful migraine, nausea due to the memory of a smell. It was the smell of pears.
The vision and sound weakness will persist as the migraine takes over the command center. Yes, the frontal cortex. This is where the pain really starts to hammer, and it's best to take a lie down here. This part can last from an hour or two to, in the case of the one bad migraine I mentioned above, six hours. During which time I could bear no light, nearly no sound, and the barest of motions.
The brain fights back, deadening the pain more and more until the migraine ends. Most times, my brain can actually feel sore, like I was exercising it, or it will feel tender, like it is bruised. This period can last for a day, sometimes.
This is my experience, but again migraines are a personal event. Everyone reacts to them differently. I, for one, have only gotten nauseous the once, while others may have it be a prevalent part of their ride on the train. Some people don't get the vision auras, others may become very dizzy. They are unique.
I step off the train, far from my starting point. It is the next day. My ears are ringing, and I feel like every sound could set the train in motion again. I think my name is Boutros and I have no idea where my glasses are. I might be wearing someone else's pants.
I look behind me and see the train disappearing. As he fades into the day, the conductor intones I'll be seeing you again...