Half-Skull Days

Last week, it rained six days straight, not for six days straight, as it can back home in the Midwest, but on six consecutive days. In the eighteen months we have lived in Southern California we have not experienced more than a day of rain at a time, just a few showers over the course of more than a year. In the hills, there were evacuations and mudslides. On the coast, just thirty minutes away, a cliff was shearing off under two apartment buildings. CNN spent an hour on an effort to save a dog. Eventually, a rescue worker was lowered from a helicopter into the viaduct to wrestle with the dog and then, dog in his arms, be pulled back up to safety. The story ended well, but it might not have.

For that week, because of the repeated storms hitting the West Coast, accompanied by low barometric pressure, I worked to stave off migraine. I didn’t succumb to the lure of bed. I never reached the point of no return, when I must be horizontal and still and in the dark and quiet, with an ice pack to my neck, for hours. When I become what Joan Didion, in her essay “In Bed,” describes as “insensible to the world around me.” Last week was a victory not possible a few years ago. Somehow, I’ve figured out how to live with migraine. It’s taken research and trial and error, but I’ve managed to thrive despite migraine, perhaps even with it. I have become a migraineur, a connoisseur of migraine, in the original sense of connoisseur as being well acquainted with. This word connotes appreciation, too, which is an unexpected possibility.

That’s not to say that staving off a migraine is not its own discomfort. A lurking migraine makes one off-kilter, unwell. Like Didion, “I used to think that I could rid myself of this error by simply denying it, character over chemistry.” Ignoring or denying it doesn’t work. In the next stage of my migraine life, I thought that I could rid myself of this anomaly by actively fighting it, but one cannot eliminate migraine. So, staving off is the best I can do. Still, the lurking migraine is much better than the pain, nausea, and severe disorientation, all of it at once. Given the alternative, I’m thankful for the lurking migraine, even as I’m discouraged and not myself.

The moderate disorientation I felt last week is a result either of the underlying migraine waiting for me to turn attention away so that it can lurch within me or of the abortive medication, or both. But what caused the migraine itself is a tricky thing, as if it stays a step ahead. My migraines have instigators, which the medical literature appropriately calls triggers. Bang indeed! A hormone drop or weather front is what I call a primary trigger, though the official literature doesn’t make this distinction among instigators. Either a hormone drop or a storm front can, and almost always does, cause a migraine.

Then there are secondary triggers, which must pair up or clump together to meet some secret threshold: freshly cut grass; mint, especially spearmint or anything mint-smelling in a green package; onions, especially on the breath hours later, but sometimes even as I cut them fresh, if I’m already in trouble; garlic, again especially garlic breath, which I can sometimes smell at a distance; certain flowers, though I don’t know exactly which ones, beyond lilacs; lack of enough sleep, though what is enough varies; waiting too long to eat, a trigger I share with my aunt; wine; dehydration; stress or, rather, the slide out of stress. Perhaps, some of the smells are not so much triggers as they are evidence of aura, my hypersensitivity to stimuli I would otherwise not notice. It’s a distinction I make: when I’m hypersensitive, the unpleasant smell of spearmint is a trigger, makes things worse, but the vibrant greens in the landscape is aura, a pleasant precursor to pain.

Part of migraine prevention, I know through experience, is avoiding these triggers. But there is no avoiding weather and hormones. Andrew Levy, in his book A Brain Wider Than the Sky, points out, “While two-thirds of women with migraines identify menstruation as a cause, only 15 percent have migraines only during menstruation, complicating the chain of cause and effect.” While I don’t have migraine only during my period, it always brings me to migraine, so the causal relationship doesn’t seem that complicated to me. My gynecologist nodded knowingly. She told me to skip the seven sugar pills at the end of the contraceptive’s circle, to jump ahead to the next pack instead of swallowing the off week, so that I could schedule a migraine for every nine weeks or so. There’s a good deal of information available about migraine: medical studies and personal anecdotes, in print and online at sites like WebMD and My Migraine Connection. Perhaps because I’ve had so much schooling, sorting through what’s out there and figuring out how it applies to me is part of understanding my headache-plagued self.

Levy writes, “Roughly 60 percent of all migraineurs identify weather change as a trigger, but half of those identify the wrong weather change, blaming falling barometric pressure when they should blame rising, or a cold blast when it’s dry air they should vilify.” What unsettled me when I first read this is that when I sought treatment from my general practitioner a few years ago, she said, Really, weather? I’ve never heard of that, but if you say so. Because the experience of migraine is individualized, each of us with different triggers or symptoms, our patterns often shifting, the menstruation and weather-change percentages seem near-consensus to me. How had my physician not known weather could be a trigger, if the majority of sufferers identify it as such? That we blame the wrong weather phenomenon strikes me as a lack of knowledge of meteorological terminology, rather than a lack of knowledge of our own bodies. In the Midwest, for instance, a cold blast is often accompanied by dry air, which is compounded by turning up the furnace.

One of the unexpected benefits of moving to Southern California, as opposed to the Midwest, is the lack of weather here and, therefore, migraine prevention, although locals dispute this lack-of-weather claim. Joan Didion, in her “Los Angeles Notebook,” writes, “Easterners commonly complain that there is no ‘weather’ at all in Southern California, that the days and the seasons slip by relentlessly, numbingly bland. That is quite misleading.” Having just been through a week of rain, I see her point and admit my narrow definition. But to say there is weather here is somewhat misleading to me. Any seasonal shift in Southern California is subtle compared with the fire-red autumns and blizzard winters of my childhood.

For the first year here, time stood almost still, each day pretty much like the last, the various flowering bushes taking turns blooming all year long. It creates a pleasantly bewildering state of mind. A day still felt roughly like twenty-four hours, but the larger timeframes became less discernible, less meaningful. My changed sense of time—my diminished ability to perceive time moving forward over weeks and months—diminished my ability to perceive stress. If tomorrow will be much like today, what’s the hurry? As much as I miss sitting on a warm radiator to watch big snowflakes fall, I am awestruck that a change in geography can have such a profoundly positive effect on me, that the Midwest I adore kicked the legs out from under me, while the geography I cannot grasp allows me to see the light of every day. Strange medicine, sunshine.

My secondary triggers are not always, or individually, problems. They work like genre: if you have a character in a cowboy hat, you don’t necessarily have a western, but if John Wayne wearing a cowboy hat pulls his gun at the saloon, then you probably do. Of course, you can have a western without John Wayne. So, prevention becomes a quest for clues, for awareness of exactly how the self rubs up against the world in a given moment. I have become better at noticing the familiar stranger as soon as he rides into town. I can look at a pack of spearmint gum now and know whether it might be a trigger today, or whether it’s temporarily benign to me.

The staved-off migraine’s disorientation has left me aware of my own incoherence, my inability to track time accurately or to guess what I might say next, or not be able to say. When I couldn’t think of the word scale, upon which I had slammed my toe and made a racket in the bathroom only moments before, I pantomimed stepping onto the scale and looking down to see my weight. But even my husband is not used to this sort of communication and shrugged; at least he was no longer worried that I’d injured myself. I would not call what I felt in this semi-articulate moment pain, but I was suffering. Every bit of coherence I mustered took great effort, when lucidity is usually taken for granted, like breathing.

Even after the fact, as I try to articulate what I feel exactly, in the staving off or in the depths of a full-blown migraine, I fall short. Depths, in fact, is the wrong word, for it implies direction. There exists no word for the feeling of simultaneously being boxed in and without any boundary. Levy writes, “Maybe the language of migraine is a run-on sentence, in part because you can’t ever find the right words, in part because the migraine is also a compound of too many interlocking features.” Yes. Exactly. When I read someone else’s account of migraine, it rings true. But it’s also wrong. I think fragments, too, are the language of migraine: a subject slipping out of grammatical grasp, a period interrupting a thought’s completion. The language of incoherence, piecemeal thinking. Or being felled in your tracks.

Or, as Levy goes on, “Maybe the language of migraine isn’t really language at all. It’s language just disappearing.” If that’s true, what does that mean for the migraineur who is a writer? If the migraineur’s language is just disappearing, how does Didion put so much carefully organized language on the page?

Because I was so conscious of the migraine beneath my surface this past week, I expected to be unproductive—and, in fact, felt sluggish in the moment and in the moment I expected next. Instead, though, I finished drafting a short story that had lodged in my head on a plane ride a few weeks earlier, the longest story I have ever written and the first story I have written in years. And I wrote, from scratch to an unwieldy whole, an essay about marriage. These writings may be no good, in the end, for migraine skews my judgment, making me both overly enamored and utterly disappointed with given things.

I also participated successfully in two meetings on Tuesday, though I may have inadvertently offended a colleague at the first because my wording was territorial or my tone was strident, so I patched up that possibility with e-mail afterward. Sometimes, I say things without thinking or don’t remember what I’ve just said, though I know I’ve said something. There’s no predicting the next migraine conversation, even in hindsight.

I edited an interview my students had done, and I scoured through a new website to generate a four-page list of corrections before it launched. With an actual migraine, a full-blown headache, I could not have looked directly at a computer screen without keeling over. Often, the stark contrast of black type on white paper is too much, or I read a line again and again until it becomes a knife in my eyes. Last week, I even went to the post office, where the ceiling fan strobes make me queasy even on good days, and to the grocery store. I was, overall, incredibly productive. I didn’t hurry as if I faced a deadline, though I had the sense that time was running out—and still running out. I kept doing merely one more thing before the pain knocked me over, but the pain stayed just at bay.

So, I came to terms with that migraine. But it has not always been that way, and I’ve been trying to figure why and, by extension, what role migraine plays in my life.

I don’t remember my first migraine. They began less than ten years ago, I know, but I did not note the first one because I defined it as migraine only a few years later, once I became aware that my headaches fit the pattern. I remember one migraine that developed during a meeting about reinstating the Illinois Poet Laureate, a position that had been held for decades by Gwendolyn Brooks and, before her, Carl Sandburg. On the way into Chicago, the world could not have been more vibrant, every line sharp, every color crisp, my body filled with energy. I could hear the crisp conversations of others on the el, their individual inflections. I perceived everything; I soaked in the world through my senses. I felt great—really great—for no logical reason. Back then, I did not recognize aura for what it was: a prelude.

Forty minutes into the meeting, after most of the important discussion was accomplished, both disorientation and pain hit. This initial transition is slower but akin to when The Wizard of Oz switches from black-and-white to color, only in reverse. I wanted to lie down flat. The earth’s spin dizzied me. I felt I might fly off the earth’s surface. Or I was growing too heavy to move far. I wondered how I would make it home. I knew I had to get home. Outside, in the oppressive air that precedes a large Midwestern storm, I made my first certain connection between the cause of my pain and the migraine itself, and also between the beautiful aura and the horrible pain. Yet, the next time the world was vibrant, I didn’t make the connection; the pain took me by surprise again and again, the aura remaining an ingenious ruse for years.

I remember another migraine that developed on a flight from Chicago to Oregon. I could barely walk from the plane. I wanted to press my head against a cold hard surface that had no odor of its own. I wanted to spit out the words on my tongue. But the thought of moving my mouth—no. I crawled into bed, waking every few hours to hear my sister and my husband celebrate Thanksgiving. I did not believe that I would ever get out of bed. I concentrated on seconds at a time. I could not imagine a future.

Migraine hasn’t killed me, though. In fact, it ebbs and flows in ways that make it manageable, often hitting the day after a big event—like the final grading before that trip to Oregon—or lurking while I teach a class. I tend to be most pathetic only when I can afford to be. Like a parasite, it can’t kill its host; it requires a level of thriving in me to sustain the pattern and variation that is its goal.

Because they often occur in the immediate aftermath of heightened activity or demands, for a long time I called them tension headaches and blamed them entirely on stress. Didion writes of the “migraine personality,” which seems a perfect crucible for stress: “ambitious, inward, intolerant of error, rather rigidly organized, perfectionist.” I don’t keep a perfect house or give great attention to my own appearance. I have to remind myself to comb my hair at least once a day, and I don’t always vacuum under the furniture, though I know I should. But I do have household rules—as for proper loading of the dishwasher or kitchen cabinet organization—which my husband struggles to value and, therefore, follow. A grammar error or a misinterpreted remark can stick in my craw. Like a popcorn kernel in a molar. These adjectives—ambitious, inward, intolerant of error—and the personality they represent don’t describe the whole of us, but there’s something that rings true. I have come to wonder whether this migraine personality is a contributing factor or whether certain personality traits become honed in response to migraine. The qualities may, after all, be excellent ways to deal with migraine. If my cabinets are in order, I can find a can of soup or the icepack in the freezer door on a day in which I become insensible, in which a squint is too open-eyed, too tense. If my world is well-ordered, it will cohere when I do not. The migraine personality as precondition too simply puts the blame on me as the cause of my condition, as if I could cure myself by mixing up the glassware and plates on the same cabinet shelf, as if no blithe spirit could be afflicted, or as if pain is punishment for ambition.

Family history may be somewhat more useful than personality in understanding my condition: my maternal grandmother, maternal aunt, and sister all suffered migraines long before I did. My grandmother didn’t call them migraines, or even headaches, perhaps because she thought headaches were associated with hangovers. No, she was under the weather or not feeling well, and she couldn’t take naps because she’d awaken in pain. My grandmother had a stroke in a taxicab, coming home from the dentist, so I worry about stroke, even though my cholesterol numbers are very good. Some studies indicate that migraineurs are twice as likely to have a stroke and that more than a quarter of the strokes in people under forty-five years of age are caused by or correlated with migraine. Migraineurs with aura are more likely than those without aura to suffer a stroke, and migraineurs on the pill who smoke are at even higher risk. At least, I’ve never smoked; in fact, the thought of a cigarette with a migraine makes me queasy. The tricky distinction between causation and correlation matters, but isn’t often made by researchers.

Unlike my grandmother and aunt, my mother isn’t sure she’s ever had a headache in her life, a thing I have trouble imagining. She deals with her own pain, the result of clubfoot and the childhood surgeries that allowed her to walk. But she thinks of a headache as an on-or-off state, not a condition, a thing you might have once for some reason and maybe never again, like chicken pox, or something acute, but swiftly healed, like stubbing your toe. She doesn’t doubt it’s painful, but she doesn’t understand it.

Even if a given personality and heredity explain migraine, that information is a crapshoot and not a cure. My mother-in-law swears she can avert a headache by pinching pressure points near her knee as soon as she feels it coming on. That didn’t work for me, either because I don’t recognize a migraine early enough or don’t press my thumb and forefinger hard enough or in exactly the right places. A friend’s mother attests to biofeedback. Another trick is to, at the migraine’s first twinkling, plunge your hands under the hottest water you can stand.

Mostly, though, for cures we turn to medicine. There exist two types of medication: preventative and abortive. Preventative meds are recommended for someone with more than one migraine a week and include a host of drugs used to treat other conditions. If you have asthma—and one study indicates you’re twice as likely to have asthma if you have migraine—you shouldn’t take beta blockers; channel blockers have a lot of drug interactions; antidepressants have side effects and can interact with abortive migraine meds; and anti-seizure and allergy drugs can leave you too drowsy to accomplish more than if you’d had the migraine. In many cases, no one knows why these drugs prevent migraine, and they are hit and miss at reducing either frequency or severity. Prevention is as much a crapshoot as causation, so I’ve not yet tried these treatments. They represent an admission and commitment for which I must not be ready.

For a while, aspirin, if I took it the day before a storm or my period was coming, helped take the edge off, a sort of mild prevention. Now, I resort to abortive pills. The expensive one works okay. Even with insurance, it costs $70 for six tablets, and I often have to take more than one pill because I use the lower dose. The cheaper one seems to work better, and I probably want it to. Without insurance, it would cost more than $250 for nine tablets, but with insurance, it is $10. The tablet must be taken at first onset, before I’m sure the inkling will actually become a migraine. With the more expensive medication, I hesitated, telling myself I didn’t want to overmedicate, didn’t want to take it just in case. I’m surprised at how my risk assessment has adjusted in relation to cost. Now, I act quickly, popping that pill if I can think of anything that might have triggered my migrainy inkling.

The last time I took this pill, though, I felt as if I had the worst hangover of my life. My intestinal tract twitched, my neck grew sore and wobbly, my throat swelled, my whole self was physically uneasy. It wasn’t worse than my worst migraine; I could function, just barely. But it was worse than having the sort of migraine I now usually have; the reaction scared me, in part because I didn’t expect it, in part because it didn’t get better as the day eased on. Just when I’d thought I’d figured some things out about migraine, this reaction took me by surprise with a new version. Migraine would not be outdone. I could not let myself sleep when I felt so unfamiliar.

My experience and history with migraine is not exactly the same as Didion’s, nor does it sync up point by point with Levy’s, but reading them, I felt as if I were among familiar company. When I read “In Bed” for the first time eighteen months ago, after several friends recommended it, I immediately felt relief that someone else understood and could put migraine into words. Even though there existed differences among our experiences, I was excited when I read the descriptions of my migraines in their work. Yes, someone understands! Finally, reading that—and other information and others’ descriptions—made me feel better about my lot in life. I was not alone in this migraine thing; my experience was validated by their experiences.

Two weeks later, I looked at the essay again and noticed its publication date. I was dumbfounded: it had been published more forty years ago. Why was my experience with migraine little better than in the late 1960s? Why had so little been done since, in Bewitched, Darrin’s persnickety, rigidly organized, even perfectionist, mortal mother complained of sick headaches triggered by the stress of witnessing witchcraft, of brushing up against the world in an unexpected, illogical way? We have a great deal of collective information, but that hasn’t changed the individual, very human experience of migraine.

If that’s the case, I thought, Hildegard of Bingen, who suffered migraine in the twelfth century, is as good a touchstone as Didion. Of course, Hildegard didn’t define her aura and pain as migraine; it was contemporary writer and neurologist Oliver Sacks and others who have made that diagnosis. No, Hildegard defined her migraine symptoms as visions and signs from God and, driven by them, became a prolific writer and composer, headed up two convents, offered medical advice, and eventually joined the Canon of Saints. Given her hefty and numerous accomplishments, I imagine she probably had a so-called migraine personality.

Aura, if we look to Hildegard, is the gift of an altered state. Even beyond aura, when she was bedridden, she managed to use her condition as leverage, claiming she had been stricken because God was unhappy that the abbot refused to let her nuns move to a more independent convent. She turned woe is me into it’s your fault. Instead of letting it do her in, Hildegard somehow—using the conventions of her time—gave her migraine purpose and defined it within the context of her own ambitions. There exists great danger in women accepting their plights, talking of their afflictions as blessings. I’m uncomfortable with the idea that one should be grateful for suffering.

Several years ago, a dear friend, who also shares a deep interest in Hildegard but does not share migraine, wrote that she was suffering from writer’s block. Maybe I didn’t fully appreciate my friend’s excruciating pain when I wrote back that writer’s block might be a natural or useful part of the larger process. By that, I meant that perhaps we need, in some deeply physiological way or in some mysterious cognitive way, to shore up. My friend continues to be an exceptionally productive writer overall, and I believed then that her words would flow again, that she would reach a point of ah-hah when words would fall back into place for her and out onto the page. It’s called the bathtub moment—or eureka—based on an anecdote about Archimedes, who had worked and worked on a problem, only to be struck with the solution as he stepped into his bath and saw the water level rise. Though that story is likely made up, Einstein had eureka moments in the midst of his intellectual daydreaming, after intense mathematical work. Cognitive scientists assert that incubation—which can feel like an impasse—and eureka are important stages in the creative process. But my comments sounded to my blocked friend like dismissal of the severity of her problem. My words hurt her, or compounded her hurting.

I continue to struggle to understand the relationship between writing and suffering. Clearly, acute suffering itself is unproductive. One of Nancy Andreasen’s interesting points in The Creating Brain is that, while chronic, non-episodic mental illness like schizophrenia is debilitating, some mental illnesses, like mood disorders, involve sensitivity to stimuli that may be akin to aspects of creativity. That’s not to say that mental illness is creativity, but that the two states may share some characteristics. It strikes me that migraine, too, is an episodic experience of over-sensitivity to stimuli. The world is too much. Mood disorders—and alcoholism, perhaps to dampen the mood swings—appear more common in writers, but the writers in Andreasen’s study “indicated that they were unable to be creative when either depressed or manic.” Conclusions based on small studies and on anecdotal lore seem a bit loosey-goosey to me, but what if short periods of utter lack of creativity—whether from migraine, writer’s block, or depression—are part of a larger process that is greatly productive? What if some aspects of the unproductive period, like sensitivity to external stimuli or physical self-awareness or obsessive thinking, are strange, alternative—destructive—versions of some attributes of creative productivity?

The onset of my first migraines coincides with my increased success as a writer—publication and productivity—rather than signaling a stalling point. I cannot possibly attest to causation, as I had undoubtedly reached, after numerous years, a point in my career and in my writing practice that allowed for important strides and external recognition. It is possible, too, that learning to manage migraine and developing an awareness of my physical self in relation to my surroundings may encourage the kind of discipline I need for writing. To embrace and credit migraine for my creative work would be ludicrous. Even if it plays a role, other things matter much more; Andreasen mentions intellectual freedom, a community of creative people, fair competition, mentors, and economic stability.

But what if migraine matters in the way Didion suggests: “For when the pain recedes, ten or twelve hours later, everything goes with it, all the hidden resentments, all the vain anxieties. The migraine has acted as a circuit breaker, and the fuses have emerged intact. There is a pleasant convalescent euphoria.” Migraine, because it debilitates, forces a temporary letting go; I can’t hang onto much when in the throes of its pain. In its wake, though, migraine offers a couple of days of exhilarated awareness or relief or calm before one moves back into the world as it usually is. Perhaps, also, I feel the need to accomplish something before the next migraine comes to shoot me in the back before I hear its spurs jingling. I’m usually not sure when that next migraine will be, but I expect it to come. I have an unknown timeframe between migraines and can’t procrastinate.

Given what I now know about migraine, how might it fit into my creative process? Hildegard did not write immediately about her visions, but eventually was, by her own admission, compelled by illness to set her hand to writing. My poem “Barbie Gets a Migraine,” which I posted online at My Migraine Connection, sorts through my circumstances by afflicting a perfect plastic version. Certainly, plenty of people experience the altered state of aura or the excruciating pain of headache, but are not compelled to write metered verse, compose piano sonatas, or paint cubist portraits. Writers don’t need migraines; anyone would be far better off without it. But if we’re stuck with these migraines, maybe we can figure out how not to let them disrupt life entirely or permanently.

I’d like to go further; I’d like to construe them as useful, despite how uncomfortable I am with claiming that disorientation or pain is something for which I should feel lucky. Levy suggests that a person can be “smart and kind enough to respect their value.” It seems that every migraineur I read about—Didion, Levy, Hildegard, Emily Dickinson, Picasso, Thomas Jefferson—reached a point at which they said, Okay, I give up. Now I must acknowledge this part of myself and get to my work. Migraine “entwines itself with a life and with the purpose of the life,” Levy writes. “But to understand this fact, I soon learned, meant thinking in narrative terms, about a whole life, not in episodes.” When I have a full-blown migraine, it defines me. It consumes me, and I am only that migrained body—not a writer, not a teacher, not a friend, not a wife—while it lasts. But migraine is episodic, which invites me to experience the condition as part of my larger life story.

There are always several ways to perceive a given event or to tell a particular narrative. My lawyer-parents taught me early on that it is better to have many witnesses to an accident you cause than to have only one. Many witnesses—Didion, Levy, Hildegard—will provide the jury with many versions of the migraine. And the jury itself may come up with a dozen ways of sorting through those stories.

That dog rescued from the rising flood waters last week presented rescue workers with two choices: let the dog find his own way to safety (or fail to do so), or risk their own lives to save the dog. The firefighters could be passive or active. From my vantage, at home lounging in a comfy chair, the dog looked to be in no immediate danger of being swept away. The rescue team chose to rescue the dog, but they claimed it wasn’t because dogs are worth rescuing. They said that they risked their lives because they feared, if they didn’t, someone less well-trained would, thereby necessitating a more desperate rescue of a human being. They’d seen that before; they knew how badly things could go. So, they looked at the big picture, considered the best use of their resources, and trusted their expertise. They understood human nature and drew from past experience. And yes, maybe Joe St. Georges, the man lowered from the helicopter to grab the dog, has a soft spot for animals, too. We try to figure out what we can do so that our story—or at least the episode in which we’re currently immersed—ends well. Or at least, we try to ensure that things don’t get worse. People will disagree whether it’s the right decision.

I have come to think of migraine not as a constant, lurking threat, though it is that. I have come to understand it not as something that can be denied or fought, though it can be treated. Instead, migraine is part of the story I must tell of who am I now. Part of what tells my story. All the research, documentation, and anecdotes are right, but they aren’t all right at the same time, not from every vantage. I will be grateful if menopause makes migraine part of my past history, though I fear it could become worse. Unlike Levy, I know I can live without it. I want to live without it.

As Hildegard might have said and as Didion says by the end of her essay, “I am wise in its ways…I count my blessings.” Unlike the rescue workers, who wavered between action and inaction, who had a decision to make, I have no choice about these extremes, little control over the way events unfold within these extreme states. That said, sorting through the available information and others’ accounts of migraine, along with accumulating my own experience of it, has taught me a way to live as a migraineur.

An old term for the condition came from the Greek word for half skull. Sometimes during migraine, I press my hand over the eye where the pain is gathering and imagine the dark and the pressure of my hand replacing that side of my head. No one wishes to be left with half a skull. But sometimes, I have only half a skull with which to live.

This is a reprint of work originally published in The Pinch.

Anna Leahy is the author of the nonfiction book Tumor and the poetry collections Aperture and Constituents of Matter. Her work has appeared at Aeon, The Atlantic, BuzzFeed, The Southern Review, and elsewhere, and her essays have won top awards from The Los Angeles Review, Ninth Letter, and Dogwood. She directs the MFA in Creative Writing program at Chapman University, where she edits the international Tab Journal. See more at https://amleahy.com.

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